After back and neck pain, shoulder pain is the third most common musculoskeletal complaint of patients.

Shoulder Pain Diagnosis

Shoulder pain diagnosis can be tricky as many things can cause an individual to experience pain in the shoulder. For example, shoulder pain can result from issues within the shoulder, the upper area of the spine or the upper arm.

Diagnosing shoulder pain properly is key in making sure the appropriate treatment methods are used to relieve the patient’s symptoms and maintain full range of motion. To properly diagnose your shoulder pain a doctor may use many methods at his disposal such as:

• Physical examination
• Review of medical history
• Diagnostic injections
• Imaging tests (ie: x-ray, ultrasound, MRI)

Causes of Shoulder Pain

Let’s take a closer look at some of the many things that can cause an individual to experience shoulder pain.

1. Damage to the Shoulder Muscle

A sprain, strain or tear to the major shoulder muscle can cause shoulder pain.

2. Tendonitis

Tendons connect muscle to bone in our body. When tendons become inflamed the condition is called tendonitis. Tendonitis of one of the four rotator cuff tendons in our shoulder or the biceps tendon in our upper arm is a common cause of shoulder pain.

3. Tendon Tears

In addition to becoming inflamed, tendons can also partially or completely tear off the bone. Tendon tears can occur from long time use of the joint or a sudden injury. Shoulder pain can be caused by a tear in one of the four rotator cuff tendons or the biceps tendon.

4. Bursitis

Bursae are small fluid filled sacs that help cushion joint components, prevent them from rubbing against one another and reduce friction during joint motion. Bursitis is a condition in which these bursae become swollen or inflamed. Bursitis of the shoulder is a common cause of shoulder pain.

5. Impingement Syndrome

Impingement is a condition in which the shoulder blade puts pressure on the soft tissue in the shoulder joint. This repeated pressure can cause pain and potentially lead to bursitis or tendonitis.

6. Osteoarthritis

Osteoarthritis of the shoulder can be caused by an injury or occur over time and may cause symptoms such as swelling, stiffness and pain.

7. Adhesive Capsulitis

Adhesive Capsulitis occurs when the connective tissue inside your shoulder joint (called the shoulder capsule) stiffens. In addition to this tightening of the capsule, the amount of lubricating fluid (called synovial fluid) in the joint is reduced. Adhesive capsulitis may result in extreme loss of motion and is hence sometimes called “frozen shoulder”. The causes are not fully understood but individuals with diabetes, thyroid disease or Parkinson’s disease may be more prone to this condition.

8. Cervical Spondylosis (Arthritis of the Neck)

The upper region of the spine is referred to the Cervical spine (learn more about the spinal anatomy). Degenerative changes (that are normal to the aging process) can lead to arthritis. Arthritis of the cervical area of the spine is also called Cervical Spondylosis and can cause pain in the neck or radiate down to the shoulder and arms.

9. Cervical Radiculopathy

Radiculopathy is a condition in which nerve irritation causes pain to radiate away from the source of the problem. Radiculopathy is commonly associated with irritation of the nerve fibers in the spinal column and can cause pain in the extremities (ie: arms, legs). Cervical radiculopathy is irritation to the nerves in the upper (or cervical) area of the spine and can lead to shoulder and arm pain.

Shoulder Pain Treatment Options

After your shoulder pain is properly diagnosed your doctor can recommend an appropriate treatment plan.

Non-Surgical Treatment of Shoulder Pain

Many shoulder pain causes can be successfully treated without surgery. Common non-surgical treatment methods include:

• NSAID’s
• Physical Therapy
• Heat Therapy
• Corticosteroid Injections

Surgical Shoulder Pain Treatment

Surgical treatment options may be more suitable for rotator cuff tears, a fracture of the shoulder blade or for spine-related problems that don’t respond to non-surgical treatment methods. In many cases, these surgeries can be performed through a tiny incision in which the doctor uses a camera to assist in the repair. These types of surgeries, often referred to as “minimally invasive” or arthroscopic, can often be performed on an outpatient basis.

Total Joint Replacement

In extreme cases, complete replacement of the shoulder joint is recommended.

References

1. https://www.ncbi.nlm.nih.gov/pubmed/18300628
2. https://www.ncbi.nlm.nih.gov/pubmed/19995495
3. https://www.ncbi.nlm.nih.gov/pubmed/16450690
4. https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-pain-and-common-shoulder-problems/
5. https://orthoinfo.aaos.org/en/diseases–conditions/frozen-shoulder/
6. https://orthoinfo.aaos.org/en/diseases–conditions/cervical-spondylosis-arthritis-of-the-neck/