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6 reasons that may be causing your shoulder pain and how to treat it

December 19, 2023
shoulder pain

Do you suffer from chronic pain in your shoulder as well as a lack of mobility? Shoulder pain and injuries is a common complaint for many adults. 

Shoulder pain and injuries include a range of conditions, each with its underlying causes and symptoms. As one of the most mobile joints in the body, the shoulder is susceptible to different forms of discomfort, which may lead to injuries and pain. 

Various reasons may cause the discomfort, including overuse, trauma, age-related wear and tear, or any underlying medical condition. Whatever the cause, it’s crucial to treat shoulder pain as soon as possible because prolonged damage to the joint can lead to problems later on, such as arthritis or a frozen shoulder

If you are constantly experiencing shoulder pain, or it returns easily, there may be more reason behind it besides a temporary strain or injury. 

shoulder pain
Shoulder pain is a common complaint as it is one of the most mobile joints in the body.

Here are some 6 common types of shoulder injuries and conditions that may be causing your pain:

1. Rotator cuff injuries

The rotator cuff consists of four muscles that keep the head of your upper arm bone firmly in place inside the shoulder socket. Rotator cuff injuries [1] are a common cause of shoulder pain due to overuse and wear and tear of the joint. It feels like a dull ache and often worsens with age. It is also common for rotator cuff pain to be especially bad at night. 

Rotator cuff injuries can be treated in several ways, depending on the severity of your pain. Surgery may be required for serious injuries. For mild cases, physiotherapy and medication can help alleviate the pain and improve symptoms. 

Symptoms of rotator cuff injuries include:

  • Sudden, sharp pain in the shoulder
  • Weakness and limited range of motion
  • Gradual onset of pain, especially with overhead activities 

Rotator cuff injuries consist of: 

  • Rotator tears: tears in the rotator cuff muscles [2] or tendons can result from overuse, ageing, or traumatic injury.
  • Rotator cuff tendonitis: sometimes, inflammation of the tendons in the rotator cuff can result in severe shoulder pain and restricted movement.
rotator cuff injuries
Rotator cuff pain can be caused by a tear, tendinitis, or tendinopathy.

In general, rotator cuff injuries are commonly caused by:

  • Sports: sports and exercises that include repetitive overhead motions or activities, such as throwing, swimming, or lifting heavy weights, can all lead to overuse injuries and strain on the shoulder. Plus, athletes involved in sports [3] that require frequent and forceful shoulder use, such as baseball or weightlifting, may be more susceptible to shoulder injuries.
  • Genetic factors: some individuals may be genetically predisposed [4] to certain shoulder conditions, such as rotator cuff disease.
  • Occupational hazards: rotator cuff injuries that cause shoulder pain often start early for those who work in occupations requiring them to perform overhead motions repeatedly. These include painters, decorators, and construction workers. 
  • Poor posture: those with poor posture, especially in activities involving computer work or desk jobs, may experience chronic shoulder pain and muscle imbalances.
rotator cuff injury
A rotator cuff injury can cause pain and limited range of motion in the shoulder. 

2. Bursitis

Also known as inflammation of the bursa – a small fluid-filled sac that cushions the joints; bursitis [5] refers to a condition in which the bursa becomes inflamed and causes pain. Bursitis can be prevented by caring for your joints, such as warming up before workouts, gradually increasing exercise, using protection for your joints such as padding, resting sufficiently, and not overusing your arm when feeling pain. However, if it still happens, it may be time to visit a specialist to seek treatment such as medication, surgery, or physiotherapy

The most common causes of bursitis are injury or overuse, which can also be caused by infection. Pain, swelling, and tenderness near a joint are the most common signs of bursitis. Bursitis can be treated with rest and medicines to help with the inflammation. Antibiotics are used if infection is found.

Symptoms of bursitis include:

  • Pain and tenderness around the shoulder joint 
  • Redness, swelling, and warmth in the affected area
  • Pain that worsens with movement
  • A bulge or lump that appears at the joint

Common causes of bursitis include:

  • Overuse: overuse of the shoulder joint without sufficient rest can result in bursitis.
  • Injury: traumatic injury can cause damage to the joint, leading to inflammation that causes bursitis.
  • Infection: in some cases, an infection can lead to the joint becoming inflamed. 
bursitis
Bursitis occurs when the bursa becomes inflamed, causing symptoms such as pain and tenderness.

3. Shoulder impingement syndrome

Shoulder impingement syndrome happens when the rotator cuff rubs or pinches between your humerus and the top outer edge of your shoulder. When the tendons of the rotator cuff and the subacromial bursa are compressed or pinched during shoulder movements, it can result in this painful condition. This impingement leads to pain, inflammation, and limited range of motion. It is a common cause of shoulder pain, with shoulder impingement syndrome being the cause of 44% to 65% of all shoulder pain complaints [6].

Symptoms of shoulder impingement symptoms include: 

  • Pain when reaching overhead or behind the back
  • Weakness in the affected arm
  • Pain that may worsen at night
  • Gradual onset of symptoms

Common causes of shoulder impingement syndrome include: 

  • Repetitive motions: shoulder impingement syndrome is common in those who frequently engage in repetitive overhead rotational movements, such as baseball, tennis, swimming, window washing, and painting. 
  • Injury: injuries such as a fall onto an outstretched arm or a hit directly onto the shoulder can result in shoulder impingement syndrome. 
poor posture
Poor posture, caused by prolonged sitting, can cause shoulder pain and muscle imbalances. 

4. Frozen shoulder

As mentioned previously, lingering shoulder pain can also lead to a condition known as frozen shoulder. Frozen shoulder [7] is the gradual onset of stiffness and pain. The condition is marked by the thickening and tightening of the capsule surrounding the shoulder joint, which may impact the joint's range of motion.

Signs and symptoms of a frozen shoulder typically begin gradually and then worsen. However, it usually gets better within one to three years with treatment. It is believed to be caused by keeping a shoulder still for an extended period, such as after breaking an arm or having a surgical procedure.

Frozen shoulder is usually treated with physiotherapy, such as range-of-motion exercises. Medication such as corticosteroids, painkillers, and numbing medications through injections may also be prescribed. Surgery may be recommended in rare and severe cases to allow the frozen shoulder joint to move more freely.

frozen shoulder
Frozen shoulder usually occurs due to long periods of immobility of the shoulder.

Symptoms of frozen shoulder (adhesive capsulitis):

  • Gradual onset of shoulder pain
  • Stiffness and limited range of motion, especially in external rotation
  • Pain that worsens at night
  • Difficulty with activities requiring arm movement

Certain factors and causes may indirectly lead to frozen shoulder. These include:

  • Age: those above 40 are at a higher risk of developing a frozen shoulder.
  • Reduced mobility: those with limited mobility in the arm and shoulder, such as rotator cuff injuries, broken arms, stroke, or surgery recovery, may be prone to developing a frozen shoulder.
  • Certain diseases: people with certain systemic diseases are more likely to develop frozen shoulder. These include diabetes, hyperthyroidism, hypothyroidism, cardiovascular disease, and Parkinson’s disease.
swelling
Swelling and inflammation in the shoulder are common signs of shoulder injury. 

5. Shoulder fractures and dislocation

Shoulder injuries such as fractures and dislocation can cause severe pain and limited movement in the joint. When the shoulder joint is forced out of its normal position, often due to trauma or shoulder instability, it can result in shoulder dislocation. A dislocated shoulder happens when the upper arm bone pops out of the cup-shaped socket in the shoulder blade. This causes pain and discomfort in the shoulder. When there are fractures in the shoulder bones, such as the clavicle [8] or humerus [9], they can also cause pain.

Fractures and dislocation in the shoulders are usually caused by traumatic injuries such as car accidents, falls, or sports injuries. Fractures and dislocated shoulders require prompt treatment. A sling or brace may be necessary for a few weeks until the shoulder heals. In some cases, surgery may be needed to repair the fracture. Recovering from these types of shoulder injuries can take a few months. 

Symptoms of shoulder dislocation:

  • Severe pain and instability in the shoulder
  • Visible deformity or abnormal shoulder shape
  • Limited or complete loss of shoulder movement

Symptoms of shoulder fractures:

  • Intense pain, swelling, and bruising
  • Inability to move the arm
  • Deformity or misalignment of the shoulder
sharp and sudden shoulder pain
Fractures or acute rotator cuff tears may cause sharp or sudden pain and impact daily activities.

6. Arthritis

Arthritis [10] is a condition due to damage to the cartilage of the joints. It can be caused by overuse and lack of treatment for shoulder pain because it happens when the cartilage starts to wear down on the socket of the shoulder joint. This leads to chronic pain, stiffness, and reduced mobility in the arm and shoulder. Our shoulder joints may experience degenerative changes as we age, resulting in osteoarthritis. The wear and tear on the joint can cause pain and reduced functionality.

Although it is a condition that can severely impact one’s quality of life, several treatments for arthritis lead to effective results, these include certain stretches and exercises, lifestyle changes, ice or heat application, and medication. 

Shoulder pain due to arthritis can be caused by:

  • Osteoarthritis: the constant wear and tear of the shoulder joint can lead to arthritis and pain, resulting in osteoarthritis [11]. 
  • Rheumatoid arthritis: rheumatoid arthritis [12] is an autoimmune condition affecting multiple joints, including the shoulder.

Symptoms of arthritis:

  • Persistent joint pain is often worse in the morning or after inactivity
  • Stiffness and reduced range of motion
  • Joint swelling and warmth
shoulder pain
The risk of shoulder injuries and pain increases with age. 

How is shoulder pain treated?

Now that you know the reasons behind shoulder pain, you should know that several forms of treatment are available. Once a diagnosis is confirmed, an appropriate treatment plan can be developed based on the underlying condition and individual needs. 

It's crucial to consult with a qualified healthcare provider, such as a physiotherapist, for a thorough evaluation and proper diagnosis. 

Once that’s done, there are several treatment options that your specialist will discuss with you. The treatment plan typically depends on your pain, the underlying cause (such as if a traumatic injury or overuse causes it), and the severity of the condition. 

Here at Physioactive, our shoulder injuries expert, Dr Denis Mecklenburg, with 17 years of experience and over 1000 treated shoulders, will give you the most effective treatment for your shoulder injury. Some commonly used treatment options for shoulder pain and injuries include:

  • Shockwave therapy: helps reduce or eliminate many (chronic) painful conditions such as shoulder injuries and pain. Radial Shockwave Therapy is fast, safe, non-invasive, and effective. 
  • Manual therapy: manual therapy is a collection of specific hands-on techniques used in diagnosing and treating various joint and soft tissue injuries, such as shoulder pain and injuries. Manual therapy helps alleviate pain, increase the range of motion, induce relaxation, reduce soft tissue inflammation, and improve tissue repair.
  • Exercise therapy: studies [13] have shown that exercise therapy is an effective treatment for various joint and soft tissue injuries. Exercise therapy improves strength, mobility, stability, and coordination, ensuring a better and faster recovery.
  • Ultrasound: ultrasound is a painless and non-invasive procedure that uses high-frequency sound waves applied directly to the injured tissue. This increases tissue relaxation, local blood flow, and scar tissue breakdown, reducing pain, and increasing support during healing.
  • Dry needling: if you suffer from chronic pain syndrome, multiple sclerosis, or fibromyalgia, dry needling may be able to relieve your pain. The technique effectively soothes sore muscles and aches. 
  • Electrotherapy: electrotherapy blocks pain signals to the brain, reducing pain. It increases blood flow, reduces swelling, and promotes healing.
  • Thermotherapy: thermotherapy utilises heat to treat acute or chronic pain symptoms, especially those related to muscle tension or spasms. The heat helps to widen blood vessels, increasing blood flow to the skin, relaxing superficial muscles, decreasing muscle spasms, and reducing joint stiffness. 
  • Cryotherapy: cryotherapy involves cold therapy to reduce the amount of fluid flowing into the tissues; this slows the release of chemicals that cause pain and inflammation.
  • Taping and strapping: sports taping supports the affected joint during sports, increasing its stability by preventing excessive movement and thus reducing pain. 

Seeking timely medical advice is crucial for accurate diagnosis and appropriate management of shoulder injuries and pain. If you suffer from shoulder pain or injuries, schedule an appointment with Physioactive for proper diagnosis and individualised treatment. 

exercise therapy
Exercise therapy may help strengthen the shoulder muscles, improve range of motion, and correct muscle imbalances. 

References

  1. Mayo Clinic Staff. 2023. Rotator Cuff Injury: Symptoms & Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/syc-20350225#:~:text=The%20rotator%20cuff%20is%20a,common%20and%20increase%20with%20age.
  2. Author Unknown. 2021. Rotator Cuff. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/21504-rotator-cuff
  3. Tooth, C., Gofflot, A., Schwartz, C., Croisier, J. L., Beaudart, C., Bruyère, O., & Forthomme, B. (2020). Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review. Sports health, 12(5), 478–487. https://doi.org/10.1177/1941738120931764.
  4. Dabija, D. I., Gao, C., Edwards, T. L., Kuhn, J. E., & Jain, N. B. (2017). Genetic and familial predisposition to rotator cuff disease: a systematic review. Journal of shoulder and elbow surgery, 26(6), 1103–1112. https://doi.org/10.1016/j.jse.2016.11.038
  5. Johns Hopkins Medicine. (n.d.). Bursitis. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/bursitis#:~:text=Bursitis%20is%20inflammation%20of%20a,elbows%2C%20hips%2C%20and%20knees.
  6. Author Unknown. 2021. Shoulder Impingement Syndrome. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/7079-shoulder-impingement-syndrome
  7. Mayo Clinic. (n.d.). Frozen Shoulder (Adhesive Capsulitis): Symptoms & Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684#:~:text=Frozen%20shoulder%2C%20also%20called%20adhesive,risk%20of%20developing%20frozen%20shoulder.
  8. Oliver Jones. 2020. The Clavicle. Teach Me Anatomy. https://teachmeanatomy.info/upper-limb/bones/clavicle/
  9. Oliver Jones. 2020. The Humerus. Teach Me Anatomy. https://teachmeanatomy.info/upper-limb/bones/humerus/
  10. Author Unknown. (n.d.). Shoulder Arthritis. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/shoulder-arthritis
  11. WebMD Editorial Contributors. 2022. Shoulder Osteoarthritis (Degenerative Arthritis of the Shoulder). WebMD. https://www.webmd.com/osteoarthritis/shoulder-osteoarthritis-degenerative-arthritis-shoulder
  12. Centers for Disease Control and Prevention. (n.d.). Rheumatoid Arthritis. CDC. https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html#:~:text=Rheumatoid%20arthritis%2C%20or%20RA%2C%20is,usually%20many%20joints%20at%20once.
  13. Geidl, W., Deprins, J., Streber, R., Rohrbach, N., Sudeck, G., & Pfeifer, K. (2018). Exercise therapy in medical rehabilitation: Study protocol of a national survey at facility and practitioner level with a mixed method design. Contemporary clinical trials communications, 11, 37–45. https://doi.org/10.1016/j.conctc.2018.05.004 
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