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Shoulder Pain


What is shoulder pain?

The rotator cuff is a group of muscles which help to control the movement of the shoulder's ball and socket joint. If this control is inadequate then the muscles can become stressed or squashed between two bones, causing pain in the shoulder or upper arm, particularly when lifting the arm, lying on it or using the affected muscles. 
People who work or do sports and/or hobbies that require putting their hands above shoulder height are the most likely candidates for rotator cuff problems. However, a shoulder injury, new or repetitive activity may also cause the condition to develop. Age also has an effect, with rotator cuff problems developing as you get older.
Rotator Cuff
Rotator Cuff

Frozen shoulder, or adhesive capsulitis, is the painful and gradual stiffening of the shoulder capsule (the tissue that surrounds the shoulder joint). Over time, this painful stiffening leads to sleep disturbance and limits your ability to use your arm for day-to-day activities.

The exact cause of the condition is unknown. For some reason, your body has an over reactive response to a minor injury and tries to heal your shoulder capsule with scar tissue. It affects one in 20 people and is more common in women than men. Most cases of frozen shoulder happen between the ages of 40 and 60.  

Frozen shoulder can be categorised into three phases:

  • Painful Phase

  • Stiffness Phase

  • Thawing Phase

The shoulder is one of the most commonly dislocated joints.

Shoulder instability means that the shoulder can dislocate (be pulled out of joint) or sublux (moves more than it should do) during day-to-day activities. Both dislocation and subluxation can happen for a variety of reasons. How it happens affects the type of treatment you will receive.

The three main causes of shoulder instability are:

  • Traumatic dislocation – where the shoulder undergoes an injury with enough force to pull the shoulder out of joint (eg. a violent tackle in rugby, or a fall onto an outstretched hand)
  • Non-traumatic dislocation –caused by repeated shoulder movements gradually stretching out the soft tissue cover around the joint causing the rotator cuff muscles to become weak
  • Positional non-traumatic – the ability to dislocate your shoulder without any form of trauma. This may start off as a party trick, but if repeated, it can happen during everyday activities

Osteoarthritis of the shoulder is the gradual wearing away of the cartilage of the joint. This leads to the two bones of the joint rubbing together causing pain.

Patients who have had previous trauma or shoulder surgery are most likely to develop osteoarthritis in later life. Symptoms include swelling, stiffness, aching and sharp, stabbing pains. 

Acromioclavicular joint pain occurs where the collar bone meets the shoulder blade. Pain in this joint can occur if you carry out a lot of activities that require you to lift your arms above your head.

Making changes to the amount of overhead activities you do can ease the pain. Painkillers can manage the symptoms, but seek advice from your GP or pharmacist before taking. If the pain is persistant, physiotherapy will also help.

Injections can be given to settle the pain if it is severe and if the pain does not improve, surgery to remove the end of the collar bone may be considered. 

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Referred shoulder pain is when you experience pain away from the area that is actually injured or is causing a problem, e.g. pain in the shoulder which is usually referred from the neck or upper back. 

As with frozen shoulder, bad posture is the main cause of referred pain in your shoulder and it can often be managed by merely improving your posture and keeping your neck moving. 

Dealing with shoulder pain

Shoulder pain can usually be easily managed by you, at home. Simply reducing or stopping the activity that has caused the pain can make an enormous difference.

To deal with rotator cuff pain, take a break from the activity that has caused the problem or which makes it worse.  You can also take painkillers as advised by your pharmacist or GP. 

Gentle exercises can help prevent your shoulder from stiffening up and rehabilitate your muscles.

If you are suffering from frozen shoulder you should:

  • Avoid activities that involve you lifting your arms over your head or behind your back to reduce irritation
  • Use pain relief such as anti-inflammatories, as advised by your pharmacist or GP
  • Ice/Cryotherapy - place a wet flannel and a pack of frozen peas on your shoulder for 20 minutes up to every hour
  • Complete a simple range of movement exercises - watch our exercise video and download our exercise sheet to the right.

If you are suffering from frozen shoulder, you should also correct your posture. If you slouch, your ability to lift your arm above your head reduces by 30 per cent.

Sitting and standing in a good posture with your shoulder back will help your movement as well as prevent the tendons in your shoulder catching. Slouching also squashes all of the structures in your shoulder against the ridge above the joint, causing pain and irritation.

Following a first-time dislocation, your arm may be put in a sling. Your doctor or physiotherapist will advise you on when to remove it to exercise.

  • Changes to your activity/rest: Making changes to the activities you do does not mean that you have to stop moving or stop using your shoulder altogether. Try to avoid activities that involve lifting your arm over your head, or contact sports for the first three months after the dislocation.
  • Maintain good posture: Sitting and standing in a good position with your shoulders back will help your movement as well as prevent the tendons in your shoulder from catching.
  • Painkillers and/or anti-inflammatories: Simple painkillers such as paracetemol can be used to dull the pain, but they do not cure the problem. Anti-inflammatories can also be effective. It is best to consult your GP if you have not taken these before.
  • Ice/Cryotherapy: Icing your shoulder can be a very effective way of reducing your pain. Place a wet flannel and a pack of frozen peas on your shoulder for 20 minutes every hour. Check the skin under the ice every five minutes to ensure that you don’t get an ice burn. Once the pain begins to settle, you can then start to ice your shoulder less frequently. 

If you are suffering from osteoarthritis of the shoulder then you should:

  • Do exercises to keep the joints healthy and stimulate the natural lubricating fluid
  • Use heat treatment - use a warm hot water bottle, a wheat bag or the shower. Download the heat and ice treatment advice sheet on the right.
  • Your GP may give you an injection to settle the pain if severe
  • Have physiotherapy

Acromioclavicular joint pain:

  • Pain management
  • Your GP will give you an injection to settle the pain if severe
  • Physiotherapy
  • Surgery to remove the end of the collar bone may be considered if the pain is severe and does not improve with other management techniques

 

Referred shoulder pain

  • Correct your posture - Try sitting with a rolled up towel in your lower back and tuck your chin in.
  • Pain relief as advised by your pharmacist or GP
  • Exercises and stretches to keep the joints healthy and prevent nerves getting trapped or irritated
  • Physiotherapy


Avoiding shoulder pain

Avoiding rotator cuff problems

  • Avoid excessive unaccustomed activity with the hands above shoulder height e.g. doing tasks like painting the ceiling, hanging curtains and trimming the hedge in short periods of time
  • If you exercise, ensure you balance your training programme to incorporate strength work for all muscle groups
  • Take breaks from repetitive shoulder movements and heavy lifting 

Avoiding acromioclavicular joint pain 

  • Avoid excessive overhead activities

Avoiding shoulder impingement  

  • Correct your posture - if you slouch, your ability to lift your arm above your head reduces by approximately 30 per cent. Sitting and standing in a good posture with your shoulders back will help your movement as well as prevent the tendons in your shoulder catching
  • Try not to slouch as this squashes all the structures in your shoulder against the ridge above the joint, causing pain and irritation

Avoiding referred shoulder pain

  • As with shoulder impingement, bad posture is the main cause of referred pain in your shoulder and often can be managed by merely improving your posture and keeping your neck moving

Avoiding osteoarthritis 

  • Unfortunately osteoarthritis is a problem we will all have to deal with at some point in our lives. But if you keep yourself fit and active, correct your posture and keep your shoulder strong and flexible you can help to alleviate and manage your shoulder symptoms. 
 
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Useful links: 

For a patient information leaflet on Shoulder Pain click here.