Shoulder pain is one of the most common musculoskeletal issues reported throughout the world. It’s estimated that two out of every three humans experience some form of shoulder pain within their lifetime. As the part of the body responsible for providing strength and mobility to the arms, the shoulder is subject to some rigorous demands, which makes it highly susceptible towards injuries and pain. Although many shoulder pain issues can be treated with a few sessions of onsite or online physical therapy for shoulder pain, some serious conditions can even require surgery and several months of rehabilitation procedures.
Understanding The Shoulder
The shoulder joint is made up of three bones, which include the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). The two joints between these bones are responsible for the movement of the shoulder, which include the acromioclavicular (AC) joint located between the acromion (the top portion of the scapula) and the clavicle, and the glenohumeral joint (also known as “shoulder joint”) which is a ball-and-socket joint situated between the scapula and the humerus that enables the arm to rotate in a circular motion or to hinge out and up away from the body. The top portion of the humerus bone (also known as the upper arm bone) has a round structure, which is known as the ‘ball’, while the outer edge of the scapula has a dish-shaped part, which is known as the ‘socket’. This complex design allows for the arms to achieve different kinds of motions, including rotation and shifting. Besides these movements, the scapula also has the ability to slide along the ribs.
The three bones in the shoulder are further strengthened and supported by a collection of muscles, tendons, and ligaments, which work together to provide flexibility and stability during movements. An important structure in the shoulder is the rotator cuff, which is composed of the tendons that support the ball at the top of the humerus in the glenoid socket and provide mobility and strength to the shoulder joint. A collection of sac-like structures known as bursa are also important in allowing the bones, muscles, and tendon to smoothly glide alongside each other and protecting the rotator cuff from the acromion’s bony arch. Overall, these complex interactions make the shoulder the most movable joint in the body.
What Can Cause Shoulder Pain?
Because of the dynamic range of motion allowed by the shoulders to the arms, it is inherently an unstable structure and is vulnerable to heavy muscular stress and tissue damages. An overwhelming majority of shoulder pain complaints are diagnosed as localized tissue, ligament, or bone damage issues. However, in some cases, problems in other regions of the body like the gallbladder, liver, cervical spine or heart, can also cause pain in the shoulders. It is therefore important to get the condition properly checked by a physician so that the right treatment can be obtained. Early treatment of shoulder pain can also prevent the problems from compounding further or even becoming chronic.
Common Shoulder Pain Conditions
There are several kinds of shoulder pain conditions. Some of the most common are mentioned below:
Tendinitis, also called tendon inflammation, is a condition caused by stress or injury to the tendons in the shoulder complex. Injuries to any of the four rotator cuff tendons or one of the bicep tendons can bring pain and result in mild to severe inflammation around the shoulder area. It’s especially common among athletes and weightlifters. There are two types of tendinitis, which include:
- Acute tendinitis: which is a short-term condition treatable with some rest and physical therapy
- Chronic tendinitis: which is a recurring or long-term condition caused by the tendons’ inability to repair themselves and may require specialized treatment, including surgery
Tendon rupture is an injury caused by the tearing of the fibrous tissue connecting the bone with the muscles. Majority of rupture can cause pain, while some can also be asymptomatic. A variety of factors can cause tendon injury, ranging from heavy weightlifting to degenerative changes caused by aging. A significant proportion of tendon rupture issues cases have the potential to become chronic, because of which it is important to treat it in a timely manner. Treating a torn tendon can take weeks to months, and may need a combination of treatments including surgery, physical therapy, and extended medication.
Shoulder impingement syndrome is a condition caused by the inflammation of tendons of the rotator cuff muscles as they pass through the subacromial space, which is the passage beneath the acromion. Shoulder impingement can result in pain, weakness, and loss of movement at the shoulder. It’s more commonly seen among artists, weightlifters, and athletes. The condition is usually treated by conservative treatment procedures like rest and physical therapy, but some more serious conditions may require treatments with steroids or even surgery.
Shoulder instability is caused by the forced shifting of the humerus away from the shoulder socket. It’s usually caused by long-term stress or sudden injury. It usually occurs when the lining of the shoulder joint (the capsule), ligaments or labrum become stretched, torn or detached. The condition is commonly associated with pain, decreased range of arm/shoulder motion and swelling. Depending upon the severity of the condition, the treatment for instability may need rest and a few physical sessions, to extended immobilization with sling and surgery.
Osteoarthritis is a condition characterized by the wear and tear of the shoulder because of degeneration caused by aging. It’s one of the most common causes of shoulder injuries among people above 60. Symptoms of the condition include swelling, pain, and stiffness around the shoulder area. There’s no cure for osteoarthritis, but simple lifestyle changes, including light exercises and supportive therapies, can help lessen the symptoms and allow patients to do normal everyday activities. In the most severe cases though, surgery maybe considered as well in order to strengthen or replace damaged joints.
A fractured shoulder often results from a trauma injury primarily caused by accidents, falls or stress on one or more of the three bones within the shoulder complex. It’s among the most common shoulder issues requiring surgery. However, some light fractures can be treated by non-invasive methods, including onsite and online physical therapy for shoulder pain and rehabilitation.
Shoulder dislocation is a condition caused by the detachment of the humerus from the shoulder socket. Dislocation is usually caused by impact injuries, with the humerus shifting to a position at the opposite angle of the impact. Dislocation can bring conditions like severe pain, swelling and limited range of motion. Depending upon the level of the dislocation, treatment for shoulder dislocation can vary from immobilization and physical therapy to surgery, and it may take several weeks to several months for normal motion to be restored.
Frozen shoulder, also called adhesive capsulitis, is a disorder commonly observed among people with low levels of movement around the shoulder. It’s a condition frequently observed among patients with diabetes. Its caused by the thickening and tightening of tissues in the shoulder, which leads to the development of scar tissue over time. Typical symptoms include joint pain, stiffness, and limited range of motion, which tends to worsen without treatment. However, physical therapy treatment can restore mobility and strength in most cases.
Risk Factors for Developing Shoulder Pain
Shoulder pain is a relatively common condition and can affect people of all ages and backgrounds. However, some shoulder pain conditions affect certain population groups a lot more than others. Based on the observations of shoulder injury incidences, the following groups are at high risk of developing shoulder pain:
- People above 60: primarily conditions like osteoarthritis, frozen shoulder, and tendinitis
- Athletes and people doing in intensive physical activities: conditions like fracture, dislocation, and tendon rupture
- People with diabetes: conditions like frozen shoulder and fracture
- Smokers: conditions like tendinitis, rotator cuff degeneration, and lung cancer
- Children: conditions like bursitis and tendinitis
It’s estimated that up to 25% of all shoulder pain reports are from people with at least one episode of shoulder pain, while more than 40% report either minor or serious recurrence of the pain within a 12 month period.
Physical Therapy for Shoulder Pain
Physical therapy is often used as a first-line treatment for several shoulder pain conditions. Depending upon the nature of the injury and pain, the physical therapist may use different treatment methods including heat and ice treatments, electrical stimulation, and strengthening exercises to reduce pain and restore functionality in the shoulders. After some sessions of onsite therapy, partial or full recovery can be achieved by patients through a combination of exercises and online physical therapy for shoulder pain.