A couple of weeks ago I wrote a blog about knee pain and the five most likely reasons for it. Today I’d like to do the same for shoulders. The shoulder is a beautifully constructed part of the body. But it’s also quite a complex mechanism – and as such, various gremlins can come along to cause it problems.
Here, then, are the top five most common ones.
A subacromial impingement
OK, don’t be intimidated by the medical-speak. Let me unpack that… The subacromial space is the tiny area between the acromion (one of the uppermost bones in your shoulder) and the underlying tendon. If that tendon becomes irritated or inflamed – after a sudden injury, say, or after a weekend spent doing a repetitive activity, such as decorating – it may begin to swell in the space and rub against the bone. This obviously causes discomfort, which is felt on the outer part of the shoulder or into the upper arm. The pain usually worsens when you move your arm upwards.
A rotator cuff tear
This one is closely related to impingement, above. Your rotator cuff is a combination of four muscles below the acromion that allows you to raise and lower your arm. Sometimes we can tear it – either through long-term wear-and-tear, or because of a sudden accident, such as a fall. In both cases it will be quite painful. But here the pain will also be associated with weakness and loss of movement. So you’ll suddenly find that you’re struggling to raise your arm in the normal way.
Frozen shoulder, or ‘adhesive capsulitis’, occurs when the capsule or lining of the shoulder initially becomes inflamed, and then thickens and ‘shrink-wraps’ the shoulder. This is initially very painful; the pain then improves, leaving the shoulder very tight and stiff. This may be overcome with physiotherapy and steroid injections, but sometimes requires treatment with a manipulation under anaesthetic, often combined with a keyhole surgery procedure to release the tight capsule.
As I wrote in the previous knee blog, osteoarthritis is most commonly found in older people – but it does affect youngsters, too, particularly if they’ve had an injury in the area. What happens is that the protective cartilage between the joints gets worn away, leaving bone to grind against bone. For this reason, osteoarthritis usually causes a dull ache that never quite goes away. It will also feel central within the shoulder, since it’s usually emanating from the ball-and-socket joint, at the heart of the shoulder’s operations.
If you’ve ever dislocated your shoulder, it won’t have gone unnoticed! Shoulder dislocations cause a wide range of painful symptoms, from bruising to intense pain, and of course you may be able to see that the joint itself has been displaced merely by looking at it. The general rule of thumb with dislocations is that if you have one, you’re much more likely to have another. So shoulder dislocations recur. And they tend to happen either because of trauma – a rugby tackle, for instance – or because the joints are more stretchy than average, meaning they have a tendency to pop out more easily. We treat the first cases with surgery, to repair the damaged tissue. The second scenario is a bit more complicated, often involving more conservative treatment, such as physiotherapy.
The bottom line with recurrent or constant pain is that it provides a warning flag about a problem below the surface. This means you should certainly get it seen by a medical professional – whether the pain feels similar to the symptoms highlighted above, or quite different. There are of course all kinds of treatments available, and surgery is only one of many approaches. If you’d like to sit down with me and discuss your own symptoms, do make an appointment. I’d be delighted to help.