Experiencing shoulder pain? Here are the common causes and best ways to manage the pain - Highgate Private Hospital
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Experiencing shoulder pain? Here are the common causes and best ways to manage the pain

Shoulder pain can have a massive impact on your day-to-day functioning and is a common presentation in many GP surgeries and A&E departments. This article deals with more longer-term causes of shoulder pain, as well as how to help with managing the pain at home.

If you experience any of the following in relation to your shoulder pain, you should go to A&E:

  • Major trauma/accident
  • Sudden pain
  • Pain that is very severe
  • Inability to move your arm
  • Change in the shape of the shoulder or arm
  • Pins and needles in your arm or hand that won’t go away
  • Numb arm or shoulder
  •  Arm/shoulder that is very hot or very cold to touch

These signs tend to indicate a break in a bone, ruptured tendon or dislocation, which will need more immediate treatment.

What could be causing my shoulder pain?

The shoulder is one of the more complex joints in the body, so when someone is experiencing pain in their shoulder there are several potential sources of the problem. Overall, the joint contains two ‘sub-joints’: the glenohumeral joint (the ball and socket joint where your arm joins on to your shoulder blade) and the acromioclavicular joint (commonly abbreviated to AC joint or ACJ) where the clavicle joins the shoulder blade. These are shown to the right:

The AC joint is more commonly the source of shoulder problems, rather than the ball and socket joint itself, although both are prone to dislocation and arthritis.

In addition to these joint elements, the shoulder also comprises a series of muscles, collectively known as the ‘rotator cuff’. This is made up of four separate muscles that help to stabilise the top of the humerus (upper arm bone) in the socket joint on the shoulder blade. As there are so many elements in this joint, there is not much extra space around it, so sometimes the tendons of these rotator cuff muscles can get squashed (medically termed ‘impingement’) or get small tears, which can also cause pain.

‘Frozen shoulder’ is another source of shoulder pain, and is caused by inflammation and stiffness in the connective tissue capsule that surrounds the joint. This is also known as ‘adhesive capsulitis’ and can cause restricted movement as well as pain.

The final common source of shoulder pain is the bursae of the shoulder joint. A bursa is a small sac of joint fluid that sits around the joint. These are found in joints all over the body. There are several present in the shoulder joint, and can sometimes become irritated and inflamed (particularly in such a cramped space) causing a ‘bursitis’ and resultant shoulder pain.

What can I do to help with shoulder pain?

Although there are several potential causes of shoulder pain, the treatment and management is generally similar and the following strategies can be helpful in most circumstances:

  1. Exercises

The most important thing to remember is to keep moving your shoulder! Although movement may be painful, most things will be made worse by not using the joint. This can make any later physiotherapy even more difficult

  • Here are a few exercises that can help. You should start to feel some improvement in 2 weeks, although it can take 6-8 weeks to feel the full benefit:
    • Pendulum: Stand upright and support yourself with your good arm, holding onto a table or chair. Let the arm of the painful shoulder hang down, swing the arm backwards and forwards, then in circular motions
    • Stretch: Stand up straight, arms by your side and raise your shoulders up towards your ears, hold for 5 seconds and return to normal posture. Next squeeze your shoulder blades together, hold for 5 seconds and return to normal posture. Finally, pull your shoulders downwards, away from your ears, hold for 5 seconds and return to normal posture
    • Lean: Stand in a doorway, reach up to hold the door frame and lean slightly forward until you feel a good stretch in your shoulders
    • Door press: Stand in a doorway with your elbow bent at 90 degrees and tucked into your side. Stand so that your palm is touching the inside of the door frame. Push against the door frame for 5 seconds and relax. Repeat on the other side of the door frame, trying to push with the back of your hand

For all of these exercises, start slowly and build up the time and repetitions as you feel stronger. If you feel any strong or sharp pain, stop the exercise 

  1. Posture

    • A slouched position can make shoulder pain worse!
    • When sitting, try to keep a small cushion behind the lower back to help you sit upright. It can also be helpful to rest the arm of the painful shoulder on a cushion
    • When standing, make an effort to stand with a straight back, with shoulders gently pulled back
  2. Pain Relief

    • Paracetamol and ibuprofen are very effective painkillers for pain caused by muscle and joint problems. As they work differently, they can often be taken together for more effective pain relief.  Ask your pharmacist for more details
    • Topical ibuprofen gels can also be helpful and are applied directly over the area of pain. These can be used in combination with oral medications
    • Applying heat or ice packs can also reduce pain. Ice helps to bring down swelling and heat helps to relieve stiffness. Alternating between the two can also provide relief

If the pain doesn’t get better after 2 weeks, it is advised to go and see a GP. They may prescribe some stronger pain medication or injections, advise further exercises or refer to a physiotherapist or specialist for further tests or treatment.

Date: 22/02/2019
By: gpittson