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:
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
- 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
- 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.