Shoulder Pain - What Can Cause It?

Shoulder pain can be a persistent dull and nagging sensation in the upper arm or shoulder area. It can be easily differentiated from neck pain as it is related to the movement of shoulders i.e. it will increase and decrease with shoulder movements especially overhead activities. The other signs to identify shoulder pain is if your shoulder movements are reduced.

If you find it difficult to scratch/wash your back, comb your hair or reach your back pocket. Shoulder pain can happen due to various reasons, vary from person to person depending on the activities he/she is involved in, for e.g. sports, manual job etc.. It can be a single major injury or multiple small injuries due to repetitive usage patterns. Also, degenerative changes in various parts of the shoulder can lead to shoulder pain.

In the case of middle to old age, injuries that can cause shoulder pain are-

• Biceps Tendonitis
• Acromio-clavicular Joint arthritis
• Scapular Dyskinesia
• Trapezitis
• Suprascapular nerve entrapment In young age, injury due to sports or gym activity can cause shoulder pain
• Superior labral anterior/posterior (SLAP tear)lesion

Also, traumatic or repeated dislocations of the shoulder can cause shoulder pain due to...

• Bankart lesion

Diagnose Shoulder Pain-

Shoulder pain can be diagnosed only after a thorough history taking and clinical examination. However, some imaging studies can be very helpful like:

1. X-rays: Through an x-ray one can view the shoulder in many different views
2. Ultrasound: With ultrasound, you can also check the damaged caused to the tendons and muscles of the shoulder but the quality of reporting depends upon the expertise of the doctor.
3. MRI: MRI gives a clear picture of the shoulder as it shows everything related to a shoulder joint that is joints, vessels, tendons and muscles that too from different angles.
4. Diagnostic Arthroscopy: A surgical procedure often used by orthopaedic surgeons to diagnose and treat issues inside a joint. Arthroscopy has the big advantage that one can use it to diagnose as well as treat at the same time.

Treatment for Various Types of Shoulder Pain-

1. For Shoulder Impingement or Rotator Cuff tear: Give rest to the shoulder for a few days only Dedicated Physiotherapy Protocol Bursal injections If these fail then, (Surgery)Arthroscopic sub-acromial decompression If Cuff tear is found, then one can go for Arthroscopic/Mini-open repair
2. Labral Lesions: For anterior Labral lesions (Bankart's) following anterior shoulder dislocation then surgery in the form of Arthroscopic Bankart's repair is the only option to reduce risk of recurrence and degeneration.

SLAP Lesions -

1. Pain relief and physiotherapy as the first step If this fails then following surgical options are available
2. Arthroscopic debridement or repair of labrum
3. Biceps tenotomy or tenodesis

Arthritis -

In this case, the joint is already destroyed and has to be resurfaced for pain relief and to maintain ROM. If Rotator cuff muscles are working, then Shoulder resurfacing hemiarthroplasty (preferred in young people), that has a life of 10 to 15 years, Total shoulder replacement (preferred in middle-aged to old people) has a life of 10 to 15 years. But, if rotator cuff muscle is not working then Reverse Geometry Shoulder replacement is recommended, that has a life of 10 years.

It is always advisable to get yourself diagnosed properly in case of shoulder pain as management changes depending on clinical situations. Neglecting shoulder conditions can lead to bigger problems later on.

Remember "a stitch in time saves nine"