Comprehensive Guide to Shoulder Pain

Understanding Shoulder Pain

Shoulder pain refers to any discomfort in or around the shoulder joint. It is a common issue due to the shoulder's wide range of motion, facilitated by a group of four muscles and their tendons known as the rotator cuff.

Causes of Shoulder Pain

Shoulder pain can arise from various issues, most commonly involving the rotator cuff tendons becoming trapped and inflamed under the bony area of the shoulder. This condition is known as rotator cuff tendinitis or bursitis. Other common causes include:

Arthritis: Degenerative changes in the shoulder joint.
Bone Spurs: Bony projections that develop along the edges of bones.
Bursitis: Inflammation of the bursa, a fluid-filled sac that cushions the joint.
Fractures: Broken shoulder bones.
Dislocation: The shoulder joint is forced out of its normal position.
Shoulder Separation: Injury to the acromioclavicular (AC) joint.
Frozen Shoulder: Stiffness and pain in the shoulder joint.
Overuse Injuries: Repeated stress on nearby tendons, like the biceps.
Nerve Injury: Damage to nerves affecting shoulder movement.
Rotator Cuff Tears: Tears in the tendons of the rotator cuff.
Poor Posture: Incorrect shoulder alignment and movement mechanics.
Referred Pain: Pain originating from other areas, such as the neck or lungs.

Home Care for Shoulder Pain

Managing shoulder pain at home can involve several strategies to alleviate symptoms and promote healing:

Ice Therapy: Apply ice to the affected area for 15 minutes, then remove it for 15 minutes. Repeat this 3-4 times daily for 2-3 days. Always wrap the ice in a cloth to avoid frostbite.
Rest: Avoid activities that aggravate the pain for a few days.
Gradual Activity Resumption: Slowly return to regular activities with guidance from a physical therapist.
Pain Relief: Over-the-counter medications like ibuprofen or acetaminophen can help reduce inflammation and pain.

For those with a history of shoulder pain:

Use ice and ibuprofen after exercising.
Engage in exercises to stretch and strengthen rotator cuff tendons and shoulder muscles, as recommended by a healthcare provider or physical therapist.
Continue range-of-motion exercises if recovering from tendinitis to prevent frozen shoulder.
Maintain good posture to ensure proper alignment of shoulder muscles and tendons.

When to Seek Medical Help

Shoulder pain can sometimes indicate more severe conditions, necessitating prompt medical attention. Seek immediate help if you experience:

Heart Attack Symptoms: Sudden left shoulder pain, pressure, or crushing pain extending from the chest to the jaw, arm, or neck, especially with shortness of breath, dizziness, or sweating.
Severe Injury: Intense pain, swelling, bruising, or bleeding following a shoulder injury.

Contact a healthcare provider if you have:

Shoulder pain with fever, swelling, or redness.
Severe pain even with minimal shoulder movement.
Pain persisting for more than 2-4 weeks despite home treatment.
Swelling or discoloration of the shoulder area.

Medical Evaluation and Treatment

During a medical evaluation, your healthcare provider will perform a thorough physical exam and may order blood tests or imaging studies such as X-rays or MRI to diagnose the issue. Treatment options may include:

Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.
Injections: Corticosteroid injections to reduce inflammation.
Physical Therapy: Exercises and treatments to improve shoulder function.
Surgery: Considered if other treatments fail, particularly for severe cases.

For rotator cuff problems, self-care measures and exercises are typically recommended.

References

Gill TJ. "Shoulder Diagnosis and Decision-Making." In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine: Principles and Practice. 5th ed. Philadelphia, PA: Elsevier; 2020
Martin SD, Thornhill TS. "Shoulder Pain." In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021