Your shoulder has one of the widest ranges of movement of any joint. From scratching your lower back to brushing your hair, your shoulder moves freely and without restriction. But, with such freedom also comes instability. The shoulder lacks many support structures seen in other ball-and-socket joints, like the hip.

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Shoulder pain is, therefore, extremely common. It’s also debilitating. In this article, we’ll explain what shoulder pain is and what causes it. And we’ll also advise on when to seek medical attention.

A quick overview of shoulder anatomy

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To understand how shoulder pain occurs, you need to understand the shoulder’s structure. The shoulder joint has three bones:

1. Humerus (Upper arm)

2. Scapular (Shoulder blade)

3. Clavicle (Collar bone)

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The humerus and clavicle attach to the scapular, meaning the shoulder joint is actually two joints. The glenohumeral joint (GHJ) is a ball-and-socket joint with a shallow socket held in place by the rotator cuff muscles and ligaments. The acromioclavicular joint (ACJ) supports the scapula, leading to fewer injuries. 

Causes and associated symptoms of shoulder pain

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Every structure in the shoulder can become injured, causing a specific presentation of shoulder pain. Rotator cuff problems are amongst the most common. In fact, more than 2 million Americans report rotator cuff problems annually.

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Here are some causes:

• Rotator cuff problems involve three potential causes: (1) tendonitis or inflammation of the tendons, (2) bursitis or inflammation of the lubricating fluid-filled sacs, (3) rotator cuff tear where the tendon pulls from the bone. Pain will occur on reaching or throwing and typically worsens at night. If inflamed, the shoulder may also be stiff.

• Frozen shoulder or adhesive capsulitis presents with joint stiffness and pain. The condition persists for months, gradually resolving. The cause is unknown.

• Osteoarthritis caused by the wear-and-tear of the cartilage covering the joints results in bone scraping on bone. Expect reduced movement, pain, and stiffness.

• Tendon tears most commonly involve an anterior-posterior tear of the glenoid labrum. It’s most often caused by a fall on an outstretched hand. 

• Subluxation or dislocation is where the shoulder is unstable in the joint or, as a result of trauma, is disconnected from the joint entirely. This requires medical attention.

Other causes include calcific tendonitis, bicep tendonitis, biceps tendon rupture, ACJ arthritis, ACJ separation, and distal clavicle osteolysis.

Treatment

Treatment for shoulder pain will depend almost entirely on the cause. However, if not severe, you can manage symptoms with these tips:

• Rest is particularly important for inflamed or irritated joints. Too much rest can lead to joint stiffness, however.

• Ice and heat application will reduce pain and swelling. Usually, ice packs are for acute injuries, and heat pads are for chronic conditions.

• Gentle exercise is critical. You’ll want to improve your mobility and strength. Working with a physiotherapist can also be helpful.

• Medications, like NSAIDs (ibuprofen), will relieve inflammation-associated pain. For prolonged shoulder pain, a doctor may prescribe a steroid injection.

Chiropractors are trained to perform manipulations to the shoulder joint that will help normalise shoulder movement, once the shoulder is moving better the shoulder pain will be relieved. Another technique that a Chiropractor may use is dry-needling which is great to relieve any tight shoulder muscles which could be contributing to the pain. When treating shoulder pain, the chiropractor will always assess the cervical spine to make sure there is a proper nerve supply to the shoulder joint.

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Always consult a medical practitioner if the pain is severe in both shoulders, prolonged for over a week, or you feel feverish or unwell.

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