Chronic shoulder pain can develop from a variety of conditions that affect the anatomical structures of the shoulder. These include acromioclavicular arthritis, adhesive capsulitis (frozen shoulder), shoulder instability (dislocated shoulder), shoulder arthritis and rotator cuff pathology. This article will discuss each of these pathologies.
1. Acromioclavicular Arthritis – Your clavicle is the small bone that you can feel and see just above your chest. If you run your fingers along this bone towards your shoulder it will lead you to a small joint called your acromioclavicular joint. This joint is prone to problems because of it closeness to the surface of the skin and its small size. It is usually injured as a result of a trauma, like a fall landing on an outstretched arm or directly on the shoulder. Aggressive and prolonged overhead activity can also irritate this joint because of compression. Pain from this joint is usually localized directly over the joint or it can spread toward the neck. It usually doesn’t go into the arm.
2. Adhesive Capsulitis (Frozen Shoulder) – this is a problem that causes extreme stiffness and loss of motion in your shoulder. It can also cause a lot of pain. At its most severe your arm will move only an inch or two away from your side. This problem usually occurs gradually with minor stiffness or pain. Over time these symptoms become worse and our ability to use your arm becomes more pronounced. X-rays will usually be negative. Diabetics and those with thyroid conditions are prone to this problem because of poor tissue integrity.
3. Shoulder Instability – this occurs when the ligaments surrounding the shoulder become weak or overstretched. Instability can be caused from a trauma that forces the shoulder to dislocate. The shoulder may “pop” back into place by itself but it often has to be put back in by a doctor. Patients that dislocate are usually younger than 40 years old. Once they have a dislocation it is likely it will happen again because of the looseness in the ligaments. Strengthening exercises can sometimes help stabilize the joint. If the instability continues then surgery will be considered to fix the problem.
4. Rotator Cuff Problems – this could range from a tendonitis to a complete muscle tear. Pts. with rotator cuff pain are usually over 40. Pain is often felt in the upper arm, not the shoulder itself. The pain usually does not go below the elbow, but in the case of chronic shoulder pain the symptoms can radiate to the thumb. Signs and symptoms include weakness, pain when raising the arm, pain at night when sleeping on the affected side and a positive impingement sign. Conservative treatment can be helpful in many cases. In stubborn cases where pain does not resolve injection may be necessary. In the case of a large rotator cuff tear surgery is likely.
These are the most common causes of chronic shoulder pain and rotator cuff pain. If you have been experiencing any of these problems you should consult your physician for advice. They will coordinate your care and discuss your available options for improvement.