Shoulder Pain Management

Because of the complex makeup of the shoulder joint, these complex movements make the shoulder extremely vulnerable to sprains, strains, tears and inflammation of the capsules, muscles, ligaments and bursa that are involved in the make-up of the joint itself. The shoulder joint is actually made up of three joints and one “articulation”, where the head of the humerus (the long bone of the upper arm), meets the articulation with the collarbone and the shoulder blade (scapula).

There are 4 main muscles that are involved in keeping the joint together and in the complex movements, whenever the arms are moved. There are of course many other muscles involved, however these 4 muscles play the major role in the integrity of the joint itself. As a group, they comprise the rotator cuff. It is these muscles that are most vulnerable to tears, strains, sprains and inflammatory processes.

Where in the shoulder area the pain occurs will play an important role in the diagnosis of the condition itself. It is therefore recommended that any individual with shoulder pain be evaluated by their healthcare professional. The evaluation will consist of various tests involving the movement of the arm through all range of motion (ROM), and neurological inspection to see if there is any nerve involvement. The shoulder will also be x-rayed, especially if there was trauma involved, to rule out fractures, and to see the condition of the bones, joint and bursa. The bursa is a little sack of fluid that allows the muscles to glide smoothly as they are flexed or extended.

There are two areas where this bursa is located and they can become swollen, inflamed or even infected. In an acute bursitis, the patient generally complains on any movement of the arm, and is generally worse at night, with difficulty in sleeping on the affected side. Pain and tenderness is generally located on the point of the shoulder. An acute bursitis left untreated can develop into a chronic bursitis. Pains that occur along the top of the shoulder, and radiate into the side of the upper arm into the deltoid muscle, and further down the arm, even into the fingers, may be related to nerve impingement (pinched nerve), which can originate in the neck (cervical spine). Depending on the side of the hand, or the fingers affected will determine the nerve branch involved.

This condition called “Brachial Neuritis”, or “Brachial Neuralgia”, is due to the involvement of the group of nerves exiting from the spinal vertebrae, called the “Brachial Plexus”. The pain can be very intense on any movement of the arm and any pressure along the distribution of the nerve pathway. Pains that occur over the shoulder blade (scapula) area can be due to the large muscle (trapezius) and underlying smaller muscles that have become spastic. The spasticity of the muscles can be brought on by overuse or trauma to the muscle.

The muscle will develop a nodule or nodules that will in turn cause trigger points that often send radiating pains to sites far removed from the trigger points. Pains that occur under the shoulder blade may signal a warning that the pain is not in the shoulder itself, but can be related to a pain from one of the organs in the body. The shoulder where the pain occurs can give the clue which of the organs are affected and causing the radiating pain into the shoulder.

Pain under the left shoulder blade can be a signal that there is a problem with the stomach or in the chest. Pain under the right shoulder blade can be a signal of a gall-bladder inflammation or gallstones. Or it can relate to liver disease, or a problem with the duodenum. There can of course be many other problems that can affect the shoulders and cause pain of minor or major proportions. Here are just some of those problems that are most apt to affect the shoulder:

  • Rotator cuff syndrome that can either be a strain/sprain, or a tear.
  • Muscles that are not part of the rotator group can be torn or strained.
  • Tendons and ligaments can be torn or strained.
  • Inflammation of the shoulder joint, due to a virus that may originate in other parts of the body.
  • Joint dislocations that are directly related to a trauma, such as in golf, tennis, squash, bowling, handball, football and basketball. It can occur in other scenarios such as a fall on the hand or elbow striking the ground.
  • Osteoarthritis of the shoulder joint.
  • Rheumatoid arthritis (RA) of the shoulder joint.
  • Fractures that are related to a direct trauma, or a fracture that is related to osteoporosis, and can be due to a very slight traumatic incident. In the osteoporosis individual, the fracture can occur spontaneously during a normal movement.
  • An inflammation of the bursa (Bursitis).
  • Cancer of the upper end of the humerus (Sarcoma).
  • Cancer of the Breast that can metastasize to the shoulder.

The above conditions are generally the most frequent causes of pains that affect the shoulder. A shoulder pain is not usually cut and dried, and it is therefore that we again recommend the individual seek professional guidance. The individual usually tries to help rid them of the pain when it first occurs. That may be appropriate if the pain is not due to a serious fall or trauma. If it does occur under those conditions, your healthcare professional should be seen as soon as possible. However, if the pain occurs while engaged in a sport and occurs during a golf swing or tennis match, or even in the lifting of an object, or even a minor slip and fall, the individual will look for ways to find some relief for that pain before seeking advice from their healthcare professional.

There are things one can do to find some relief from pain. A painful condition such as this will cause the individual to change their lifestyle. The pain may also affect their sleeping soundly and thus affect their general health. The individual may wish to start his or her own program of self-care by following this regime. If as stated above, the pain develops while engaged in sports, lifting an object, or a minor slip and fall, they should apply an ice pack as soon as possible. A better way of applying the cold is an “Ice Massage”. This should be used at least 2 to 3 times daily for 20 minutes at a time, during the next 48 hours.

Preparing the ice is quite easy. Fill several paper cups with water and place in freezer. When frozen, use one cup at a time to massage the painful muscles. As the ice melts, tear off part of the cup to expose the ice and continue the massage. After the 48-hour period, heat can be applied to the area. Another useful adjunct is first applying the cold, then the heat as a combination therapy. During the entire regime as stated above, the individual should also use a good analgesic gel. Using an analgesic gel will also help reduce the pain. The gel should be used at least 3 to 4 times daily. A good time for its use would be, morning on awakening, noon, evening, and before bedtime. Using a regime, such as above, will lessen the pain you are going through, and speed your recovery time. It will also lessen the chance of the condition becoming chronic if left untreated. “Mother Nature” is a great healer, but everyone, even “She”, can use a little help at one time or another. However, a word of caution!! If your condition does not improve after 2 weeks, you should seek a consultation with your Chiropractor or Medical doctor.