Shoulder pain is one of the most common joint pains in adults. The shoulder is the most mobile joint in the body, so it is easily overloaded. In most cases the pain comes from the tendons and the bursa around the joint, less often from the joint itself or from the neck. This page helps you work out where the pain may be coming from; the individual conditions have their own pages.
Symptoms
- Pain at the front or side of the shoulder, which sometimes runs down into the upper arm.
- Pain when you lift your arm above your head or reach behind you, for example when getting dressed.
- Pain at night, especially when you lie on the shoulder.
- Stiffness and limited movement.
- Weakness when lifting things.
- Pain in the shoulder and arm with numbness down to the fingers, if the cause is in the neck.
Where it hurts and what the pain is like point to the cause. Pain at the side that comes on when you lift your arm is most often from the tendons. A shoulder that gets stiffer and stiffer and won’t lift even with someone’s help suggests a frozen shoulder. Numbness down the arm points to a nerve.
Why it happens
- Overloaded tendons of the rotator cuff (shoulder tendonitis and bursitis).
- Stiffness and pain with no clear cause, most often between 40 and 60 (frozen shoulder).
- Irritated nerves of the shoulder (brachial plexitis), or a trapped nerve in the neck: cervical spondylosis (osteochondrosis).
- A fall onto the arm, or a dislocated shoulder.
- Wear of the joint with age.
- Working with your arms above your head, and sports with throwing or swinging: tennis, volleyball, swimming.
In younger people the pain is more often from overload in sport or work. After 40, wear of the tendons and frozen shoulder are more common.
How we treat it
Bring your ultrasound scan or MRI, if you have one. Kaloyan checks how the shoulder moves, which movement hurts and how strong the arm is. He does tests for the tendons and checks the neck too, because shoulder pain sometimes comes from there. For an irritated tendon he often starts with ultrasound therapy, which works deep in the tissue and helps it settle. For stiffness and tight muscles around the shoulder he prefers TECAR therapy, because it warms the area and makes movement easier.
The core of the treatment, though, is exercise: first for mobility, then for the strength of the muscles that hold the shoulder and the shoulder blade. Kinesio taping supports the shoulder between visits and during sport. Usually 4–8 sessions are needed, 2–3 a week. If a torn tendon is suspected, Kaloyan will refer you for an ultrasound scan or to an orthopaedic doctor.
What you can do yourself
- Don’t keep your arm still for long. Move it within the range that doesn’t hurt.
- Sleep on your back or on the good shoulder, with a pillow under the sore arm.
- Limit work with your arms above your head for a while.
- When you lift something, hold it close to your body.
- If the shoulder is stiff, heat before moving helps. If it hurts after exertion, apply cold for a short time.
When to see a doctor first
Most shoulder pain isn’t urgent. See a doctor first in these cases:
- The pain started after a fall and you can’t lift your arm.
- The shoulder looks deformed, or is swollen and red.
- You have a fever together with the shoulder pain.
- Pain in the left shoulder with shortness of breath, chest pain or sweating. In that case, get emergency help.
- Severe pain in the shoulder and arm with numbness or weakness.
