Shoulder pain is a very common complaint and includes any pain that arises in or around the shoulder. Shoulder pain may originate in the joint itself, or from any of the surrounding structures such as muscles, ligaments or tendons. There are many causes of shoulder pain and depending upon the cause, treatment options are often tailored to the individual patient.
Causes of Shoulder Pain
- Bursitis is an inflammation of the bursa. Bursa is a fluid filled sac within the shoulder joint that cushions the joint and allows for smooth movement of the joint. Bursitis can cause pain and tenderness around the joint and must be treated as they can be rather debilitating.
- Frozen Shoulder , also called adhesive capsuliitis is a common condition that leads to stiffness of the shoulder joint
- Calcific Tendonitis is a condition of calcium deposits within a tendon, most commonly within the rotator cuff tendons.
- Shoulder Instability is a problem that causes a loose joint and can be caused by a traumatic injury (dislocation) or may be developmental
- Arthritis is less common in the shoulder than in the knees and hips, but can be painful
Treatment of Shoulder Pain
Physical therapy is an important aspect of treatment of nearly all orthopaedic conditions. Physical therapists use different modalities to increase strength, regain mobility, reinforce the shoulder joint and allow for increased the range of movement.
Subacromial space injections
Subacromial space injections are commonly used in the treatment of shoulder bursitis The subacromial space is a small space that is present between the wing bone and the top end of the shoulder. Within the space there is a bursa. Bursitis pain can be treated by an injection under ultrasound guidance with a solution of local anaesthetic and injectable steroid
Intra-articular joint injections
Intra-articular joint injections refers to an injection directly into the shoulder joint space with a solution of local anaesthetic and steroid. Steroids have a powerful anti-inflammatory effect that can reduce pain and inflammation quickly and dramatically. Patients who have a great deal of difficulty moving the shoulder may find that intra-articular joint injections can relieve the symptoms and allow them to increase their range of motion. However, the effect of steroids may be short lived and patients may require repeat injections in the future.
Suprascapular nerve blocks
Suprascapular nerve block: The suprascapular nerve is a nerve that supplies the shoulder joint and lies around the back. This nerve is responsible for transmitting pain impulses. Blocking this nerve with an injection of local anaesthetic and steroid can be rather helpful in treating shoulder pain. Patients may require additional treatments such as physical therapy following the nerve block procedure.
Medication Management: Over-the-counter such as Tylenol and Ibuprofen are often sufficient in managing mild cases of shoulder pain. However, if the shoulder pain is moderate to severe and is disrupting their arm movement and quality of life, stronger analgesics can be considered. Opioids or narcotics can be considered as a last resort when other treatments have failed to offer relief or improve quality of life. Dependence and addiction is a concern when using these medications and patient should be closely monitored when prescribed opioids.