3DefinitionShoulder pain involves any pain in or around the shoulder joint.Considerations The shoulder is the most mobile joint in thehuman body. The joint includes four tendons.The purpose of a tendon isto hold muscle to bone. Together,these four "rotator cuff" tendonsstabilize the upper arm bone to theshoulder socket and allow a widerange of motion in the shoulder.
4Mechanism of the painAny swelling, inflammation, tearing, or bony changes around these tendons causes pain when a person tries to move the arm above the head, behind the back, or straight out in front.
5Reasons beyond that pain Because of its high level of mobility, the shoulder has heavy reliance on the muscles around the shoulder to act as dynamic stabilisers during movement of the arm. Dysfunction of the stabilising mechanics, either at the shoulder joint itself or around the shoulder blade, combined with or without abnormalities in the anatomical arrangement of the structures around the joint, or biomechanical faults make the shoulder particularly prone to pain and injury.
6How common are these conditions? Around 11 patients out every 1000 visit their GPs with shoulder complaints each year.
8Frozen shoulderFrozen shoulder is clinical syndrome charachterized by gross restriction of shoulder movement associated with contraction and thickening of the joint capsule.affect middle age.Also associated with severe pain disturb sleeping,There is frequently history of a minor trauma lead to shoulder cuff tearing, initiating prolonged inflammatory changes and contraction of shoulder cuff responsible of symptoms.If there is no improvement with appropriate treatment for 4 monthes , manipulation of the shoulder under general anasthesia.
9Other CausesBursitis / Rotator Cuff Tendonitis The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff.Rotator Cuff Tear Rotator cuff tears occur when the tendons of the rotator cuff separate from the bone. Surgery is sometimes necessary for this condition.Calcific Tendonitis Calcific tendonitis is a condition of calcium deposits within a tendon -- most commonly within the rotator cuff tendons. Treatment of calcific tendonitis depends on the extent of symptoms.
10Shoulder Instability Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition.Shoulder Dislocation A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.Shoulder Separation Also called an AC separation, these injuries are the result of a disruption of the acromioclavicular joint. This is a very different injury from a dislocation!Labral Tear A Bankart lesion is a type of labral tear most commonly due to dislocation of the joint. Bankart lesions cause problems of persistent instability.
11SLAP Lesion The SLAP lesion is also a type of labral tear SLAP Lesion The SLAP lesion is also a type of labral tear. The most common cause is a fall onto an outstretched hand.Arthritis Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery.Biceps Tendon Rupture A proximal biceps tendon rupture occurs when the tendon of the biceps muscle ruptures near the joint.
13Referred shoulder pain Gallbladder conditions - usually right shoulder pain.GallstonesCholangitisCholecystitisInternal bleeding (see Bleeding symptoms) - often causing shoulder-tip painReferred heart painAnginaHeart attackPolymyalgia rheumatica
14DiagnosisDetermining the source of the problem in the shoulder is essential to recommending the right method of treatment.The first step is a thorough medical history.Next, perform a physical examination including the movements
16Investigation: Plain X-ray of the shoulder: - Antro-posterior. - Lateral.CT.Scan; provides a more detailed view of the shoulder areaMRI and ultrasound are other valuable diagnostic tools because they provide images of the soft tissues without using radiation .Special investigations.
17If you suspect infections : WBC Blood cultureChest x-ray Aspiration of jointEMG (electromyogram), which can indicate nerve damagean arthrogram, an X-ray study in which dye is injected into the shoulder to allow the orthopaedist to better see the joint and its surrounding muscles and tendonsArthroscopy : is a surgical procedure in which the orthopaedist looks inside the joint with a lighted telescope. It is sometimes used to diagnose causes of shoulder pain and indicate soft tissue injuries that are not apparent in the physical examination, X-rays and other tests.
20Treatment It depends entirely on the cause of the problem. Shoulder Pain Treatment Basics :Rest:The first treatment for many common conditions is to rest the joint, and allow the acute inflammation to subside.Acute rotator cuff tears require immobilization in a sling. But It is important to use caution when resting the joint, because prolonged immobilization can cause a frozen shoulder.Ice and Heat Application:Ice packs and heat pads are among the most commonly used treatments for shoulder pain.
21Stretching: Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain.Physical Therapy: Physical therapy is an important aspect of treatment of almost all orthopedic conditions. Physical therapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity. Some specific exercises may help you stregthen the muscles around the joint and relieve some of the pain associated with many conditions.
23Common Causes of Pain and Dysfunction of the Shoulder rotator cuff strains/tearsrotator cuff tendinitisglenohumeral (shoulder joint) instabilityglenohumeral dislocation/subluxationacromioclavicular joint injuryfractures of the clavicle (collar bone), or scapula (shoulder blade)adhesive capsulitis (frozen shoulder)biceps tendinitisreferred pain from the cervical or thoracic spinereferred pain from soft tissuesnerve entrapments (eg suprascapular, long thoracic) or brachial plexus injurylevator scapula syndrome
24PreventionIf you have had shoulder pain in the past, use ice and ibuprofen after exercising.Learn proper exercises to stretch and strengthen your rotator cuff tendons and shoulder muscles. A doctor or physical therapist can help.
25If you are recovering from tendinitis, continue to perform range-of-motion exercises to avoid "frozen shoulder."In sports-related activities, learn proper technique to prevent painful and expensive shoulder problems.
26References Clinical Orthopaedic Examination McRae AAOS: American Academy of Orthopaedic SurgeonsEssential orthopedics and trauma