Shoulder pain? Here’s what you can do to treat it and prevent it
Published: May, 2015
A few simple measures can protect your most flexible joint and put it back in service after overuse or injury.
All you need to do is rotate your arm to realize what a marvel your shoulder is. It’s the body’s most flexible joint and one of the most essential. Whether you’re reaching the top shelf, swinging a golf club, or washing your hair, “it’s the one joint you can’t stop using,” says Karen Weber, a physical therapist at Harvard-affiliated Spaulding Rehabilitation Network. “We do a lot of repetitive motions with our arms. When our shoulder muscles aren’t strong, we can set ourselves up for injury,” Weber says.
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Whether or not we’re carrying the weight of the world on our shoulders, shoulder pain gets us down in several ways. First, pain is pain and never fun. Pain is exhausting and interferes with everything we do. And, we use our arms for almost every activity and most movements, so if it happens to the arms, it happens to the shoulders, too.
Next, when shoulders are unstable, weak and painful, they pull our posture out of alignment and this creates a cascade of other effects, such as weakened abdominal muscles, unhappy back muscles and a literal pain in the neck. After looking at the causes, we’ll cover shoulder pain treatments you can explore at home.
Causes of shoulder pain
According to physicians and physiotherapists, shoulder pain is the third most common musculoskeletal condition that they see in their clinics, after low back and neck pain.
Due to the ball and socket joint system, the shoulders tend to be susceptible to injury because of the inherently unstable design of the shoulder system. The shoulders are the most mobile joint in the body but the price of this broad range of mobility is instability and tendency toward injury and dislocation.
The shoulders are ready for reaching, throwing, lifting, pushing and all sorts of twists, turns and bending, but this leaves them primed for injury.
“Unfortunately, this mobility comes at the expense of stability,” and that leaves the shoulder vulnerable to injury, says Clifford Stark, DO, medical director of Sports Medicine at Chelsea in New York City.
Anatomy of the shoulder complex
The bones of the shoulder include the humerus (upper arm), scapula (shoulder blade), and the clavical (collar bone). These bones form a cage inside which are the muscles and other soft tissue ready to twist, reach, bend, throw and carry.
The shoulder muscles begin with the trapezius, levator scapulae, and rhomboids at the top of the spine connecting the scapula and clavicle to the torso. The pectoralis muscles, latissimus dorsi, teres major and deltoid connect the arm to the torso. The biceps, brachii, triceps and coracobrachialis reside in the upper arm, but are part of the shoulder complex.
The four infamous rotator cuff muscles, subscapularis, supraspinatus, infraspinatus and teres minor muscles link the scapula to the arm.
Shoulder conditions and treatments
Rotator Cuff Injury / Shoulder Tendonitis: As mentioned above, this area is infamous because rotator cuff pain and injuries are the most common of all the shoulder conditions. Most rotator cuff injuries result from repetitive stress on the muscles, tendons and ligaments of the shoulder and/or scapula. Repetitive motions wear on that cuff and inflammation results, causing pain, limited mobility and your need for shoulder tendonitis treatment!
This condition often brings mild symptoms of shoulder weakness and pain in the beginning, but continues to be aggravated over time.
Treatment includes reduced activity, especially overhead movements, posture adjustments, and changing movements to help the healing, as well as ice, heat and OTC anti-inflammatory drugs. Physical therapy is effective, as well as myofascial release and massage (your therapist or our massage balls).
Shoulder joint instability: Loose joints might seem cool in a yoga class because the range of motion is phenomenal, but the risk of dislocation isn’t cool at all. It’s a common condition among athletes, but can also occur due to trauma, and, genetic make-up. Laxity is more commonly known as ‘double-jointed.’
Treatment includes strengthening rotator cuff muscles and scapular muscles to reduce dislocations. Taping is another treatment that is recommended.
Shoulder Dislocation: Once a shoulder has dislocated, pain is acute until the joint is re-stabilized by your doctor. Recovery will involve ice, rest and anti-inflammatory drugs.
Frozen Shoulder An apt name, it’s just like it sounds – immovable. Adhesive capsulitis literally means sticky inflammation and involves reduced mobility. The symptoms are similar to arthritis, but arthritis tends to move into other joints.
Treatment will help the shoulder thaw if it includes massage and myofascial release. The tissue experiencing sticky inflammation needs to be gently coaxed apart. Specific exercises, such as shoulder rolls, scapula rolls and arm stretch are especially therapeutic for this condition. Acupuncture and electrical microcurrent stimulation (see bottom of page) are also helpful.
And, once the shoulder has recovered, keep it warm, supple, strong and stretched with regular movement and exercise.
Shoulder Impingement: Muscles getting pinched by bones is uncomfortable and can become painful if it becomes chronic. The bones and the muscles are battling and the nerves are caught in the crossfire.
Physical therapy is the best treatment for this condition, as strengthening the muscles and balancing all the muscles and tissues that affect the position of the shoulder effectively can relieve the impingement.
Myofascial release and massage help relax the muscles involved so that they can loosen their grip on the bones and everything can relax back into place giving you quick shoulder pain relief.
Exercise is helpful with this condition; pendulum, arm stretch.
Bursitis: This is the swelling of the small fluid-filled pads called bursae that act as cushions in our joints. It frequently occurs at joints that perform frequent repetitive motions, which includes the shoulders. With bursitis, you may have aching and stiffness around the shoulder joint and note tenderness when pressing near it. The pain may be worse at night and be either sharp or diffuse.
Treatment includes reduced activity, RICE (rest, ice, compression, elevation), and massage and myofascial release of neighboring muscles. Gently, but rapidly vibrating the arm helps to bring relief, and massaging the arms.
Osteoarthritis: Degenerative joint disease is caused by the normal wear and tear of the cartilage in the joint. Cartilage is like rubber and provides a cushion between all the bones so that they slide smoothly. Over time, cartilage can thin and the bones are left to grind against each other and this causes swelling, pain an d limited mobility.
Arthritis needs movement, but it must be measured and appropriate, so a physical therapist is helpful to use the best exercises to stretch, strengthen and support the joint. Remember, Eddie the otter at the Portland Zoo? How does he get shoulder pain relief? His physical therapy includes playing basketball!
Treatment can also include heat and ice, anti-inflammatory medications and often steroid injections.
Thoracic Outlet Syndrome (TOS), is a complex condition whose medical definition is still evolving. Essentially, TOS involves compression between the neck and shoulders in either the veins, arteries and/or nerves, which results in pain and limited mobility that requires treatment. Physical therapy, myofascial release, acupuncture, exercise(such as Shoulder Rolls, as seen above), and electrical simulation are helpful in relieving the variety of symptoms caused by TOS.
Shoulder Pain Treatment or Prevention?
What’s better than shoulder pain relief? Avoiding shoulder pain in the first place! The old adage, “An ounce of prevention is worth a pound of cure,” is a real dynamic in the body. When we warm up before exercise it improves muscle performance and reduces injury. When we follow healthy lifestyle routines we experience fewer health problems. When we know we’re going to be doing something that might fatigue, strain or injure us we can prepare or aid recovery through myofascial release, exercise, grounding, light therapy or the new field of electromedicine (see videos below).
The body is designed for motion, much like a car; when we leave our car sitting in the garage for several days, the battery dies, fluid sediments collect and the tires lose their shape. So it is with the body – it needs a jump-start, too, if it’s been too sedentary.
Exercise and food are medicine! These measures earn interest in the body the way an investment portfolio does while we are spending and replenishing the resources of the body. Our health (and shoulder pain relief) is in our hands!
FRIDAY, June 25, 2004 (HealthDayNews) — Widely used pain-relief drugs may actually interfere with healing in a common shoulder-repair surgery, researchers report.
Nonsteroidal anti-inflammatory drugs (NSAIDs) — which include aspirin, ibuprofen, and arthritis drugs such as Celebrex and Vioxx — are often the medication of choice to relieve post-operative pain following rotator-cuff surgery.
But according to a new study, these drugs may also have adverse effects on bone healing, which is a necessary part of rotator-cuff recovery.
The findings, which are being presented Friday at the meeting of the American Orthopaedic Society for Sports Medicine in Quebec City, Canada, have been verified only in rats, and are therefore extremely preliminary.
Almost 2 million people in the U.S. seek care for rotator cuff problems each year. The rotator cuff consists of muscles and tendons surrounding the top of the upper arm bone that work together to hold it within the shoulder joint. Rotator cuff injuries are especially common in people over the age of 40.
Most rotator cuff repair involves reattaching the tendon back to the bone and then letting the bone grow back into the tissue. However, “our failure rates are quite high, up to 50 percent,” said Dr. Scott A. Rodeo, one of the authors of the study and an associate professor of orthopedic surgery at the Hospital for Special Surgery in New York City.
Although NSAIDs have not been studied yet in tendons-to-bone healing, they have been shown to negatively affect healing of fractures, spinal fusions, and ligament healing.
“The interaction between NSAIDs and the process of healing has been suspected for a long time and is the source of an ongoing argument,” said Dr. Michel Dubois, director of the New York University Pain Management Center and professor of anesthesiology at New York University School of Medicine, both in New York City.
“NSAIDs may interfere with the process of healing by their very nature,” he said. “They are supposed to fight inflammation, but inflammation is part of the healing process.”
“Healing really invokes bone formation, so based on that and the fact that NSAIDs can impair bone healing, we thought these medications may impair healing,” Rodeo said. “Are they having a detrimental effect on basic biology and basic healing?” Rodeo asked.
For this study, the researchers performed rotator-cuff surgery on 180 laboratory rats. One-third of the animals were treated with the NSAID Indocin. Another third were treated with Celebrex, one of a newer class of NSAIDs called cox-2 inhibitors, and the final third were given standard rat food with no medication.
The tendon-to-bone healing in the rats treated with either of the two medications was “distinctly less robust” than in the control group. Five tendons (four in the celecoxib group and one in the Indocin group) did not heal at all after eight weeks. All the tendons in the control group healed.
Although the rat model is standard for this type of study, “there are limits to how much we can extrapolate,” Rodeo conceded. The results need to be validated in larger animal models, possibly sheep, he added.
If in fact it does turn out that NSAIDs were inhibiting healing in humans, there are several alternative medications for pain relief, including acetaminophen medications such as Tylenol, or various opiates.
But Dubois noted that the “the advantage of NSAIDs is the fact that they are supposed to have less side effects.”
For more on rotator cuff problems, visit the American Academy of Orthopaedic Surgeons.