Shoulder pain is usually the rotator cuff tendons (the thick bands of tissue that connect the muscles to the bones) that tear, but sometimes the tear occurs in the muscle. The most common site of a tear is in the supraspinatus tendon. Severe injuries can cause several of the tendons and muscles to tear. There are special movement tests that your doctor can use to help determine which of the muscles or tendons has been torn.
Causes of Shoulder pain
There are a few conditions that cause agony and point of confinement development of the shoulder joint, including the accompanying.
Rotator cuff disorders
The rotator sleeve is a gathering of muscles and ligaments that assistance to move the shoulder and hold the joint set up. Rotator sleeve issue result from irritation or harm to the rotator sleeve muscles or ligaments, or aggravation of the subacromial bursa (the liquid filled cushion that sits under the most astounding piece of the shoulder) – called subacromial bursitis.
The irritation can be caused by:
- general mileage that happens with age;
- exercises that require steady or tedious shoulder movement (particularly above shoulder level, for example, swimming or painting);
- truly difficult work; or
Genuine rotator sleeve damage and untreated irritation of the ligaments can cause the rotator sleeve to tear.
The torment related with rotator sleeve issues is ordinarily felt at the front or outwardly of the shoulder, especially when you raise your arm or lift something over your head. You may likewise see the torment more when lying in bed, especially when lying on the influenced side.
Extreme wounds can cause shortcoming of the shoulder muscles, limited shoulder development and constant torment.
Rotator cuff tears
Your rotator sleeve is a gathering of muscles and ligaments that hold the shoulder joint set up and help move the shoulder. The 4 muscles (and their ligaments) that make up the rotator sleeve include:
- the supraspinatus;
- the infraspinatus;
- the subscapularis; and
- the teres minor.
Frozen shoulder, also known as adhesive capsulitis, is characterized by progressive pain and stiffness in the shoulder. The pain is felt deep in the shoulder joint and may be worse at night. The pain can be felt with movement in any direction, and stiffness and loss of shoulder movement develop.
The exact cause of this condition is not known, but it sometimes develops following other shoulder injuries or shoulder surgery. It is thought that resting a painful, injured shoulder for too long can cause the shoulder muscles and connective structures to stiffen up. Frozen shoulder can also develop spontaneously, and people with thyroid problems or diabetes seem to be at increased risk.
Most people with frozen shoulder tend to improve within 2 years, with or without treatment, but not all will regain full range of movement. Improvement is usually gradual.
Dislocated shoulder and shoulder instability
A shoulder dislocation occurs when the ball-shaped head of your upper arm bone (humerus) comes out of the shoulder socket. It may be caused by a fall, a sporting injury, or trauma, and is an extremely painful condition.
A dislocated shoulder is visibly deformed or out of place, and there may be swelling or bruising around the joint. Shoulder movement is severely restricted in people with a dislocated shoulder.
Doctors can usually put the shoulder bones back into place using gentle maneuvers. Pain relief and sedation are usually given beforehand.
Following a dislocation, the shoulder joint sometimes becomes unstable and susceptible to repeated dislocations. This condition is known as shoulder instability and causes pain and unsteadiness when you raise your arm or move it away from your body. Your shoulder may feel as if it is slipping out of place when you lift your arm over your head.
SLAP (superior labrum anterior posterior) tear
The socket part of the shoulder joint has a ring of tissue around it that deepens the socket, making the joint more stable. This tissue is called the labrum. When the top part of the labrum is injured or torn, it is known as a SLAP tear. SLAP tears are usually the result of an injury such as a fall onto your shoulder or outstretched arm, although they may also arise from repeated lifting or other overhead activities.
Symptoms of a SLAP tear can include pain on throwing or lifting your arms overhead, popping or clicking in the shoulder, a feeling of weakness or instability and a general shoulder ache.
Arthritis causes progressive joint pain, tenderness, swelling, and stiffness. Both rheumatoid arthritis and osteoarthritis can affect the shoulder joint.
Sometimes shoulder pain is actually due to problems in your neck or a mixture of several different problems. Rarely, shoulder pain may be caused by infection, problems with the nerves, or a tumor.
It is also possible to feel pain in the shoulder that actually relates to pain in another area of the body – this is known as referred pain.
Doctors can often work out the cause of shoulder pain based on the symptoms and physical examination. Where the pain is felt, both at rest and when moving the shoulder is a clue to the cause of the shoulder pain.
Part of the physical examination involves testing shoulder strength and the range of movement in the shoulder joint, as well as testing for signs of shoulder impingement.
When it’s thought that pain may be limiting the range of motion of the shoulder joint (rather than a weakness), an injection of local anesthetic into the shoulder may be recommended. Once the pain is relieved, shoulder movement and strength can be tested to help to confirm the diagnosis.
Sometimes X-rays or other scans such as an MRI or ultrasound, or arthroscopy may be recommended. During arthroscopy, your doctor can look inside the shoulder joint using a small telescopic instrument that has a camera on the end.
In addition to relieving pain, treatment is aimed at restoring mobility in your shoulder joint. The choice of treatment depends on the shoulder problem.
Your doctor will discuss the risks and benefits of the various treatment options for shoulder pain, and which treatment(s) would be most suitable for you. The timing of various treatments will also depend on your diagnosis.
Pain relievers are often used as an initial treatment for shoulder pain. Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are often recommended.
Another simple way of easing shoulder pain is by applying a cold pack to your shoulder. Cold packs can reduce inflammation, and are most helpful when applied for the first few days following a shoulder injury. After that, you can switch to using a heat pack; intermittent applications of heat can help relax the shoulder muscles.
You should also rest the shoulder for a couple of days after most injuries. If you have dislocated your shoulder, you may need to rest your arm in a sling or splint for several weeks after the joint has been manipulated back into place.
However, with most shoulder problems it isn’t a good idea to rest for too long, because it can cause the shoulder muscles and connective structures to stiffen up. So, while you should avoid or alter any activities that aggravate your symptoms and avoid strenuous activities and lifting heavy objects, you should still move your shoulder to help make sure that you regain full use of the joint.
By returning to your normal activities as soon as possible (within the limits of disability and pain), you can help prevent your shoulder joint from stiffening up.
Physiotherapy can help improve shoulder strength and flexibility as well as relieve the pain associated with most shoulder problems. Physiotherapists use a variety of different therapies, including:
- ultrasound therapy;
- laser therapy; and
- transcutaneous electrical nerve stimulation (TENS) — a therapy that uses mild electrical currents to treat pain.
- Taping the joint can also help stabilize it and reduce pain during activities.
Physiotherapists can also teach special rehabilitation exercises to stretch and strengthen the rotator cuff muscles of the shoulder. Exercises that improve your shoulder’s range of movement helps reduce the stiffness that occurs after a period of immobility. A range of motion exercises may be followed by resistance exercises and weight training to strengthen the muscles.
Depending on the cause of your shoulder problem, corticosteroid injections may be given to relieve the pain in the short term. The corticosteroid, which is often mixed with a local anesthetic, reduces inflammation and allows you to move the shoulder more comfortably.
Some people with shoulder problems will need to be treated with surgery. People with shoulder instability or rotator cuff problems that are not responding to less invasive treatments may benefit from an operation, and shoulder joint replacement may be considered for people with arthritis.
There are also some conditions that need to be treated initially with surgery. Including some rotator cuff tears and dislocated shoulders that cannot be reduced (put back in) with simple manual maneuvers. Young people who have had a dislocated shoulder may need surgery to prevent recurrent dislocations.
Arthroscopic surgery (surgery performed with a special tubular instrument with a camera on the end that is inserted through an incision in the shoulder joint) may be tried for frozen shoulder, rotator cuff tears or SLAP tears of the shoulder.
Acupuncture may help with short-term pain relief in people with rotator cuff disease.
Occasionally, frozen shoulder is treated with what’s known as manipulation under anesthesia. In this therapy, your shoulder is gently moved while you are under a general anesthetic. Muscle relaxants are also given during this procedure.
Arthrographic distension (also called hydrodilation) is a procedure that may be used in the treatment of frozen shoulder. It involves injecting a local anesthetic, corticosteroid, and saline into the shoulder joint, done under radiological guidance. It may help relieve pain and improve function and range of motion. But there is a lack of evidence showing it is more effective than other treatments.
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