Shoulder Pain and Symptoms: General Overview
Conditions discussed here are covered in greater depth in 'Conditions I Treat' section
Shoulder pain is experienced by many people - 2.5% of the UK population seek advice for a shoulder complaint annually. Shoulder pain is commonly felt as an ache into the upper arm as far down as the elbow. It is not only felt in the shoulder itself. This is called 'referred pain' and is due to the way the nerve supply to the shoulder joint and overlying skin and soft tissues is formed.
Shoulder pain can also be felt at the end of the collar bone where it meets the point of the shoulder. It can also be felt as muscular type pain around the shoulder blade and up in to the neck muscles.
Shoulder problems can arise from an injury or wear and tear (age related changes) or often a combination of both.
Collar bone fractures and shoulder dislocation often arise in younger people from sporting injuries and high energy injuries such as car or bicycle crashes. These type of injuries sometimes require surgery but often settle with time and physiotherapy.
Degeneration of the tendons is one of the most common shoulder problems- it accounts for 70% of onward referrals from primary care. This often presents as pain into the upper arm when lift the arm away from the body, forwards or sideways. It can interfere with sleep, hobbies and work. Usually we try injections and physio before considering surgery.
It normally starts with inflammation and thinning of the shoulder tendons (40s-50s) but can progress to 'full thickness' tears and possibly complete tendon ruptures. Treatment is based on patient symptoms, age and expectations but attempted repair can be considered by key hole surgery. Please see Subacromial Impingement/Rotator Cuff Tear above.
Shoulder arthritis is much less common than hip or knee arthritis but can cause severe pain and stiffness that cause difficulty in daily activities and sleep. Arthritis can arise after an injury or fracture, after previous historical surgery or as a result of tendon failure. Physio, painkillers and injections may all help but if pain is uncontrollable, a shoulder replacement may be considered as a last resort. The type of replacement depends on tendon function - see Total/Reverse Shoulder Replacement.
Frozen Shoulder is a further common cause of painful shoulder stiffness. It is most common in patients in their 50s and most prevalent in patients with diabetes. It normally will settle if left but can take a long time so recovery is often helped with special injections and occasionally surgery - see Frozen Shoulder