Shoulder pain

Shoulder pain is very common. It is most often felt in the upper arm rather than in the joint itself. The shoulder joint is held together by muscles and ligaments rather than by the shape of the bones. It is these soft tissues that are a common source of pain.

Often much of the damage is done over a long period of time rather than from just one precipitating cause.

The tissues most commonly involved are:-

  • tendons - these are the structures that attach muscles onto bone
  • ligaments - these are tough elastic bands that prevent excess joint movement
  • capsule - a soft tissue bag that engulfs the joint and contains joint fluid within.

It is not uncommon for the neck to be involved in shoulder pain. It can be the major cause or  sequel to shoulder problems. Head posture will definitely affect the shoulder as many muscles and nerves travel between these two areas. . A physiotherapist will show you good ergonomic postures and exercises to help maintain them. Pain from whatever source in the shoulder begins to alter the natural movement patterns and complex balance of muscles that exists here. This is often difficult to identify oneself and requires professional help in overcoming

Treatment may follow more than one direction. The following are some of the commonest employed.

  • Physiotherapy
  • Some form of anti-inflammatory tablet. This may be prescribed by your doctor, or you can buy several different types over the counter at the chemist. Nurofen is probably the most common. This is a proprietary name for ibuprofen.
  • Injection, probably by your G.P, of cortisone and local anaesthetic into or around the shoulder joint.

Useful tips

  • Do not allow the shoulder to stiffen. Even if it is painful you should make sure the arm is raised above the head as far as it can go, at least twice a day. Hold it there for 20 seconds
  • Keep the shoulder moving. Your physiotherapist will advise on the exercises most suitable for your individual needs. The shoulder joint is our most mobile joint & to allow for such a large range of motion it has to have a large baggy capsule to envelope the joint. The lining of this capsule can become inflamed and tight. Carefully prescribed movement can help in preventing an associated loss of mobility. Developing a frozen shoulder is always a risk with any shoulder injury, keeping it moving is the best form of prevention.
  • If it is difficult to move the arm because muscles are weak, you may find it  possible if you bend your elbow. This shortens the lever and is a useful way of raising your arm above your head if you have been experiencing pain with this movement.
  • Pain when lying down is often a problem with shoulders. It is generally not a good idea to lie on the shoulder. The most comfortable position is often lying on the pain free side and cuddling a pillow with the other arm. If lying on ones back, a pillow or rolled towel under the arm, right up into the armpit, may help. Make sure you take some painkillers, such as paracetamol, just prior to going to bed.
  • Many people with very painful shoulders find some relief by leaning forwards onto the good arm on a table allowing the affected arm to hang like a pendulum over the edge.Holding a small weight (eg 1kg bag of sugar/rice etc) in the hand swing the arm both back and forward and also side to side. The weight provides a little traction.
  • If the arm is painful even at rest,  take the strain off the joint by putting your hand in your pocket or in the loop of your belt when walking and support it when sitting.
  • Do not allow yourself to rest in the round shouldered position. It compromises shoulder movement and allows your neck to drift into an appalling posture! It also allows the muscles at the front of the shoulder to shorten and those at the back to lengthen. This affects the ability of those muscles to work. Muscle that have become too long are very inefficient, whilst those that are too short become over active and dominant. Try to take both arms (with straight elbows) out to the side and backwards as far as you can.
  • Try practising keeping your hands on your lap whilst simultaneously taking your shoulder blades back and down towards the small of your back. It is not as easy as it sounds.
  • If your shoulder is stiff try keeping your elbow in to your side & simultaneously swinging your forearm out sideways. It may not go very far but it is a good exercise that stretches and strengthens at the same time.
  • The biomechanics of the shoulder are quite complex but for many shoulder problems it is advantageous to have even an elementary grasp of them. Ask your physiotherapist to explain them

Neck and shoulder pain

The neck can also be the source of shoulder and arm pain. Be especially aware of symptoms that extend below the elbow. If you get tingling or a deadness in the hand try to analyse if they are confined to any specific fingers or are generally throughout the hand. This sort of information can be very useful in coming to a more accurate diagnosis and therefore effective treatment.

For both neck and shoulder problems a combined approach using both physical therapy and drugs seems most beneficial. There is another information sheet giving more detailed advice for neck problems. Please ask your physiotherapist for one.

Read about more common conditions, or contact us to find out how we can help.