In my stint in Sri Lanka I have seen many patients with pain issues around the shoulder. This prompted me to write about shoulder pain. Shoulder pain is one of the commonest pain issues one can experience. The shoulder has a wide and versatile range of movement. It is the most mobile joint in the body. When someone develops shoulder pain it can hamper one’s lifestyle due to impaired movement of the joint. The day to day activities can be challenging and painful.
The shoulder is a ball and socket joint. It is made of three bones:
Humerus - Long bone in the arm
Clavicle - Collar bone
Scapula - Shoulder blade
The movement of the shoulder is aided by the rotator cuff.
Rotator cuff is made of four tendons arising from four muscles:
Supraspinatus
Infraspinatus
Teres minor
Subscularis
Tendons are the tissues that connect the muscle to the bone.
There are two main joints in the shoulder:
Acromioclavicular joint
Glenohumeral joint
(Shoulder joint)
Movement of the shoulder joint is by the rotator cuff which is made up of four tendons. When the rotator cuff or the bones are inflamed or damaged lifting of the arm above the head is difficult.
The shoulder can be injured in accidents, sport or manual labour
Causes of shoulder pain
Arthritis – Osteoarthritis
Osteoarthritis can affect the shoulder. Movements can be
limited, e.g. combing the hair can be challenging.
Frozen shoulder – Short period of pain in the shoulder.
Shoulder movements are limited and painful.
Torn Cartilage
Torn rotator cuff
Swollen tendons
Bone spurs
Broken bone
Accidents
Pressure on nerves in the neck
Heart disease
Disease of gall bladder
Referred pain from other areas
Diagnosis
Thorough examination of the shoulder by the doctor
X- rays of the shoulder can show wear and tear
MRI scanning
Treatment
Excluding arthritic conditions
Treat arthritic conditions if any
Application of a shoulder sling and rest
Physiotherapy
Simple analgesics
Opiates – Fentanyl patch
Shoulder injection with a steroid
PRP (Platelet rich plasma) injection
Surgery - Referral to a shoulder surgeon which can result in
arthroscopy
Rotator cuff repair carried out through keyhole surgery
(Arthroscopic repair)
Shoulder replacement (Extreme cases)
Treating shoulder pain can be challenging due to its functions
and the increased range of mobility. It can be frustrating to the
patient as well as the doctor.
Dr Namal Senasinghe MBBS, Dip in Pain Med, FFARCS, FFPMCA, CCST(U.K) is a Consultant in pain medicine at the London Pain Management Centre, No. 31, Horton Place, Colombo 7, Sri Lanka. Hotline 0767155716