Shoulder pain: causes, symptoms and treatment

Almost one in two people get shoulder pain each year, according to the British Medical Journal. 

The shoulder is the most mobile joint in the human body and is used in many everyday motions, such as getting dressed, brushing your teeth and picking up objects. It is therefore not surprising that shoulder pain can affect your quality of life as everyday tasks become more difficult. 

Understanding the cause of your pain is the first step to overcoming it.

How do your shoulders work?

Your shoulder is made of a main ball and socket joint that moves in tandem with your shoulder blade, known medically as your scapula. The joint sits within a tough fibrous sleeve called the capsule. Lining the capsule is an inner layer called the synovium, which lubricates your joint.

A group of muscles and tendons called the rotator cuff that surrounds your shoulder joint, provide support and make sure that the top of your upper arm bone stays in the shoulder socket.

What causes shoulder pain?

Shoulder pain can come in different forms. You might feel pain when you move your shoulder, or you might feel it all the time.

If the problem originates in your shoulder, you’ll normally feel pain over the front of your joint and/or in the upper part of your arm. Pain in other parts of your shoulder can sometimes be caused by a problem with your neck — this is called referred pain.

Shoulder problems are commonly caused by five conditions:

• Arthritis
• Fracture
• Instability
• Inflammation of a tendon (tendonitis) or fluid-filled sacs called bursae (bursitis) 
• Tendon tear

Arthritis

Both osteoarthritis and rheumatoid arthritis can cause shoulder pain.

Osteoarthritis happens when cartilage (smooth padding that protects the ends of your bones in joints) wears away. This causes your bones to rub against each other, leading to restricted movement, stiffness and pain. 

Osteoarthritis is more common over the age of 40 and can be caused by overuse. This means you have a higher chance of getting it if you have a physically strenuous job or take part in activities or hobbies that involve repetitive movements of your shoulder.

Rheumatoid arthritis is an autoimmune condition, which means your immune system mistakenly attacks your healthy tissues. Rheumatoid arthritis damages your joint linings, causing inflammation.

Fracture

A bone fracture can be very painful and is usually caused by a sudden impact. However, as you get older, your bones become more brittle and can fracture more easily, even with a minor impact.

The bones in your shoulder joint that most often get fractured are the clavicle (collarbone), scapula and humerus (upper arm bone).

Instability

This refers to looseness in your shoulder joint which makes it more likely to dislocate ie the head of the upper arm bone comes out of the shoulder socket.

Instability can be caused by a sudden injury or from overuse. If the surrounding tendons and ligaments become loose, your shoulder is more likely to dislocate repeatedly.

Inflammation 

Your tendons connect your muscles to your bones. When you have an inflamed tendon, it is called tendonitis. It’s uncomfortable as it restricts the movement of your affected joint.

The smooth movement of your joints is helped along by fluid-filled sacs in a joint called bursae that cushion the bones, ligaments and tendons. Bursitis is when these sacs become inflamed. 

Tendonitis and bursitis can happen through overuse of your shoulder, eg if you regularly play tennis, lift heavy objects or paint walls. 

Tendon tear

A sudden injury or fall can cause a tendon to tear. This becomes more likely as you get older. Tendons can tear part way through or completely.

Who is at risk of developing shoulder pain?

Shoulder pain often occurs because of overuse. If you regularly do activities that involve overhead use of your arms, whether that’s playing certain sports or as part of your work, you’ll increase your risk of shoulder problems.

Age is a factor, as tendons become less flexible and bones become more brittle as you get older. Rheumatoid arthritis has also been linked to family history and smoking.

What should you do if you’re suffering from shoulder pain?

Taking ibuprofen can help reduce inflammation and manage your pain. If you’re still in pain after two weeks then you should make an appointment to see your GP.

Your GP will ask you which movements are painful so they can get an idea of what’s happening inside your shoulder. You might have an X-ray or an ultrasound scan, or for more complex problems, you may need an MRI scan.

How is shoulder pain treated?

Most shoulder problems benefit from physiotherapy. Your GP or physiotherapist will give you a set of exercises designed to ease stiffness and strengthen the muscles around your shoulder. Transcutaneous electrical nerve stimulation (TENS) or applying heat or ice packs, may also help ease your pain.

If you are still in pain, your GP may recommend steroid injections to reduce inflammation and help you to move your shoulder more comfortably.

How can surgery help?

Most shoulder problems improve without the need for surgery. However, some more serious conditions will need surgery. Keyhole surgery can be used to investigate and fix a variety of problems. It leaves a smaller scar than traditional surgery and usually offers a less painful recovery.

Can the shoulder joint be replaced?

If you’ve got severe, long-term pain in your shoulder, shoulder joint replacement is an option. It is most commonly used to treat patients with permanent damage to the joint caused by osteoarthritis or rheumatoid arthritis.

Surgery involves replacing part of your upper arm bone with a plastic cup that is fitted into the socket of the shoulder blade.

After your surgery, physiotherapy and exercise are needed to help you recover and gradually regain movement of your shoulder joint. 

Shoulder joint replacement surgery is a well-established procedure, with good outcomes. However, you may not regain full range of movement of your shoulder. 

Caring for your shoulders

Your shoulders get put through a lot every day, so it's helpful to do what you can to keep them in good shape. 

If you work at a desk, pay attention to your posture and make sure you have a supportive chair that helps you sit well. If you have to lift heavy items, take care to bend at the knees so you put less strain on your back and shoulders. And finally, be careful when you're reaching over your head to lift something and use a ladder or stool where possible.

Maintaining an active lifestyle with regular exercise can also help your shoulders by strengthening the muscles around them.