Written by Mr Nashat Siddiqui for Doctify
Orthopaedic Surgeon, Mr Nashat Siddiqui’s guide to shoulder pain and injuries.
What is the most common cause of shoulder pain?
Unlike the hip joint, the shoulder is made up of more than one ‘joint’, and therefore there are many areas that can cause pain.
The tendons that attach around the joint form a cuff, called the Rotator Cuff. They can wear away over time or due to overuse, and sometimes they are injured by trauma. This is what is known as a Rotator Cuff Tear.
The main part is what is commonly known as the ‘ball and socket’ joint. This can become inflamed as in frozen shoulder, as well as pain from arthritis or previous fractures. The joint itself can become unstable, often due to dislocations, and can cause pain or a feeling of instability in certain positions.
There is a tight space underneath the bony prominence of the shoulder called the subacromial space, and inflammation of the structures in this space is known as Subacromial Impingement, commonly called ‘impingement’ or ‘bursitis’. Ordinarily the structures are smooth but when inflamed they can become roughened and painful, as seen in this image taken during a keyhole operation:
The shoulder is attached to the collarbone (clavicle) via a small joint called the Acromio-Clavicular Joint (ACJ) which is under a lot of stress even in normal movement and is therefore prone to pain and inflammation from overuse or injury.
How is shoulder pain usually treated?
Mild pain is usually treated with rest, anti-inflammatory/painkilling medication, and avoiding aggravating activities. If pain persists then the exact cause needs to be determined. This is done by careful physical examination and often investigations such as an MRI or ultrasound scan and X-rays.
Often targeted physiotherapy is all that is needed, but sometimes steroid (‘cortisone’) injections are required, and in severe cases surgery is performed.
Are there sports that should be avoided by people who suffer from shoulder pain?
Until the shoulder pain has settled, exercise that involves lifting the arm high should be avoided, as should sudden movements such as with racquet sports. Swimming can also worsen shoulder pain, particularly the front crawl. However, it is important to maintain strength around the shoulder by regularly performing rotator cuff exercises, which can be guided by a physiotherapist.
In what cases would someone require a shoulder operation?
Once all appropriate simple treatments have been tried, such as anti-inflammatory medications, physiotherapy, and steroid injections, and the shoulder remains painful then surgery may be needed. In most instances this will be due to impingement of structures or a rotator cuff tear that needs to be smoothed out or repaired using a keyhole (arthroscopic) procedure.
In instability cases the shoulder stabilising structures need to be repaired, which is also usually arthroscopic. In arthritic cases the ball and socket joint may need to be replaced with a metal and plastic artificial joint:
What would the recovery be for this kind of operation?
While surgery is usually very successful it can take several months to fully recover, depending on the severity of the case and the complexity of the operation. I always suggest a tailored treatment plan, with surgery reserved only in cases where all other treatments have failed, as final recovery may take up to a year.
In most instances 2-3 weeks off desk-based work are needed, and driving can be resumed at around 4-6 weeks, but it can take longer depending on the type of surgery performed.
A sling may need to be worn for up to 6 weeks depending on the complexity of the procedure. A personalised physiotherapy regime is essential after the period of sling immobilisation has finished.
Surgery is, thankfully, not commonly needed for the majority of shoulder problems, most of which can be treated by making an accurate diagnosis and personalised treatment plan.
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