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Shoulder Pain Management
Due to the complex makeup of the shoulder joint, these complex movements make the shoulder highly vulnerable to sprains, strains, tears, and inflammation of the capsule, muscles, ligaments, and bursae that are involved in the make-up of the joint. The shoulder joint is actually made up of three joints and one “articulation” where the head of the humerus (the long bone of the upper arm) connects with the collarbone and the shoulder blade (scapula).
There are 4 main muscles that are involved in maintaining the joint and complex movements, whenever the arm moves. There are of course many other muscles involved, however these 4 muscles play a major role in the integrity of the joint. As a group, they include the rotator cuff. These are the muscles that are most vulnerable to tears, strains, sprains and inflammatory processes.
Pain in the shoulder region plays an important role in diagnosing the condition. It is therefore recommended that anyone with shoulder pain be evaluated by their healthcare professional. The evaluation will include a variety of tests including movement of the arm through all range of motion (ROM) and a neurological examination to see if there is any nerve involvement. An X-ray of the shoulder will also be done, especially if there is trauma, to rule out fractures and to look at the condition of the bones, joints and bursa. A bursa is a small sac of fluid that moves easily when muscles are flexed or extended.
There are two areas where this bursa is located and it can become swollen, inflamed or infected. In acute bursitis, the patient usually complains of any movement of the arm, and is usually worse at night, with difficulty sleeping on the affected side. Pain and tenderness are usually at the shoulder point. Acute bursitis left untreated can develop into chronic bursitis. Pain that occurs over the shoulder, and extends into the deltoid muscle along the upper arm and down the arm, even into the fingers, may be associated with nerve impingement (pinched nerve), which may originate from it. Neck (cervical spine). Depending on the side of the hand, or fingers will determine the affected nerve branch.
This condition, called “brachial neuritis” or “brachial neuralgia,” is caused by involvement of a group of nerves that exit the spinal vertebrae, called the “brachial plexus.” The pain can be very intense with any movement of the hand and any pressure with the distribution of the nerve path. Pain over the shoulder blade (scapula) area may be due to the large muscle (trapezius) and underlying small muscles that have become spastic. Muscle spasticity can be brought on by overuse or trauma to the muscle.
The muscle will develop a nodule or nodules that will create trigger points that cause excruciating pain in areas far from the trigger points. Pain under the shoulder blade may be a warning that the pain is not in the shoulder, but may be related to pain in another part of the body. The shoulder that causes pain can tell which part is affected and the pain in the shoulder.
Pain under the left shoulder blade can be an indication that there is a problem in the stomach or chest. Pain under the right shoulder blade can be a sign of cholecystitis or gallstones. Or it may be related to liver disease or duodenal problems. Of course there can be many other problems that can affect the shoulder and cause minor or major pain. Here are some of the issues most likely to affect the shoulder:
- Rotator cuff syndrome which can be either a strain/sprain or a tear.
- Muscles that are not part of the rotator group can be torn or strained.
- Tendons and ligaments can be torn or strained.
- Inflammation of the shoulder joint, due to a virus that may originate in other parts of the body.
- Joint dislocations directly related to trauma such as golf, tennis, squash, bowling, handball, football and basketball. This can happen in other situations such as falling on the hand or the elbow hitting the floor.
- Osteoarthritis of the shoulder joint.
- Rheumatoid arthritis (RA) of the shoulder joint.
- Fractures that are directly related to trauma or are associated with fractures and can be caused by even the slightest traumatic event. In a person with osteoporosis, fractures can occur spontaneously during normal movement.
- Inflammation of the bursa (bursitis).
- Cancer of the upper end of the humerus (sarcoma).
- Breast cancer that may metastasize to the shoulder.
The above conditions are usually the most frequent causes of pain affecting the shoulder. Shoulder pain is usually not cut and dry and that is why we again recommend that the individual seek professional guidance. When pain first occurs, the person usually tries to get rid of it. If the pain is not caused by a severe fall or trauma, it may be appropriate. If this happens, you should see your healthcare professional as soon as possible. However, if the pain occurs while engaging in a sport and during a golf swing or tennis match, or lifting an object or even a minor slip, the person will seek ways to relieve it. pain before seeking advice from their healthcare professional.
There are things you can do to get relief from the pain. A painful condition like this can change a person’s lifestyle. The pain can also affect their sleep and thus affect their general health. By following this rule a person can start his own program of self-care. As mentioned above, if the pain occurs while engaging in sports, lifting something, or a minor slip, they should apply an ice pack as soon as possible. A good way to apply cold is “ice massage”. Use this at least 2 to 3 times daily for 20 minutes at a time for the next 48 hours.
Making ice is very easy. Fill several paper cups with water and place in the freezer. Once frozen, use one cup at a time to massage sore muscles. As the ice melts, tear off part of the cup to expose the ice and continue massaging. After a 48-hour period, heat can be applied to the area. Another useful adjunct is first cold, then heat as combination therapy. Throughout the regime as mentioned above, one should also use a good analgesic gel. Using a pain reliever gel will help reduce the pain. The gel should be used at least 3 to 4 times a day. The best time to use it is when you wake up in the morning, in the afternoon, in the evening and before going to bed. As above, using regimens will reduce your discomfort and speed up your recovery time. It will also reduce the chances of the condition worsening if left untreated. “Mother Nature” is a great healer, but everyone, even “she” can use a little help at one time or another. However, a word of caution!! If your condition does not improve after 2 weeks, you should consult your chiropractor or medical doctor.
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