Shoulder pain - in general
Shoulder pain arises for a variety of reasons. There are many shoulder conditions including:-
Overuse - These injuries can arise from unaccustomed activity, which is usually something involving repetitive use with the arm above shoulder height. Decorating a ceiling or serving in ballsports are examples of causes. Inflammation of a fluid sack under the point of the shoulder (bursitis), tendonitis, frozen shoulder and strain of the acromio-clavicular joint (between the shoulder blade and collar bone) are common.
Occupational over ,use - Window cleaners, builders and decorators are susceptible to 'day on day' cumulative shoulder injuries. These produce the same conditions as above.
Trauma - Falls in icy conditions, contact sport injuries typically in rugby, and seat belt road traffic injuries can cause fractures (of the head and neck of the humerus or of the clavicle), dislocations or soft tissue injuries including frozen shoulder (adhesive capsulitis).
Arthritis - Osteoarthritis as part of the ageing process can affect the shoulder (gleno-humeral) joint, or the acromio-clavicular joint (between the shoulder blade and collar bone). The shoulder is not the most common joint to suffer osteoarthritis so patients will often also suffer it in other joints such as the hips knees and hands. Arthritic shoulders often 'creak' and movement is limited.
Dislocation - Can occur as a 'one off' injury or more commonly on repeated occasions. Poor muscles in the rotator cuff which supports the joint can predispose to this and some people are born with a shallow shoulder socket which allows the ball (head of humerus) to slip out.
Other causes of shoulder pain - it should not be forgotten that pain can refer to the shoulder from other parts of the body. Neck problems can refer to either or both shoulders especially if posture is poor. Angina can refer to the left shoulder and arm and gall bladder issues can refer to the right shoulder.
With so many possible causes of shoulder, proper assessment by a trained professional prior to treatment is important and Andrew Gilmour and colleagues are frequently called upon to do this. This involves a detailed enquiry as to how the pain began and has progressed since it onset. The mode of onset and how the pain behaves when subjected to different types of activity, gives vital clues as to the nature of the problem.
This information combined with a clinical inspection and examination of the joint and surrounding area when subjected to specific mobitily testing is equally important. The history and examination combined may be sufficient to formulate a diagnosis. However, an ultrasound or MRI scan can add further useful confirmation.
Hands on Osteopathic treatment can be helpful in the treatment of soft tissue shoulder problems but often this is combined with the use of exercises to help restore movement or increase muscular stability and control.
Injecting techniques are useful in the treatment of bursitis, frozen shoulder and soft tissue trigger points and strains. The accuracy of these can be increased when they are undertaken with the aid of an ultrasound scan. Mr Chris Roberts, upper limb surgeon and Dr Steve Garber, radiologist are experienced in this. Both are based at Nuffield hospital, Ipswich. We can arrange a referral if necessary.
There are some conditions such as impingement, severe arthritis, recurrent dislocation as well as ongoing problems unresponsive to other means which may need the opinion and intervention from an upper limb surgeon.