Shoulder pain is a common problem among the general population, and can include pain that occurs around the shoulder region anteriorly (from the front), posteriorly (from the back and along the shoulder blades), and laterally (along the sides of the shoulders, up to the sides of your neck). Pain may originate from the many structures around the shoulder complex, and the pain felt can also travel to a wider area; for example, the neck, upper arm, or upper trunk.
The shoulder complex gives us a large range of motion through four joint articulations: the glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic joints (See image below). Therefore, stability is required through the support of the surrounding muscles and the ligaments and capsules around the joints. In conditions where the shoulder complex may be excessively loaded beyond what it can handle or is used to, injury may occur to the surroundings and cause pain.
Here are some common scenarios that you might identify with that may be the cause to your shoulder injury or pain:
1. Traumatic Injury
Imagine slipping on a wet floor (or bathroom), and to break your fall, you put your arm and hand out. These types of falls are also known as “falls on outstretched hand (FOOSH)”. FOOSH causes the forces to be absorbed through the shoulder and depending on the direction of fall, may sometimes result in a dislocated shoulder. Alongside dislocations, soft tissue injuries may occur that only a radiograph/X-ray or Magnetic Resonance Imaging (MRI) would be able to identify more clearly.
2. Overuse Injury
Workplace strains such as overhead working, heavy lifting and working in awkward postures are possible risk factors for shoulder pain. Some examples are occupations like car mechanics where they have to constantly reach upwards to fix a car. Another example where we also see individuals with these types of injuries are those who attend the gym regularly.
Overuse can lead to chronic inflammation and microtrauma of the rotator cuff tendons, leading to swelling and pain. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) help in stabilizing the round head of the shoulder in its place. An overuse injury may feel like a pain deep within the shoulder that progressively worsens, with an insidious onset of pain during several days or weeks, getting worse with activity.
3. Degenerative Pain
Extensive studies show that the prevalence of shoulder pain increases with age, possibly due to several reasons:
a) longer duration of work over the years creates opportunity for gradual overuse injury, and
b) aging is associated with degenerative processes and changes of the shoulder and rotator cuff tendon, which may explain the increase in symptom reporting as we age.
However, the correlation of aging and shoulder pain symptoms does not necessarily mean that aging is a definite cause of shoulder pain. There are many people who age well without developing any form of shoulder problems, and this can be attributed to how well the muscles around the shoulder work to balance the loads introduced to the shoulder throughout the day.
4. Mechanical Pain
The muscles around the scapula (the large triangular-shaped bone at the back of your shoulder, also known as the shoulder blade) must be properly synchronized for smooth motion during arm movement. Without proper working of the muscles, the shoulder tendons may impinge under the bones and create pain. You might feel pain when attempting to reach or lift upwards such as putting on your shirt, when putting your hand behind your back or head to tie up/wash your hair, or when lying down on the sore side. Combining the factors together, usage of the shoulder through imbalanced muscle activation patterns (mechanical) over the years (overuse and possible degenerative) may cause shoulder pain in many cases.
There are many other reasons why a person may develop shoulder pain. For example, conditions such as frozen shoulder where movements can slowly start to become more limited over time, or osteoarthritis where pain is felt during movements along with a grinding feeling, and many more.
However, in order to accurately identify the anatomical source of pain, a thorough assessment by a medical practitioner like a chiropractor or physiotherapist is strongly recommended. This may include a detailed physical examination of the shoulder complex and surrounding areas, as well as the possible use of diagnostic imaging such as X-rays or MRIs (magnetic resonance imaging).
If you are currently experiencing pain in the shoulder, neck or upper trunk and would like a thorough assessment regarding these issues, feel free to contact us for an initial consultation with one of our practitioners to find out what exactly is going on.
This article was written by our newest addition to our Spinefit team of practitioners, Ms. Hannah Chong. Hannah is a young, dynamic physiotherapist with experience in some of KL’s rehabilitative hospitals having treated a wide demographic range. She enjoys conversing with her patients and is a good listener; capable of understanding the challenges each of them undergo before they begin their recovery journey. Say “Hi” to her the next time you’re in the clinic!