Shoulder Pain Specialist Singapore

Shoulder pain is an extremely common but vague symptom that many patients experience. It has been estimated that between 20 and 50% of people seek help for shoulder pain within their lifetimes.

Because the entire area extending from the base of the neck, to the tip of the shoulder, both front and back can be considered “the shoulder”, there are often many conditions that can present with “shoulder pain”. Generally, the cause of the pain can be localised to either a cervical spine (neck) problem or a shoulder joint problem.

Cervical spine problems are beyond the scope of this article, hence while some symptoms of cervical spine problems will be discussed later on, emphasis will be placed on shoulder joint issues. In order for one to understand what can potentially go wrong with the shoulder joint, it is necessary to know some basic anatomy of a normal shoulder joint.

What Is Shoulder Pain?

The shoulder is a joint that is primarily composed of three bones—the upper arm bone (humerus), shoulder blade (scapula) and the collarbone (clavicle). The head of the humerus is shaped like a ball while part of the shoulder blade is shaped like a socket (the glenoid). Together they form a ball-and-socket joint (the glenohumeral joint). Additionally, the clavicle meets with the scapula just above the glenohumeral joint, forming a separate joint, called the acromioclavicular joint. The rotator cuff, a group of muscles and tendons surrounding the shoulder joint, helps to power the glenohumeral joint, while also providing it with stablility.

Shoulder pain is pain arising from the shoulder joint or any surrounding muscles, tendons or ligaments. Shoulder pain that comes from the joint typically worsens with increased movement of the shoulders or arms. It is crucial to understand your symptoms and seek medical treatment as soon as possible, as early diagnosis and management can prevent worsening of the underlying condition that might in turn, complicate treatment.

What sort of pain might a patient with shoulder problems encounter?

The most common symptom that patients seek help for is pain. Characteristics of the pain can reveal a lot about the problem.

Aching pain felt at the top of the shoulder (trapezius muscle area), back of the shoulder (especially between the shoulder blades) and base of the neck is more often associated with cervical spine issues and is beyond the scope of this article.

Shoulder pathology often causes pain either at the front or back of the shoulder, deep within the shoulder area or frequently at the side of the arm where the deltoid muscle ends. The pain may be sharp in nature, aggravated by certain movements like rotation of the arm and raising the arm up high; or it could be aching and gnawing in nature.

Some patients find that the pain is more bothersome at night and interferes with their sleep. Often times, patients feel pain if they are side sleepers and lie on the affected side. Some patients may even have difficult lying on the unaffected side because their affected arm falls across their bodies due to gravity and that causes them pain. Others may find that turning in bed wakes them up due to pain in their shoulder.

Pain aggravated by movements is very common. Sometimes patients may be relatively pain-free at rest, but experience pain when they raise their arms overhead.

Many will report having a specific arc of pain while they raise their arms, i.e. when they try to raise their arms from the side of their bodies, the movement is pain-free till their arms are about 60° from their bodies. Then they experience pain till their arms are about 120° from their bodies. After which the pain seems to abate.

Occasionally, patients may tell me that they encounter difficulties at work when lifting loads because with certain movements, they feel a sudden sharp pain which makes their entire arms go numb!

Some shoulder problems may be mainly sport specific and may only occur during over movements like over tennis serves, badminton smashes, volleyball spikes or throwing a ball. Others may occur during gym work outs like bench presses or shoulder presses.

What other symptoms might a patient with shoulder pain encounter?

Stiffness

Arguably, the next most common symptom, aside from pain, is stiffness. Many patients will find that they have gradually lost movement in their shoulders. They may experience difficulty reaching their other shoulder for scratching or bathing.

Ladies often complain that they are unable to do up the clasps of their bra, while men may complain that they have difficulty placing their wallets in the back pocket of their pants.

Active patients will find that they are unable to, perhaps, hang from the pullup bars, do certain yoga poses, reach for certain shots during ball games etc.

Weakness

Many patients will find that their arms are not as strong as they used to be. This often manifests itself during work that requires heavy lifting, or during sports.

Some patients suffer acute and severe weakness immediately after an injury and are unable to actively lift their arms. This is a condition known as pseudo-paralysis.

After a period of rest, however, many patients will be able to lift their arms again albeit with some weakness and discomfort. They then mistakenly assume that their shoulder tendons are not seriously injured.

Because the individual rotator cuff tendons merge into each other as they insert onto the humerus, even with a complete tear of the supraspinatus tendon, for example, patients may still be able to lift their arms as the surrounding tendons will be able to compensate.

Asymmetry

Occasionally, the observant patient may notice that in order to raise the arm, he/she shrugs up the shoulder on the affected side hence giving an asymmetrical appearance when viewed in the mirror.

How Is Shoulder Pain Diagnosed?

A physical examination will first be conducted to find out the cause of your shoulder pain. Your doctor will assess your shoulder and arm’s range of motion and joint stability and check for any tenderness or swelling.

Imaging tests, such as an X-ray, ultrasound scan or MRI scan, can produce detailed pictures of your shoulder to better confirm a diagnosis and allow formulation of an effective treatment plan to eliminate the shoulder pain

Is your shoulder pain affecting your quality of life, and your ability to perform everyday activities such as working, playing sports and wearing your clothes?

Dr. Bryan will assess your symptoms in detail before recommending the right treatment plan for your condition.

What brought on the shoulder pain?

Injury

Injuries are common causes of shoulder issues in all age groups. In older patients, falls are usually the most commonly mechanism of injury, whereas in younger patients, injuries are usually sport related.

Older patients often fall after having slipped or tripped over a step. The human reflex is to break the fall with our upper limbs to prevent facial or head injuries.

Many patients will experience a sudden acute pain in their shoulders, often accompanied by a snapping sensation (or noise) in the shoulder. The patient may have difficulty raising his arm after that.

Younger patients seldom sustain serious shoulder injury after a “mere” fall, unless the impact is great (e.g. falling from a height or motor vehicular accident). More often, younger patients will sustain shoulder injuries from having their arms yanked in “unnatural” positions during sports.

Commonly as well, they may feel a sudden pain while using their arms with excessive force (e.g. trying to do a really hard tennis serve or throwing a ball hard during a baseball game). The games that patients get injured playing varies from place to place.

In Singapore where I am based, games like baseball and American football are not popular, but rugby, soccer and racquet sports are. Hence the type of injuries that I see commonly may be slightly different from Japan, for example, where baseball is rather popular.

Mild “sprain”

Many patients will report that their shoulder problem started after they had sustained a mild injury while doing mundane things like reaching out for an object, reaching for something in the backseat of the car.

The mild injury might not even have been painful initially, but the shoulder pain progressively became worse after.

Anatomy of the Shoulder Joint

The shoulder joint is made up of 3 bones: the shoulder blade (scapula), the humeral head and the collar-bone (clavicle).

Movements around the shoulder involve 3 separate articulations: the glenohumeral joint, the acromioclavicular joint and the scapulothoracic articulation. When the arm is raised, the majority of movement occur at the glenohumeral joint and the scapulothoracic articulation.

Four (4) muscles are attached to the scapula and send their respective tendons across the glenohumeral joint and attach to the humerus just beyond the humeral head. These 4 tendons are collectively known as the rotator cuff.

You can think of the muscles as motors and their tendons as pulleys. Contractions of the muscles will hence bring about movement at the joint that their tendons cross. A part of the scapula, known as the acromion, forms a roof over the humeral head and rotator cuff.

To reduce friction between the acromion and the underlying rotator cuff during shoulder movements, a thin sac containing a sliver of fluid sits on the superior surface of the rotator cuff. This sac is known as the bursa.

The glenohumeral joint is a ball and socket joint, comprising the socket (the glenoid) and the ball (the humeral head).

Both surfaces of the joint are covered with an extremely smooth and rubbery cartilage (known as articular cartilage). The smooth surfaces create a frictionless articulation when lubricated with a small amount of joint fluid.

The glenohumeral joint is designed to provide a large range of movement; hence you are able to perform many tasks like reaching overhead for a high shelf or scratch your back. However, flexibility comes at the price of stability.

As such, the shoulder joint (more specifically, the glenohumeral joint) is the most commonly dislocated joint in the body. The glenohumeral joint has several means to prevent dislocations:

• The cartilage on the glenoid surface is shallower at the center than at the periphery, hence deepening the socket
• Cartilaginous extensions of cartilage (the labrum) at the periphery of the glenoid aids in further deepening the socket further yet does not restrict range of movement
• Various ligaments connect the humeral head to the glenoid helping to stabilize the joint further
• The rotator cuff helps to pull the joints together further enhancing stability

Frequently Asked Questions

Is shoulder pain serious? When should I visit a doctor?

How to prevent shoulder pain?

What will the doctor do?

What tests can be done to confirm the diagnosis?

This section will briefly discuss the common investigations that doctors carry out to identify the problem. For a more detailed discussion regarding investigations, please go to the page on investigations.

The simplest test is a series of x-rays for the shoulder. X-rays are excellent investigations for viewing bony and joint problems but they are not so useful for soft tissue problems such as labral, cartilage or tendon problems.

Most people are familiar with x-rays and are aware that they are quick, simple and non-invasive scans that take only as long as it takes to snap a photograph. X-rays, however, involve small amounts of radiation which some patients may not be so keen on.

Ultrasound scans are next in line. Ultrasounds are good and relatively simple tests which can sometimes be done in the doctor’s office. They are non-invasive and comfortable for the patient. There is no potential harm to the patient as there is no radiation at all.

The drawback of ultrasounds, however, is that they are operator dependent. That means that if a sonographer is not sufficiently proficient or experienced with ultrasounds, their ability to accurately diagnose the problem will also be adversely affected.

In addition, certain pathology within the glenohumeral joint cannot be visualized during the scan.

Lastly, in the event that a bad rotator cuff tear is detected, ultrasound examinations may not yield enough information for the surgeon to accurately predict the chances of success of surgical repair.

This may necessitate further assessment with a more detailed investigation resulting in increased cost and delay in establishing a diagnosis.

The final investigation is an MRI (magnetic resonance imaging) scan. An MRI scan is by far, the most informative scan. Although some doctors ask for an MR arthrogram (where an injection of a fluid is administered into the glenohumeral joint to enhance the appearance of some problems), I find that a plain non-invasive MRI scan is equally accurate.

This eradicates the need for the injection which may be painful and unpleasant for the patient.

What are the likely problems with my shoulder?

Billing & Payment

Medisave & Insurance Claims

The following are accredited For Singaporeans, Singapore Permanent Residents and Foreigners. If your insurance is not listed, you will still be able to make claims for eligible procedures! We have experience processing claims from many other various insurance providers. Please contact us if you have any queries.

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STEP 2

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During your consultation, Dr. Bryan will evaluate your medical history and the pain you are experiencing. You may also ask Dr. Bryan any questions you may have about your condition.

STEP 3

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Shoulder Pain Specialist Singapore

What Is Shoulder Pain?

What sort of pain might a patient with shoulder problems encounter?