Shoulder Pain Specialist Singapore
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
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 Is Shoulder Pain?
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.
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 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.
Causes Of Shoulder Pain
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.
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.
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.
Symptoms of Shoulder Pain
The most common symptom that patients seek help for is pain. Characteristics of the pain can reveal a lot about the problem. 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.
More symptoms of shoulder pain include:
- Warmth or redness around your shoulder
- A clicking or popping sensation when you move your arm
- Muscle stiffness and weakness
- Limited range of motion
- Increased pain when pressure is placed on the shoulder, eg lying on the shoulder
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.
How Is Shoulder Pain Treated?
Treatment options can generally be classified into 2 categories: non-invasive and invasive options. I generally start patients off with non-invasive treatment modalities first, unless the pathology is such that surgery is clearly required.
If non-invasive options prove to be ineffective, it may then be necessary to resort to more invasive options.
- Rest
- Ice compression to minimise inflammation and pain.
- Anti-inflammatory medications such as ibuprofen, naproxen or etoricoxib
- Strengthening exercises
- Physical therapy
- Corticosteroid injection to reduce inflammation
- Saline injection for frozen shoulder
- Platelet-rich plasma therapy
- Surgery
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?
What are the likely problems with my shoulder?
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