Shoulder pain: A comprehensive guide

Shoulder pain is one of the most common reasons patients present at orthopaedic clinics. In his latest online article, esteemed consultant orthopaedic surgeon Mr Dave Cloke offers his expert insight into the various causes of shoulder pain, as well as the treatment options available.

What are the common causes of shoulder pain and discomfort?

The most common cause in adults is problems with the rotator cuff, an issue I have discussed elsewhere. Essentially, these problems are not very well understood or explained. Discomfort can arise from the tendons of the shoulder, which may settle down on their own but occasionally require ongoing treatment, and surgery, and in some cases, result in lifelong issues.

Shoulder instability may stem from an injury or difficulties with muscle balance and control around the shoulder joint.

Frozen shoulder tends to occur in people in their fifth and sixth decade, more commonly in women and those with diabetes. It causes pain and then stiffness that can last for a couple of years.

Arthritis can occur either within the shoulder joint itself or at the joint at the end of the collarbone.

How can I differentiate between normal shoulder pain and a potentially serious orthopaedic issue?

Essentially, there’s no such thing as "normal" pain! I would advise anyone experiencing joint pain lasting more than a couple of months to seek evaluation from a primary care doctor or physiotherapist.

Are there specific lifestyle factors or activities that contribute to shoulder pain, and how can they be managed?

Sports involving heavy use or contact with the upper limbs can lead to true injuries around the shoulder. However, more subtle are repetitive sports such as swimming, overhead sports, and rowing. The higher the level of participation in these activities, the more repetitive the movements, increasing the chances of acquiring overuse injuries.

These injuries may be due to subtle inadequacies in technique or equipment and are best addressed by a qualified coach and therapist team. For most of us not engaging in these activities, there is no real link between our daily routines and shoulder issues.

What are the non-surgical treatment options available for relieving shoulder pain?

This greatly depends on the diagnosis, which should be given by someone with expertise. Certainly, rotator cuff pain can often be alleviated with well-directed physiotherapy treatments.

 Physiotherapy can also be extremely useful for some shoulder instability problems and frozen shoulder. The next step in treatment often involves injections. Again, it is important to receive a diagnosis from someone experienced, who may administer the injection or direct you to have it done by a radiologist using a scan. Injections can be very helpful for providing both diagnosis and treatment, often providing temporary relief and potentially avoiding surgery.

When should I seek medical attention for persistent or worsening shoulder pain, and what diagnostic steps are typically involved in identifying the cause?

Any bone or joint pain persisting for more than a couple of months should be assessed by a medical professional, including a physiotherapist with an interest in these areas. The British Elbow and Shoulder Society provides useful guidelines for the assessment of shoulder pain. Factors such as the history of your pain, previous injuries, the site of pain, and pain on movements can all help ascertain its origin and guide possible referral for further investigation.

Ultimately, investigations should encompass all aspects of the shoulder, including the bones. Therefore, an ultrasound scan, which only looks at the tendons around the shoulder, may not be sufficient without an X-ray as well. An MRI scan provides information about all structures involved.

Mr Dave Cloke is a renowned consultant orthopaedic surgeon based in Newcastle-upon-Tyne. If you would like to book a consultation with Mr Cloke, you can do so today via his Top Doctors profile.