Additional Information on Shoulder Pain
Falling directly onto the shoulder may cause
Tears of the rotator cuff
AC joint injuries (AC joint is the joint between the collar bone and shoulder bone)
Fractures of the collar bone or the shoulder bones (ball and socket) themselves
Indirect forces onto the shoulder
Falls where the arm is forced outwards and backwards can lead to a dislocation of the shoulder. If this happens the stabilising ligaments can be torn and this may result in repeated (recurrent) dislocations.
Specific sports shoulder injuries
In certain sports shoulder injuries are more common than in other sports. For instance, in rugby and football direct contact and indirect forces causing shoulder dislocations are not uncommon. In rugby the most common shoulder injuries are to the AC (acromio-clavicular) joint. This can usually be treated conservatively without surgical intervention.
Repetitive throwing in sports
In throwing sports like baseball and cricket, the repetitive nature of the injury leads to failure of certain structures like the rotator cuff and labrum (cartilage in the joint). This may lead to “acquired instability” of the joint and “SLAP lesions”
Repetitive shoulder injuries
In certain occupations and sports a repeated motion may lead to wear and tear, swelling and even failure (tearing) of structures. An example would be a person that is a painter having to reach up all day during overhead motion. The rotator cuff might swell and become severely inflamed resulting in a condition referred to as rotator cuff “tendonitis” for “bursitis”. Certain gym exercises may also injure structures like the AC joint, rotator cuff and biceps tendon.
Degenerative shoulder injuries
In older people when the tendons and ligaments start becoming weak injuries may occur with minimal force. It is well known that rotator cuff tears may develop with almost no force at all and in fact tear spontaneously. This is due to poor blood supply to the tendon making the tendon more vulnerable. In some instances there may slight degenerative arthritis not causing any symptoms and the activity may them bring the pre-existing condition to the fore.
Many of the above mentioned shoulder injuries can be treated conservatively but some, especially rotator cuff tears, may require surgical repair.
- Young girls (14 to 20 years old) – consider thoracic outlet syndrome. Young athletic males participating in sport (14 to 21 years old) – consider shoulder instability due to previous dislocations.
- There is often a previous injury where the shoulder was dislocated the first time.
- Young active males and females (18 to 30 years old) – consider os-acromiale.
- Males and females 40 years and older – rotator cuff impingement syndrome
- Females 45 to 55 years old – could have frozen shoulder (adhesive capsulitis).
- Females and males 40 to 60 years old – consider calcific tendonitis.
- Active sporting males with pain on top of the shoulder – consider acromio-clavicular pain.
- Males and females 50 years and older – consider rotator cuff tears.
- Males and females 60 years and older – consider osteoarthritis of the shoulder.
The above information indicates commonly occurring conditions in certain gender and age groups. Additional factors that may help in making the diagnosis is the nature and localisation of the pain.
- Pain on top of the shoulder: May be caused by acromio-clavicular (AC joint) problems
- Pain in the shoulder and outside of the upper arm: Rotator cuff problems may have this pattern.
- Pain at the back of the shoulder: Consider arthritis.
- Pain in the neck and upper part of the shoulder: May be caused by referred problem from the neck.
- Pain in the neck, shoulder and radiating down the arm into the hand: Consider neurological problems like disc problems in the neck or thoracic outlet syndrome.
- Night pain: Pain at night occurs with most shoulder problems. Usually shoulder instability does not affect sleep but most other conditions do when a person lies down at night. The reason is that any inflammation is worse when the position of the structure is lower due to the pressure effect of gravity – in the upright position the shoulder is elevated.
- Constant or intermittent pain: Most mechanical reasons for pain (e.g. rotator cuff tears) mostly cause pain with certain movements like lifting the arm. On the other hand certain conditions cause constant pain unrelated to movement – these would be pain from nerve conditions like referred from the neck or thoracic outlet syndrome.
- Severity of the pain: Acute “blinding” pain usually occurs with calcific tendonitis when the calcium is being absorbed. Other conditions may cause intermittent pain depending on position of the arm and the activity. If the pain is constant and running from the neck down to the shoulder and hand it is most likely from a nerve problem in the neck or thoracic outlet. If the pain is more mechanical (occurring with movements only) it would suggest a damaged structure in the shoulder.