The shoulder joint is one of the most mobile of all the human joints which makes it vulnerable to injury. So you have some shoulder pain, what could be responsible for it, and what can be done about it?
Depending upon the circumstances, shoulder pain is usually attributed to a history of acute or chronic trauma—the latter being a form of recurrent strain or chronic overuse injury. The former is usually easier to diagnose as there usually is a direct cause for the pain, like an injury. There are two types of shoulder injuries and these injuries are determined by their respective anatomical locations.
The glenohumeral joint, or the ball and socket joint responsible for most of the upper arm movements, is typically injured by several different mechanisms, the most common of which are soft tissue injuries involving the tendons or bursae that surround the shoulder joint.
As previously mentioned, these structures are damaged from various forms of trauma to several structures. The two most common are the rotator cuff tendon and the long head of biceps tendon. Several bursa such as the sub-deltoid and sub-acromial can also be affected by injury. Shoulder pain is caused from inflamed tissue which leads to pain and limitation of shoulder motion.
Examination of the shoulder joint by a trained professional can determine which structures have been injured. Several orthopedic tests such as the painful arc and painful resisted external rotation can indicate rotator-cuff tendonitis.
Of course, the injury history, location of the pain, the age of the patient, palpation and other tests like the drop-home test can usually secure a diagnosis. Although rotator-cuff tendonitis is a common cause for shoulder pain, bicepital tendonitis is more common. The long head of the biceps tendon can become inflamed by repeated, repetitive stress or acute injury. The pain is usually at the front of the shoulder and can refer down into the forearm. This is the longest tendon in the arm and thus it is quite susceptible to injury. The diagnosis is usually quite easy to make once the correct tests are performed and the area is palpated.
The other area frequently injured is the acromioclavicular joint which sits above the glenohumeral joint. This joint is usually injured in a manner that affects its ligaments. This is classified as a sprain-type injury and is frequently known as a “separated shoulder.” This injury is almost always attributed to acute trauma associated with falling on an outstretched arm or a side impact when the arm is at your side. The diagnosis can easily be made by looking at the patient while they are standing up as the injured side will be dropped lower and there may be a visual separation which can clearly be seen. Of course, the proper examination needs to be conducted but this condition is usually quite easy to figure out.
In my opinion, x-rays are rarely useful in the diagnosis or treatment of shoulder pain. The exception would be to order an MRI to determine the nature and seriousness of a rotator-cuff tear. However, I would want to have a diagnosis already made before ordering the MRI. Sometimes, surgery is necessary to repair these types of rotator-cuff injuries.
Various treatments including conservative therapies like electrotherapy, ultrasound, acupuncture, ice, exercise and rehabilitation can be utilized.
If you have shoulder pain, consult with an experienced doctor like a physician with a sports medicine background, chiropractor with sports medicine experience, or a medical physiatrist.