Shoulder pain
If you have shoulder pain, here’s a rundown of the most common causes of shoulder pain or shoulder problems.
Entrapment – Entrapment Syndrome – Impingement
If your shoulder hurts, entrapment is probably your problem. That’s because it’s by far the most common shoulder disorder. Entrapment can cause a lot of pain in the shoulder or upper arm. Often the pain goes down the outside of the upper arm. What happens is that your bursa under the hard shoulder socket gets pinched. The bursa contains many nerves. This is because when the bursa becomes irritated, it swells up. Therefore, when it is raised, it is more likely to get stuck. This causes shoulder and/or upper arm pain.
Why have you been trapped?
The reason you get this shoulder condition can be caused by several things. You may have developed a small bone growth over the years. This growth can press on your bursa. The most common cause of this problem and your shoulder pain is that over time you have developed an imbalance in your muscles. This has caused your shoulder blade to sit crooked on your chest wall. This has led to your shoulder’s bursa becoming irritated. You might recognize that your pain has been creeping up on you. Of course, shoulder pain can also be triggered by a blow or fall on the shoulder or elbow. If you experience pain at rest, you may be extra worried, but this is normal. If you try to work with your arm above your head, you will often recognize that the shoulder pain worsens and your arm gets tired.
How is entrapment diagnosed?
To make the diagnosis, you will need to undergo a shoulder examination. An ultrasound scan can confirm the diagnosis. Here your doctor can see and measure if your bursa is thickened. An MRI scan can also be used, but is not as accurate as a UL scan. Treatment is primarily physiotherapy with or without adrenal blockades.
What’s best – physiotherapy or surgery for entrapment? Read here that in the long run, surgery is better than physiotherapy click here
What is a shoulder blockade?
A blockade consists of a mixture of local anesthetic and adrenal gland hormone. Blockades should be ultrasound-guided for the most precise targeting. The blockade is used, for example, for entrapment, to calm down your mucosal sac. The blockage reduces the inflammation and thus the swelling of the bursa. Typically, your pain will be reduced by this blockade treatment and then your shoulder can be trained properly by a physiotherapist.
Physiotherapy guided training
You can see some of the most common shoulder exercises here. Blockades can also be used for things other than entrapment. Although adrenal cortex hormone is generally considered a bad thing to take, the benefits far outweigh the drawbacks. There will never be a long-term treatment with adrenal cortical hormone injections. I usually put a maximum of 2 blocks.
What if I haven’t recovered from blockades and physiotherapy?
If you haven’t recovered from these treatments, you may need to undergo a surgical procedure. This will grind your bone loss(acromioplasty) and create more space. The irritated part of your bursa is also removed at the same time – read more about entrapment surgery here.
AC joint pain and AC joint osteoarthritis
This joint is also called the acromioclavicular joint. It is the small joint between the collarbone and shoulder blade. The joint contains a kind of meniscus that can be damaged. Osteoarthritis is common in this joint. This can be seen on an X-ray or a scan. However, there is not always a correlation between the presence of osteoarthritis and pain in the joint.
What are symptoms of AC joint pain
If you have pain in this joint, your pain is typically at the top of the shoulder or at the front. The pain often worsens when sleeping on your shoulder, cycling, performing performance training or working with your arm in front of your body. It may be that the pain goes up towards the jaw or ear.
Why do I get pain in the AC joint?
The pain can be triggered by incorrect posture with shoulders pointing forward, pinching the joint. However, it can also be an actual shoulder injury, where your joint may have been sprained after a fall. It can settle into more chronic pain. Unfortunately, doctors often overlook that some of your shoulder pain may be coming from this joint. During a shoulder arthroscopic surgery, it is not possible to see inside the joint itself as the joint is too narrow, but it is possible to remove the joint – see below.
Treatment for AC joint pain
Treatment is initially aimed at restoring posture via a physiotherapist. A blockade of the joint with adrenal cortex hormone can often alleviate the discomfort. If the discomfort persists after the above, the joint can be easily removed with a keyhole surgery and the joint is replaced by scar tissue, which will act as a cushion.
Frosen shoulder – Periarthrosis
Frozen shoulder is a strange condition and the cause is unknown. You can spontaneously develop a frozen shoulder. It can also occur after a blow to the shoulder or shoulder surgery. The classic course is that you develop severe shoulder pain within a few days. After that, your shoulder pain will slowly decrease over the next 3 months. At the same time, mobility in the shoulder joint itself decreases and movement in the shoulder eventually only takes place in the joint between your shoulder blade and chest wall. The reduced mobility is the reason it’s called frozen shoulder. What happens is that the lining inside your shoulder becomes red and swollen due to severe inflammation. Then your joint capsule becomes very thickened and shrinks and this is what causes the shoulder joint to lose its mobility.
Self-diagnose frozen shoulder
Self-diagnosing frozen shoulder doesn’t have to be difficult, although this is, of course, only a guide and not a definitive diagnosis.
You stand in front of a mirror – take both elbows to the side – keep the elbow perpendicular (forearm straight forward) – then rotate both forearms outwards – if it’s a frozen shoulder, the healthy arm will rotate normally, while the diseased shoulder is completely locked in this position and thus does not rotate outwards. The diagnosis can be difficult to make on X-rays, ultrasound and MRI scans, but these examinations can be used to rule out, for example, entrapment or osteoarthritis in the joint with the humeral head and scapula.
Three stages of frozen shoulder
1. first the warm phase where the shoulder is inflamed and completely red inside – the shoulder hurts and slowly becomes more stiff – typically lasts 3 months.
2. Then comes the frozen phase, where the shoulder is stiff and the pain subsides – typically lasting 6 months.
3. Then comes the resolution phase, where mobility slowly and spontaneously improves day by day – typically lasting 3 months
Normally, a course of frozen shoulder lasts 9-12 months.
Treatment of frozen shoulder
In the vast majority of cases, the condition resolves itself within a year. Adrenal cortex hormone injections can help with pain during the hot phase. In the vast majority of cases, there is no treatment, just patience.
In rare cases, arthroscopic surgery is performed because it allows you to quickly regain mobility and reduce shoulder pain. Most people choose not to undergo surgery and live with the temporary discomfort. But if, for example, you’re a self-employed window cleaner, you’ll often be highly motivated to have surgery. What you gain from surgery is time—you’ll usually recover on your own anyway. While your shoulder is stiff, physical therapy usually doesn’t help improve your range of motion, but as soon as you can move your shoulder again, it’s a good idea to start exercising to restore that range of motion.
Nerve pain in shoulder
There are some people who, for unknown reasons, develop an inflammatory condition in a nerve to the shoulder. The condition causes a lot of shoulder pain and reduced strength. It is called in medical language Parsonage-Turner syndrome. It is a condition that usually resolves spontaneously over many months. It can be confused with entrapment.
SLAP lesion – Joint lip injury
A SLAP lesion or SLAP injury is an injury to the labrum of the shoulder. There is a separate Website for this type of injury
Scapula Crepitans – Snapping Scapula
This is a specific shoulder condition. Your shoulder pain is located behind the shoulder blade and radiates up toward the neck. There is a separate website dedicated to this condition
Rotator cuff lesion
This is a common cause of shoulder pain involving a tear in one or more of the tendons of the smaller muscles that lift the arm. Your injury may result from a fall or a sudden movement of the shoulder. Your tendon(s) may tear completely or partially from where it attaches to the humerus. You’ll often experience pain at night, and your arm strength will be reduced when lifting your arm forward and outward. However, rotator cuff injuries can also occur due to degenerative changes, where the quality of the tendon has deteriorated over time and the tendon more or less spontaneously ruptures. In such cases, treatment consists primarily of physical therapy, and it is not a good idea to attempt to suture the tendon, as the sutures will break.
Surgery for rotator cuff injury
The Danish Health Authority’s recommendations are that you should have your tendon(s) repaired within 3 months of the injury. Your ruptured tendon(s) are sutured to the bone with tiny anchors using a telescopic technique. Your diagnosis is made by a UL scan or MRI scan (arthrography). After surgery, you’ll need to keep your arm at rest until the tendon has healed back onto the bone, and then you’ll have a lengthy rehabilitation program. In the old days, it was thought that the arm should be kept at rest for 6 weeks, but recent research has found that 3 weeks is enough.
Osteoarthritis of the shoulder
Osteoarthritis of the shoulder joint is a slowly progressive shoulder condition, with increasing pain and reduced mobility. The cause is usually unknown, but can be due to previous shoulder injuries and hard physical work. What happens is that the cartilage in the joint slowly wears down. An X-ray of the shoulder will confirm the disorder. Treatment can be both exercise and prosthetic surgery. The surgery generally results in better mobility and less pain. In milder cases of osteoarthritis, it’s sometimes possible to perform a surgical procedure.
Fcalcification of the rotator cuff – Tendinitis Calcarea
This is a condition where, for unknown reasons, you develop a calcium deposit inside one of the tendons in your shoulder. Shoulder pain often comes on very suddenly and can be so severe that you need to seek emergency medical attention. The diagnosis is best made by ultrasound scan or X-ray. With an ultrasound scan, you can sometimes deplete the calcium in the early stages. If the calcium has become too hard, you can have a blockade with adrenal cortex hormone instead. For more chronic problems, you can have a colonoscopy to remove the calcium. During surgery to open up your tendon and suction out the calcium, the hole in the tendon may need to be sewn up.
