When To Be Concerned About Shoulder Pain
It can take some time for shoulder pain to settle, perhaps weeks or months. In general, if your shoulder pain has not begun to settle in a week or two, or if it worsens over time, then it may be worthwhile seeing an experienced doctor or health practitioner.
If you find that you need stronger medication to manage your shoulder pain, discuss this with your doctor. You may need a referral to a specialist.
Note: Shoulder pain or discomfort around the front of one or both of the shoulders can be a sign of a heart attack. It is often described as an ache, heaviness or pressure sensation spreading from the chest to the shoulders. This requires immediate medical attention. Call 000 immediately if you are experiencing these symptoms.
When Should I See A Doctor About My Shoulder Pain
It is not possible to give rules which cover every situation – it will depend on how unwell you feel and how much pain you are in. Generally speaking:
See a doctor urgently if:
- The pain follows an injury or trauma and is a bad pain or you are unable to move the shoulder at all.
- If your shoulder is hot to touch, or red.
- If you have chest pain or difficulty breathing or feel generally very unwell .
See a doctor as soon as you can if:
- The pain affects both shoulders and is worse in the mornings.
- The pain is not improving with simple painkillers.
- The pain is affecting your daily activities.
- You have other symptoms as well as your shoulder pain, such as:
- Tummy pain
- Weight loss
- A blistery rash
- You have a high temperature which is not responding to simple measures such as paracetamol, or if there is no obvious simple cause.
- You have a past history of cancer and you have a persisting pain in the bone area of your shoulder.
- You have pain in more than one joint.
- There is any swelling of the shoulder.
What Does The Rotator Cuff Do
Like most parts of the body, we dont think about our rotator cuff until there is a problem. However, your rotator cuff issue can have a great effect on your shoulder pain. In fact, you use your rotator cuff many times a day to do even basic activities, such as throwing a baseball, lifting objects over your head or even brushing your hair and teeth. The rotator cuffs role is made up of muscles that surround your shoulder joint, which guide your shoulder as it moves. Therefore, when your rotator cuff becomes damaged, this can result in poor range of motion in the shoulder and inflammation and pain.
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What Is The Cervical Spine
The cervical spine is the neck region of your spinal column. It’s made up of seven small, highly mobile bones, and their associated ligaments, muscles, and shock-absorbing discs.
Anything that aggravates or comes into contact with your spinal nerve roots can lead to radiculopathy, and that includes several common conditions in which growths or abnormalities cause something to invade the space of the nerve root.
- Herniated disc: The shock-absorbing discs between vertebrae can become damaged and may develop a bulge and/or leak fluid.
- Synovial cyst: These lumps are caused by a buildup of joint fluid that forms a sac.
- Bone spur: An extra bit of bone forms in response to damage or chronic inflammation.
- Cervical spondylosis : This condition involves the formation of bone spurs in the neck.
- Spinal stenosis: An advanced stage of spinal arthritis, stenosis occurs when the spaces in the spine become narrowed, usually due to excess bone growth.
- Degenerative disc disease : Discs between vertebrae erode and fray over time, which may cause a herniated disc. In cases of severe degeneration, bone-on-bone contact can cause bone spurs in the joint.
Night Time Shoulder Pain And What To Do About It
One very common complaint I hear from patients with shoulder problems is doc my shoulder pain wakes me up at night.
The pain can occur whether or not one lies on the painful shoulder, opposite side or on their back. Patients cannot find a comfortable sleeping position. The pain just does not let them sleep well.
Night time shoulder pain is probably the most common symptom I see in patients with shoulder conditions such as tenditinis, bursitis, tendinosis, impingement, rotator cuff tears and capsulitis. All of these conditions cause some level of shoulder stiffness and inflammation.
The reason that shoulders hurt at night is not fully understood. It may be related to the inflammation that occurs when the joint is in a prolonged static position or it might be due to the inward position of the arm while at rest. When the arm is up against the body the blood flow to the rotator cuff tendon and bursa is slightly restricted. This position might partially account for the pain. What we do know is that night time pain is a red flag that something is wrong.
When I evaluate patients with night time shoulder pain my goals are 1) to make the correct diagnosis and 2) to provide efficient and appropriate treatment to permanently relieve the pain.
I emphasize this: A Stiff joint = A Painful Joint
The longer you hold the stretch the more effective you will be at improving shoulder motion.
As the ROM improves the night time pain should start to diminish.
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Causes Of Shoulder Pain
- Since the shoulder is the most flexible joint, a number of factors and conditions can contribute to shoulder pain.
- The most prevalent cause is an injury to the soft tissues, including the muscles, tendons, and ligaments within the shoulder. This could be due to repetitive use or overuse injury.
- It can even be due to soreness of the tendon in the rotator cuff.
- Sometimes, the pain in your shoulder is actually emanating from injury to some other adjoining area, such as the neck or biceps. This is known as referred pain and does not aggravate with shoulder movement.
Some other causes of shoulder pain can include:
- Frozen shoulder due to stiffening of the tendons, ligaments, and muscles
- Spinal cord injury
- Dislocated shoulder
- Certain diseases can also cause shoulder pain, such as diseases of the cervical spine in the neck as well as liver, heart, and gallbladder diseases
Rotator Cuff Strengthening Exercises
For improved shoulder strength, the use of dumbbells, tubing and your own body weight are commonly combined with other types of strengthening exercises. Isometric exercises, a form of strengthening exercises, contract and build muscles without moving a joint or bone. Strengthening exercises are only introduced or included in the exercise regimen if the involved shoulder is strong enough to tolerate the pressure and is able to complete the exercises in a pain-free range.
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When To See The Doctor
Most shoulder injuries result from issues with the ligaments, tendons and muscles. Injuries can develop over time as the result of repetitive use or ignoring the warning signs of a problem. Occasionally, an injury will occur during or after an accident.
The Mayo Clinic recommends the following:
- Seeking immediate attention: If you are experiencing shoulder pain with difficulty breathing or feelings of tightness in your chest, you may be experiencing a heart attack. You require immediate medical attention. You should also seek immediate medical attention if your shoulder pain is caused by an injury. Please seek help right away if you are experiencing a joint that appears deformed, the inability to use the joint, intense pain, or sudden swelling.
- Scheduling an office visit: Make an appointment with your doctor when possible if you are experiencing swelling, redness, or tenderness and warmth around the joint. Do not wait to make an appointment if you feel any level of pain.
- Self-care: If you are experiencing minor shoulder pain, you can try pain relievers, resting and using ice to alleviate the uncomfortable. Avoid using your shoulder in ways that can potentially worsen your discomfort.
Outside Of The Shoulder
Several issues can cause pain on the outside of the shoulder, and the most common cause is a rotator cuff tear.
Rotator Cuff Problem
There are four rotator cuff muscles that move your shoulder, including your deltoid muscle.
There are three main types of rotator cuff problems
Rotator cuff problems cause pain, especially with activities like reaching or throwing. The deep, aching shoulder pain tends to worsen or flare up at night, and it can wake you up from sleep or make it difficult to fall asleep.
Rotator cuff problems can be associated with a limited active range of motion. Since it’s hard to voluntarily move your injured or inflamed muscle, your shoulder may feel stiff. But if someone does the work for you by lifting your arm , your shoulder will likely move normally.
Also called adhesive capsulitis, frozen shoulder is a common condition that leads to joint stiffness and pain, which can be constant. While many shoulder conditions, including rotator cuff tendinitis, can be associated with frozen shoulder, the cause is often unknown.
With a frozen shoulder, there is a decrease of both active and passive range of motion.
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Some Shoulder Conditions May Become More Common As You Age
You probably don’t think about your shoulders much, until you suddenly experience pain in one of them. Shoulder pain can make a simple act brushing and drying your hair, reaching behind your back to fasten a bra, or grabbing something overhead seem like a monumental task.
As you age, you’re more likely to experience shoulder pain from a variety of common conditions. “Shoulder problems are very common,” says Dr. Arun Ramappa, associate professor of orthopedic surgery at Harvard Medical School. The pain can come on gradually or abruptly, and it may range from mild to excruciating.
Below are some of the most common conditions you may encounter, and some tips for how to address them.
How Does The Rotator Cuff Get Hurt
The main joint in the shoulder is formed by the arm bone and the shoulder blade. The joint socket is shallow, allowing a wide range of motion in the arm. The rotator cuff is made up of 4 muscles that surround the arm bone. This cuff keeps the shoulder steady as the arm moves.
The supraspinatus muscle rests on top of the shoulder. Its tendon travels under the bone on the outside of the shoulder . This tendon is the one most often injured because of its position between the bones. As the tendon becomes inflamed , it can become pinched between the 2 bones. The sac of fluid that cushions the tendon can also be irritated and swollen.
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Shoulder Impingement Or Painful Arc Syndrome
The rotator cuff is a group of muscles and tendons that keep the upper arm bone held in the shoulder blade socket.
Pain from a problem with the rotator cuff is often called shoulder impingement. The condition causes swelling, pain or damage to the tendons of the rotator cuff. This can make it painful and difficult to move your arm properly.
You may find it painful and difficult to lift your arm away from your body, particularly if youre trying to lift your arm above your head. Your arm may feel weak or you may have a dull lingering pain in your upper arm.
Really, its nothing to do with your tendons being trapped by bones, as was previously thought. Instead, its caused by overuse or age-related problems with the tendons themselves but the name is still used. This condition can also be called painful arc syndrome.
Rest and physiotherapy are the main courses of treatment for a shoulder impingement. Your doctor may recommend an injection of steroids and a local anaesthetic, to help with the pain.
If the pain doesnt settle, or comes back within a few months of treatment, you may need keyhole surgery.
Why Is My Shoulder Pain Worse At Night
There are basically three conditions that can cause shoulder pain to worsen at night: bursitis, tendonitis, and rotator cuff injuries. This is because the inflammation involved in each can pull on the shoulder joint, especially when the area is compressed .
This can make your shoulder feel stiff and painful. You may also experience muscle spasms, numbness, or tingling that radiates down to your fingers.
Shoulder pain that worsens at night may be caused by the following:
Ice And Heat Application
Ice packs are most often used to reduce the swelling and pain from an acute shoulder injury, but they can also be used to treat shoulder overuse injuries . In these cases, the ice is applied right after the overhead activity to minimize the onset of inflammation.
Heat pads are also used to treat chronic shoulder conditions, but generally before the overhead activity is performed. Heat can relax the muscles, ease stiffness, and reduce pain.
Before applying ice or heat, talk with your doctor or physical therapist. Developing a specific plan for the timing and duration of each treatment is important for optimizing your shoulder healing.
Potential Causes Of Shoulder Pain
Shoulder tendinitis typically occurs from a repetitive motion. Occasionally, a more sudden, unexpected injury can cause the issue. Its common in athletes, especially those who may inadvertently use the incorrect form, putting additional stress on the tissues and tendons in the shoulder.
Treatment for shoulder tendinitis focuses on regaining mobility and reducing the discomfort caused by pain and swelling. Rest and ice on the shoulder is a great start it will help reduce the swelling. Physical therapy can help relieve the symptoms and help regain strength in the shoulder. Surgery is typically only needed if the tendon has been torn either partially or wholly.
Shoulder bursitis occurs when the small fluid-filled sacs that cushion and protect bones, tendons, and muscles become inflamed. The shoulder is one of the most common locations for bursitis, which often presents itself in joints that perform repetitive motions.
Rotator cuff tears are common, especially in people who are middle-aged or perform repetitive overhead motions at their job or while playing a sport. Tears can occur over time as a result of wear and tear or from a sudden accident or injury.
Most people describe the pain from a rotator cuff tear to feel like a dull ache that worsens if you sleep on the affected shoulder. The tear can make it difficult to reach behind your back to do daily tasks like brushing your hair. It may also make your arm feel weak.
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Six Reasons For Painful Muscles Between Your Spine And Shoulder Blade
I hated having them, too. But that was a very long time ago.
I got rid of the knots in my back naturally and you can, too.
But there are perfectly logical reasons you have that pain in the rhomboid area.
If youve got knots in your back, or if you know someone who does, I wrote this post for you! Or them!
So here we go:
Sometimes muscles complain. When you get knots or muscle spasms in your upper back, thats one of the ways your body says, Hey, pay attention! Im not happy!
Knots in your back muscles are symptoms that theres an issue somewherea cause. The knot arent the problem.
They are the result of something.
There are common causes of one-sided pain between your shoulder blade and spine and were going to talk about them right here. When you discover those causes, youll be on the road to get rid of your painful knots.
So, what causes one or more muscle knots in your back?
1. Thyroid. Thyroid or other immune system dysfunctions can cause a tendency to have muscle spasms Im not a doctor and you may need to work with your doctor if you have this diagnosis but natural therapies can still help you, too.
2. Posture. If you have a forward head posture or rounded shoulders the muscles in your upper back get stretched and strained and complain. They get into spasms or knots. Slouching or even straining to see the computer screen can be a cause.
Minerals help prevent miserable muscle spasms.
If youd like, I can help you do that.
How Is Shoulder Pain Treated
The treatment recommended for shoulder pain will depend on the cause.
In the first few days after an injury, putting a cold pack on the sore area can help to reduce inflammation. After that, a hot pack can be used to help relax the shoulder muscles.
Pain relievers or anti-inflammatory medications may also help control the pain.
But for persistent or intense pain, or if youre injured, you should see a doctor or physiotherapist, who may suggest:
- resting your shoulder for some time
- taping your shoulder for support, or resting your arm
- laser or ultrasound therapy
Steroid injections or surgery may be recommended for some injuries.
If the pain lasts for longer, you may get stronger pain relief medication from a specialist. This might include medication to relax the muscles or treat nerve pain. Sometimes, injections to block the pain may be recommended.
If the condition is severe, you may be advised to have nerve stimulation to the spinal cord. Sometimes surgery is needed to correct structural problems, such as an arthroscopy, stablisation surgery or a joint replacement.
Bicep Tendon Injury And Tears
Shoulder muscles are attached to bones with tendons. If you tear the biceps tendon in your shoulder, you might find yourself with less strength in the affected arm and the inability to turn your arm from palm down to palm up.
The split and tear of tendons can result from acute injury or degenerative changes in the tendons. This is usually caused by increasing age, long-term overuse and wear and tear, or a sudden injury.
Bicep tendon tears can either be partial or complete. Most are partial, where the tendon is not completely severed. But without treatment, the tendon can continue to tear and eventually separate into two pieces. This is, of course, very painful and eradicates all possibility of movement at that point.
In many instances of complete tears, the tendon pulls away from its site of attachment to the bone. Rotator cuff and biceps tendon injuries are among the most widespread types of these injuries. Injury and overuse of the shoulder are the most common causes.
Symptoms of a bicep tear include sudden and sharp upper arm pain accompanied by an audible snapping noise, bruising from the middle of the upper arm that goes towards the elbow, and a bulge in the upper arm above the elbow.