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Painful shoulder

Painful shoulder

Shoulder pain is a common reason to visit a GP. About one third of those who suffer from shoulder pain will have some form of relief within 6 weeks. After a one year the vast majority of people will no longer have any more symptoms.

It is very important to visit a GP early on when you start to develop shoulder pain that is not going away after rest and home remedies or over-the-counter pain killers. There are studies that show that leaving your shoulder complaints for weeks or months have a worse outcome for treatment.

There are 4 other factors that have negative effects on your shoulder pain. It is very important to let the GP know whether you have

  • Associated neck pain on movement
  • Shoulder pain in rest and or at night when sleeping
  • Feeling low in mood due to the shoulder pain
  • Inability to continue with normal day to day activities or work-related tasks

The GP should take these factors into consideration as early as possible and during follow-up to provide a treatment plan.

Four anatomic regions around the shoulder are involved and can cause shoulder pain if damage such as inflammation or infection occur

  • Subacromial space
    • the location of the rotatocuff and consists of 4 tendons supraspinatus, infraspinatus, teres minor and subscapularis
    • also known as Subacromial Pain Syndrome (SAPS), impingement syndrome or painful-arc syndrome
    • occurs in 80% of shoulder pains
    • The first sign is inflammation of the tendons in this region
    • The second sign is partial or complete ruptures of the tendons

In SAPS there is limitation and pain in active movement of the shoulder away from the torso (abduction). Passive movement in this plane is not limited nor painful. If you feel pain lifting your arm above your shoulder this is a strong indication of impingement syndroom or SAPS.

  • Glenohumeral space
    • the location of the shoulder joint
    • also known as frozen shoulder
    • limitation and pain in passive and active movement of the shoulder that worsens as times goes by
    • in the first 2 to 9 months there is more pain felt in the shoulder
    • this goes on 4 to 12 months when the pain lessens but the shoulder becomes more stiff
    • mostly seen in age category between 40 and 65 years of age
    • unstable shoulder is a condition that occurs in those that perform activities where they have to put their arms above their shoulder numerous times. For instance in certain sports or work
  • Acromioclavicular space
    • location between the acrominon and clavicle
    • least common cause of shoulder pain
    • more likely caused by a trauma/fall or degeneration
    • there is pain at this joint space and sometimes a swelling is felt

Further tests such as x-rays or scans are usually not performed in the early stages of diagnosis and treatment. If symptoms persist to over 3 months the GP will be able to refer you for scans.

The GP will initially prescribe and advice analgesics in the form of paracetamol or NSAIDs (Ibuprofen, Naproxen, Diclofenac). There will also be an option to visit a physiotherapy. Then the GP may discuss options for corticosteroid injections in the joint. This last option is most likely done when symptoms still persist despite analgesics and physiotherapy. There is a limitation to the number of injections that can be performed given the risks. The GP will refer to a specialist when all treatment options have failed.

Shoulder pain is a common symptom and reason for GP consultation. The main limitations are pain in active and passive movements of the involved shoulder. It is important to determine any pains that come from the neck to rule out other conditions. The GP will use a step-by-step approach to manage the pain starting with analgesics, then physiotherapy, sometimes injections with corticosteroid and if all fails referral to a specialist.

Visit a GP as soon as possible when you suffer from shoulder pain.