Shoulder Joint Pain

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: Shoulder Pain

Published: 27 November 2015

Shoulder joint pain

Is a common finding with my clients. Correct diagnosis at the outset is the key to effective treatment and recovery.

In my experience, shoulder joint pain is mostly present for one of four reasons: Tendonitis, Frozen Shoulder, Osteoarthritis or a Pinched nerve in your neck. I have written another article on the 4 main causes of shoulder pain, but here I also go into detail on these and some of the other causes of shoulder joint pain.

The shoulder joint is a complex structure, made up of a shallow ball and socket joint surrounded by many muscles, ligaments and nerves (see shoulder anatomy). As a result of this make-up, it can move in many directions and has a large range of movement. The excess movement and loose nature of the shoulder joint is the main reason for the causes of shoulder pain.

Main causes of Shoulder Joint Pain

I have seen many causes of shoulder pain in my clinic, including one client whose whose shoulder pain was arising from wearing shoes that were too heavy, resulting in his arm swing straining the muscles of his right shoulder!

However, the most common causes of shoulder joint pain that I see on a weekly basis in my Physiotherapy clinic are:

• Osteoarthritis:- Where you have wear and tear between the surfaces of a joint. I like to compare it to erosion on the surface of a stone or rock. It happens over time, as a result of overuse or due to a disease in the joint attacking the joint surfaces.

  Osteoarthritis of the shoulder joint works a little differently to this condition in the other joints in your body. In the shoulder it usually involves some degree of wear and tear to the tendons around your shoulder joint also. This is due to the fact that your shoulder is a loose joint and has more contact with tendons and muscles in its movement than it has with the surrounding bones. In most other joints it attacks the bones mainly.

  Shoulder joint pain results from this wear and tear. The pain arises from the pressure of bone rubbing against bone as well as from the inflammation in the joint and soft tissues.

• Tendonitis: (see Shoulder Tendonitis for more)Is a very painful condition in the shoulder joint and is very common indeed. When a tendon becomes inflamed and thickened it is called tendonitis. There are many types of tendonitis. The various types depend on what part of the tendon is inflamed. The most common type that I see in the shoulder joint is supraspinatus tendonitis! I love saying this word (nice to say - hard to bear), it reminds me of Mary Poppins and supercalifragilistic-expialidocious!

  Shoulder tendonitis is usually caused by poor movement patterns in your upper back, neck and shoulder. Over time these poor movement patterns can result in repetitive impingement of one or more of your shoulder tendons. They then become damaged, inflamed and eventually thickened resulting in further pinching. The end result is a continuous cycle of pain.

  Your tendon will require local treatment to reduce the inflammation and thickness, but more importantly the cause will need to be removed, in this example postural correction and movement correction is the key. A chartered physiotherapist will guide you on this.

• Frozen shoulder: This is a nasty one! Medically, it is termed capsulitis but over the years it is commonly referred to as frozen shoulder pain. It is where the capsule of your shoulder joint becomes inflamed and eventually thickens. The cause of a frozen shoulder is at large unknown but has been researched greatly. (see Frozen Shoulder Pain for more)

  From my experience I have associated frozen shoulders with stress and it usually arises some months after the stressful situation has been resolved. However this is just my own opinion!

  This inflammatory process results in you losing a lot of the movement in your shoulder joint. The early stages are very painful and the later stages - although less painful - are functionally very inhibiting due to the lack of movement. Early treatment is the key, so seek medical or physiotherapy advice as early as you can. Never ignore a painful shoulder!

• Neck pain: This can refer pain into your shoulder joint. It can refer either directly through its muscular connection to your shoulder or it can refer indirectly by a pinched nerve in your neck referring pain into your shoulder (see article on neck shoulder and arm pain for more)

  You might ask how this can happen? Similar to sciatica in your lower back, where a nerve in your back causes pain in your leg, so too can nerves in your neck cause pain in your shoulders and arms (see neck shoulder arm pain).

• Bursitis: Shoulder bursitis is where there is inflammation of a bursa around the shoulder. However, it can often be confused with an inflammation of the rotor cuff, which is a tendon structure around the shoulder joint. (see Shoulder Bursitis for more)

• Heart: sometimes heart dysfunction can be associated with left sided shoulder, chest and arm pain. Although it is commonly associated with pain and discomfort in all three areas it has been found in cases to be isolated to pain in the shoulder joint. Again, never ignore shoulder pain of any duration!

• Dislocated Shoulder: Shoulder dislocation is painful, and you’ll know all about it if you have the misfortune to experience it. It is important to seek early intervention and if you have a dislocated shoulder and follow up with an experienced physiotherapist/physical therapist so as to reduce the risks of this painful event from re-occurring. (see Shoulder Dislocation for more)

In summary

So, let me summarise shoulder joint pain!

It is a pain in your shoulder joint resulting from a trauma or condition within the shoulder joint itself. It can also be caused by a referred pain from your neck. It is frequently caused or aggravated by poor postural and movement habits. I see postural shoulder joint problems mainly in office workers and drivers who adopt a poor sitting posture, often at a poorly designed work station (see computer posture).

As with all mechanical pains, shoulder pain usually responds well to manual therapy once a correct diagnosis has been made. Diagnosis is the key!