Georgios Panagopoulos MD | Orthopaedic Surgeon
Shoulder pain refers to any complaint and soreness around the shoulder joint. Pain may be acute or chronic, radiate distally towards the arm and hand, get worse at night or with specific movements.
Causes vary and may include acute injuries, arthritis, tendonitis, etc. Timely diagnosis and treatment are essential.
Key takeaways at a glance
Shoulder pain is a very common musculoskeletal symptom affecting adults of all ages and may have multiple underlying causes.
The most frequent causes include rotator cuff tendinopathy or tears, frozen shoulder (adhesive capsulitis), shoulder impingement, arthritis, dislocations, and traumatic injuries.
Night-time shoulder pain is an important clinical symptom and often indicates underlying inflammation, tendon pathology, or rotator cuff involvement.
Accurate diagnosis requires a combination of detailed clinical examination and appropriate imaging when indicated.
Treatment is individualized and ranges from conservative management (physiotherapy, activity modification, injections) to arthroscopic or surgical treatment when necessary, ideally guided by a shoulder specialist.
Table of contents
Shoulder pain is a common orthopaedic complaint that affects millions of people worldwide. Most of us don't think about are shoulders much until we suddenly experience pain on them, which can make the simplest everyday task seem monumental.
The shoulder is a complex joint with a wide range of motion, making it susceptible to various injuries and conditions. Causes of shoulder pain are numerous. A delayed or wrong diagnosis may lead to unnecessary pain. A functioning shoulder is crucial for performing efficiently many activities of our daily living.
📊 Statistics on Shoulder Pain
- The annual incidence of shoulder pain ranges from about 7.7 to 62 cases per 1,000 persons per year (median ~37.8/1,000).
- In community samples, the prevalence of shoulder pain has a median of ~16%, with estimates ranging from ~1% up to more than 50%, depending on study methods and populations.
- Shoulder pain is the third most common musculoskeletal complaint, after low back and neck pain.
- Approximately 22% of the general population have a rotator cuff tear (symptomatic or asymptomatic) on imaging, and prevalence increases with age.
What are the symptoms?
Shoulder pain characteristics may vary based on the underlying pathology. Pain may not present in isolation, but may be associated with other symptοms, that may help in the diagnostic process. Symptoms related to shoulder problems may include the following:
- Dull or sharp pain around the shoulder
- Reduced range of motion & stiffness
- Inability to raise arm or carry objects
- Shoulder & arm weakness
- Shoulder pain, with numbness & tingling
- Shoulder pain radiating to the arm
- Swelling & tenderness around the shoulder
- Pain that gets worse with movement
- Night pain - sudden pain that might wake you up at night
- Clicking or cracking sounds while moving the shoulder (crepitus)
What are the causes of shoulder pain?
There are many causes of shoulder pain, including the following:
- Rotator cuff pathology: cuff tears, due to acute injury, or degenerative related to ageing.
- Frozen shoulder: also called adhesive capsulitis, manifested with pain & stiffness.
- Shoulder Arthritis: Osteoarthritis, rheumatoid arthritis, post-traumatic arthritis - leads to irreversible cartilage damage, pain and reduced motion.
- Dislocated Shoulder – shoulder instability: the humeral head loses its usual relationship with the glenoid - torn labrum (Bankart lesion).
- BursitisInflammation of the bursae, small fluid filled cavities that cushion the tendons.
- Tendonitis: Inflammation of the cuff tendons
- Impingement Syndrome: cuff scuffing against the overlying acromion, leading to burial sided tears, pain upon abduction & painful arc of motion.
- Fractures: Broken bones around the shoulder ( proximal humerus fractures, glenoid fractures, clavicle fractures, ACJ separation, etc).
- Calcific tendonitisα: Calcific deposits in the cuff tendons, with inflammation & night pain.
Shoulder pain - Diagnosis
An accurate diagnosis is very important for appropriate treatment. A correct diagnostic process may include the following:
- Full history & clinical exam
- Xrays
- MSK Ultrasound: to visualise soft tissues, such as tendons
- MRI scan
Shoulder pain - Treatment
Treatment choice depends on the underlying pathology and disease severity. Options may include:
Non-surgical treatment
In most cases, conservative treatment may provide long-term relief. Options include:
- Rest & activity modification
- Ice therapy
- Physiotherapy & home exercise program
- NSAIDS
- Cortisone injection
Surgical treatment
In severe cases, or if conservative treatment fails, there might be a need for surgical treatment. In many cases, surgery can be performed arthroscopically. In other cases, open surgery might be needed, ie shoulder arthroplasty or fracture fixation.
Conclusions
If you have shoulder pain, it's important that you consult with an experienced shoulder surgeon. Dr Panagopoulos will guide you to the appropriate treatment for your condition and will help to restore your quality of life.
FAQs - Frequently Asked Questions
What are the most common shoulder problems?
– Impingement syndrome & Rotator cuff tears
– Dislocation/Instability
– Calcific tendonitis
– Fractures
– Arthritis
– Frozen shoulder
What does the diagnosis involve?
– History & clinical exam
– X-rays
– Ultrasound
– MRI
What are the most common injuries around the shoulder?
– Rotator cuff tears
– Proximal humerus fractures
– Shoulder dislocation
– Clavicle fracture
– ACJ separation
Shoulder pain on the right ve left. Is there a difference?
The side that hurts usually makes no difference. The pain most often occurs on the dominant limb, that is, the one we use the most. In rare cases, the pain may be due to another condition, such as a lung, heart, or neck problem. If we have comorbidities, or sudden pain with accompanying symptoms, such as chest pain or shortness of breath, it is best to seek medical help immediately.
When should I visit a specialist?
Specialized orthopedic evaluation is required if the pain is due to an acute injury, lasts more than 2-3 weeks, worsens at night, is accompanied by weakness or limitation of movement.
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