Medical History And Physical Examination
After discussing your symptoms and medical history, your doctor will examine your shoulder. They will check to see whether it is tender in any area or whether there is a deformity. To measure the range of motion of your shoulder, your doctor will have you move your arm in several different directions. They will also test your arm strength.
Your doctor will check for other problems with your shoulder joint. They may also examine your neck to make sure that the pain is not coming from a pinched nerve, and to rule out other conditions, such as arthritis.
Your doctor will test your range of motion by having you move your arm in different directions.
Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.
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.
Rotator Cuff And Bursa Injuries
- Rotator cuff is a collection of 4 main muscles and tendons that envelope the shoulder joint and they can get damaged causing pain with lifting the shoulder.
- There are multiple terminologies that typically all mean the same thing such as tendonitis, tendinosis and bursitis all typically describe pain and damage coming from the rotator cuff areas.
- Pain from rotator cuff tendons typically located outside of the shoulder around the deltoid area but can also present with front of the shoulder pain.
- Also associate with pain while laying on the shoulder and night pain.
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If You Have To Go To The Doctor
If you talk with your doctor about right shoulder and arm pain, they may recommend the following, depending on the severity of your condition.
- Immobilization: In some cases, limiting the movement of your shoulder or arm may help it heal. This is often achieved using a sling, brace, or cast. Your doctor will let you know when it can be removed.
- Corticosteroid injections: This is a type of medication that your doctor can inject into the affected area to help reduce inflammation.
- Prescription medications: Prescription pain medications may be given for severe pain. Oral corticosteroids can help ease inflammation. If you have RA, your doctor will likely prescribe a disease-modifying drug.
- Physical therapy: Your doctor may give you a list of exercises to do that can help you regain strength, flexibility, and range of motion. In some cases, they may recommend that you work with a physical therapist.
- Surgery: Surgery may be recommended when other treatments havent been effective or when damage is severe. The specific procedure thats used can depend on whats causing your condition.
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How Does Shoulder Impingement Syndrome Develop
When your rotator cuff is irritated or injured, it swells in much the same way your ankle does when it is sprained. However, because your rotator cuff is surrounded by bone, swelling causes other events to occur. Swelling reduces the amount of space around the rotator cuff, leading to rubbing against the acromion. Like a vicious cycle, the rubbing of the rotator cuff tendons result in swelling, which further narrows the space below the acromion. In some cases, bone spurs on the acromion bone can contribute to impingement by causing the space where the rotator cuff sits to be even more narrowed
Rotator Cuff & Bursa Injuries
If your pain is primarily on the outside of your shoulder and is more severe when you lie down, it may be caused by a torn tendon in the rotator cuff of the shoulder joint. Rotator cuff injuries are painful when you put pressure on the area and when using the shoulder to reach or throw. The pain is often worse at night.
Besides rotator cuff tears, there are some other various forms of rotator cuff injuries:
- Inflammation of the tendons connecting your shoulder muscles to your arm bone is known as tendonitis. One particular form of this is calcific tendonitis, which leads to calcium crystals building up in the shoulder joint. The pain from calcium crystal tendonitis can be severe.
- Tendinosis, like tendonitis, is also the result of injury or wear on the rotator cuff. However, tendinosis causes pain when you lift your arm because of increased nerves and blood vessels in the joint due to tissue degeneration. The overabundance of nerves leads to pain when you move your arm.
- Inflammation of the fluid sac in the joint, or bursitis, can be caused by chronic irritation or a traumatic injury. In severe cases, the bursa may become infected.
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Your Shoulder Feels Stiff Or Sore
Maybe you just slept on your shoulder the wrong way. But if your shoulder stiffness persists for more than a day, you may have injured it while lifting, playing sports, or engaging in a repetitive activity.
A stiff shoulder may be caused by inflammation that arises when your body is trying to heal an injury. You could also be in the early stages of osteoarthritis a chronic condition thats caused when the protective cartilage on your bones erodes from overuse or when the joint lining becomes inflamed.
If your shoulder feels swollen, stiff, and painful, your tendency might be to use it less. However, over time, refraining from healthy shoulder movement could cause the soft tissues to stiffen and limit your range of motion.
What Is Shoulder Impingement
Your shoulder is a ball and socket joint. The ball is at the top end of your humerus bone in your arm, and the socket is part of your shoulder blade. There is a bony protuberance at the top of your shoulder blade called the acromion process.
If you have rotator cuff weakness or tightness in muscles or structures around your shoulder joint, the ball of the joint may move slightly upwards when you lift your arm. When this occurs, your rotator cuff tendons or your shoulder bursa may become pinched underneath the acromion process. This causes pain and the painful arc that happens while moving your arm. The pinching sensation is known as shoulder or rotator cuff impingement.
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Whats Causing My Shoulder Pain When Lifting My Arm
August 8, 2022 by Dr. G. Brian Holloway
A lot of additional stress is placed on your shoulder joint when you lift your arm above your head, which is why this movement is painful or even impossible for a number of people dealing with shoulder discomfort. But what underlying conditions could be causing those discomfort when lifting your arm, and moreover, whats the best way to treat it? In todays blog, we look at some of the common causes and treatments for shoulder discomfort when lifting your arms.
Stretching Rotator Cuff Muscles Too Much
The rotator cuff muscles are responsible for assisting with rotating your arm. When you stretch these muscles beyond their normal range of motion, you can irritate them and cause them to spasm.
This can lead to a rotator cuff impingement or rotator cuff tear. To prevent these issues, only stretch your rotator cuff muscles when necessary.
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Most Common Reasons You Cannot Lift Your Shoulder
Here are the most common reasons why you may not be able to move your arm. While there can be neurological reasons, like Parsonage-Turner Syndrome, most of you cannot move the arm or shoulder because of pain. The most common causes of shoulder pain and loss of motion are:
- rotator cuff tendonitis
- adhesive capsulitis or a frozen shoulder
The cause of your shoulder pain and the reason why it hurts will vary by age. Some problems are more common in different age groups. In younger athletes, tendonitis or inflammation of the rotator cuff is more common.
In middle age, rotator cuff tendinosis, calcific tendinitis, AC Joint arthritis, and a frozen shoulder are more common causes of pain.
Lets run through each of these individually.
Path To Improved Health
Your doctor can help you with a treatment plan to relieve the pain and help you restore your shoulder to normal function. Pain relief strategies include active rest. During active rest, you can and should move your shoulder. Avoid difficult activities like lifting heavy objects or repetitive overhead movements. You may also get relief by applying ice, taking nonsteroidal anti-inflammatory medicine such as ibuprofen or naproxen , and, occasionally, an injection of anti-inflammatory steroids. Special exercises may also help.
The first step of rehabilitation therapy is simple range-of-motion exercises. By bending over and moving your shoulder in large circles, you will help to avoid the serious complication of rotator cuff injury, called a frozen shoulder. You should follow these range-of-motion exercises with resistance exercises using rubber tubing or light dumbbells. The final step is resistance training with weight machines or free weights.
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What Tests Are There
Blood tests arent usually needed for most shoulder problems, but theyre sometimes used to rule out other conditions, including some types of arthritis.
X-rays are good for looking for problems with the bones in your shoulder and minor changes in the joints. However, small changes are quite common and may not be the cause of your trouble.
X-rays can only show bones and other hard substances, but they wont show injuries to soft tissue like muscles.
An ultrasound scan can show swelling, as well as damage and problems with the tendons, muscles or other soft tissues in the shoulder. It uses high-frequency sound waves to examine and build pictures of the inside of the body.
You may be referred for magnetic resonance imaging scans if your doctor suspects a more complex problem with the soft tissue in your shoulder. An MRI uses radio waves to build a picture to show whats happening to the bones and soft tissue, such as the muscles and tendons, inside your shoulder.
Sometimes dye is injected into the shoulder before the MRI to get a clearer picture especially in cases of shoulder dislocation.
Nerve conduction studies can show whether your problems are being caused by the nerves in your arm being pinched or irritated.
They measure the electrical activity in the muscles and nerves. Its common to feel slight pain or discomfort, like a tapping on the skin, but the test doesnt last long.
Some of the specific conditions that affect the shoulder include:
Shoulder Impingement Syndrome Risk Factors
Impingement syndrome is most common in young athletes and middle-aged people. People who participate in sports or jobs that require an individual to perform repetitive overhead activity are at a higher risk of developing it.
These jobs and sports may include:
- Baseball, tennis, and swimming
- Painters, carpenters or electricians
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What Are Shoulder Pain Treatments And Home Remedies
For dislocations, separations, and fractures, you need a doctorâs help to get your shoulder back in the right position and then a sling to hold it in place while it heals.
For many other issues, your doctor may suggest rest, heat or ice, and a medicine like aspirin or ibuprofen to reduce the pain and swelling.
If your shoulder doesnât improve after these first steps, your doctor may try injecting a corticosteroid straight into the joint to relieve swelling and pain.
Sometimes cartilage tears, rotator cuff tears, and frozen shoulder donât improve with rest and medicine. Your doctor may recommend surgery.
With any problem in your shoulder, your treatment plan will probably include exercises to help you stretch and strengthen the joint, and to improve your range of motion.
Treatment Options For Shoulder Pain
If a short-term condition or inflammation is whats causing your shoulder pain, anti-inflammatories and pain medications may be prescribed. Physical therapy can help restore range of motion and aid in strengthening the shoulder joint. If oral and topical treatments arent effective, steroid injections into the joint may be needed.
If these less-invasive treatments arent effective, or if the damage to the shoulder joint is too severe for other interventions, you may need surgery. Laparoscopic surgery can sometimes be performed to minimize the risk of infection, hasten healing times, and prevent scarring. If laparoscopic surgery isnt right for your condition, advanced surgical techniques followed by physical therapy can help.
The physicians at Arkansas Surgical Hospital can advise you on various treatment options and which ones are appropriate for your shoulder pain. Arkansas Surgical Hospital offers the latest innovations in surgical interventions for shoulder pain associated with raising your arm. These include Bankart repair, rotator cuff repair, SLAP lesion repair, shoulder replacement surgery, and more. To find out more, call to schedule a free consultation.
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The Most Likely Culprit
Culprit Number One is a shoulder impingement. This is essentially a friction problem. At the top of your arm is a set of powerful, flexible tendons and ligaments called the Rotator Cuff. These tendons support your shoulder and keep your arm bone securely in its socket. When things are working as they should, the tendons glide smoothly through their movements with the help of bursae . But if you develop a problem in the Cuff, they can become irritated and this may cause them to inflame and narrow the space between bone and tissue. Its a bit of a vicious circle. Inflammation causes swelling. Swelling causes impingement. Impingement causes more swelling, and so on. When you lift your arm, you narrow the space between bone and tissue even further. Result? Pain in the shoulder usually in the top or outer part. The other possibility is that you have strained, or even torn, one of the Cuff tendons. This will give you similar symptoms, but pain at rest or at night is more common.
Possible Causes Of Shoulder Pain
Your shoulder is a ball and socket joint that is supposed to be extremely mobile and strong enough to control that mobility. Your shoulder blade needs to be able to move smoothly to assist the shoulder with harder tasks and/or heavier lifting.
Although the shoulder blade gets blamed for pain much of the time , your shoulder needs to also be able to move itself independently of your shoulder blade.
Thats where having a strong rotator cuff comes in. If youre pulling something close to you, or pressing or pushing something away from you, you get to use larger muscle groups to assist with the activity, not leaving your rotator cuff on an island by itself.
On the other hand, picture holding something out in front of you or to the side, solely relying on your rotator cuff to do all of that work, thats a long lever to control! If this is similar to the onset of your shoulder pain, more than likely, one of your rotator cuff tendons or musculature around your shoulder blade just doesnt have the capacity to do what you want it to do at the moment.
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How Is Shoulder Impingement Syndrome Treated
The goal of treatment for shoulder impingement syndrome is to reduce your pain and restore shoulder function. Treatments for impingement syndrome include rest, ice, over-the-counter anti-inflammatory medications, steroid injections and physical therapy.
- Physical therapy is the most important treatment for shoulder impingement syndrome. In most cases, youll only need one or two in-office visits to learn how to continue to do physical therapy on your own at home. Youll learn stretching exercises to improve the range of motion of your shoulder. As your pain lessens, you can begin strengthening exercises to improve your rotator cuff muscles.
- Ice should be applied to the shoulder for 20 minutes once or twice a day. .
- If your healthcare provider approves, ibuprofen or naproxen may be taken as-needed to relieve pain. For more severe pain, a stronger prescription strength anti-inflammatory medication may be prescribe or a cortisone injection into the bursa beneath the acromion may be given.
- A common sense approach to activities is helpful. Avoid activities in which you need to frequently reach overhead or behind your back. These motions usually makes shoulders with impingement syndrome worse. Stop activities that involve these motions until your pain improves.
Surgery