If you have shoulder pain, you’ve probably wondered what exactly is causing you to have this pain that is interfering with your everyday life. You may have even wandered the Internet attempting to self diagnose in the hopes that you can treat on your own. During your search you come across many, many potential causes.
You will see conditions like
- rotator cuff tear
- frozen shoulder
- Impingement – which if not treated can eventually lead to rotator cuff tendinitis and tears.
There’s so many how do you know why your shoulder hurts when you raise it? And what should you do to treat it?
It is important to understand why your shoulder hurts the minute it starts to hurt. Now your shoulder pain is nothing to worry about if any of these apply to you:
- This is the first time you ever felt pain in your shoulder. You just happen to reach overhead this morning and had pain. The very first day, the very first time. This could just be a weird pain that will probably go away tomorrow.
- You had surgery on your arm in the last 2 weeks. Pain from surgery can last weeks and even months after the surgery so if you recently had surgery on your shoulder, you may still have pain when reaching overhead. You will want to let your doctor know if this pain persists.
- You had a hard workout within the last 48 hours where you did a lot of shoulder exercises. Muscle soreness can last 2 days after working out so if you recently did an arm workout, within the last 48 hours, then it can be perfectly normal to have difficulty lifting overhead. If this workout was done over a week ago and you still have pain then you need to be concerned.
If you cannot exclude yourself with one of these three things then your shoulder pain IS something to be worried about!
The first thing you need to do is find the exact cause of your shoulder pain. Finding the source and the cause of your shoulder pain will help you be able to treat it and prevent further damage to it. What could the problem actually be?
- Tendinitis is an inflammation of the shoulder muscles. There are several muscles of the shoulder that could be inflamed. It is important to find out which muscle of the shoulder are inflammed.
- Common signs and symptoms: Pain with reaching overhead, pain with sleeping, pain with lifting an object off the floor, shoulder muscles that are painful to the touch.
- With arthritis you must realize is that everyone over the age of 18 arthritis will show up on an x-ray but most of the time it is not the cause of your pain.
- Common signs and symptoms: Constant pain that is not made better or worse with activity. Pain that is the same upon waking and pain that is the same going to bed.
- Rotator cuff tear
- This is what people commonly think they have when they have shoulder pain and just becuase you have this does not necessarily mean that you will require surgery.
- Common signs and symptoms: Pain that radiates into the side of the arm, pain with reaching overhead
- Frozen shoulder
- Frozen shoulder is the result of something else going on in the shoulder. For some reason, whether it be tendinitis, a tear or something else, you have limited the amount that you move your shoulder. This causes it to ‘freeze’ and you are unable to move it.
- Common signs and symptoms: You are unable to move your shoulder, it is literally ‘frozen’. No matter what you do you cannot push the shoulder any further.
- Many people who have competed in sports that have an overhead component (swimming, volleyball, baseball, etc) usually can have instability.
- Common signs and symptoms: Usually this type of condition doesn’t hurt. This type of shoulder condition leads to other shoulder problems but this in and of itself does not cause pain.
- This is a traumatic event unless you are someone who can do this very easily. Anyone who can do this very easily, knows how to deal with it.
- If you feel that you have sustained a traumatic shoulder injury that has caused it to come out of its socket then you need to seek medical attention asap.
- This is a common cause of rotator cuff tears and it can be ignored for awhile. But while you are ignoring it or taking Advil to relieve the symptoms, it is sawing away at your rotator cuff causing a TON of more time and money in the long run.
- If you have primary impingement, there is a space (below bone on top and the arm bone) becomes progressively occupied by bone spur formation on the undersurface of the acromion (the bone on top). These bone spurs form from either an anatomical variation in which the acromion ‘hooks’ into the subacromial space or through degeneration in which repetitive use causes microtrauma to the undersurface of the acromion and the body responds by forming bone.
- This form of impingement typically occurs in older adults or people with anatomical differences in their acromion, and is corrected surgically.
- Secondary impingement is more common and typically occurs in younger people aged 25-40. The reason the structures in the subacromial space are pinched is not due to bone occupying the already narrow space, but due to instability where the humerus cannot be held correctly in place and the humerus migrates up into the space causing impingement.
- Secondary impingement, where the humerus is not held correctly in the joint, can occur for a few reasons. The rotator cuff composed of four small muscles that attach from your shoulder blade to your humerus function to hold the humerus in place.
- When these muscles are overworked, say from repetitive overhead activity, or are weak, they cannot hold the humerus in place and impingement occurs. In addition, when your shoulder blade is not positioned properly, the rotator cuff muscles are placed in sub-optimal conditions causing them to overwork and fatigue eventually leading to impingement.
- Another cause of secondary impingement, that is applicable to virtually everyone, is posture. If you have a slouched posture where your head is forward, shoulders are rounded and mid back is flexed, the shoulder blades and rotator cuff muscles are put out of place and shoulder motion is lost. You can see this work if you try it yourself. Sit in a slouched posture and try to lift your arm overhead, now sit up straight and try lifting your arm once again. You can see how posture affects the way that your shoulder moves just by attempting this at home. Poor posture also causes the front portion of your body to become tight and the back muscles to become stretched out and weak.
- As impingement occurs, whether primary or secondary, if it is not addressed it can lead to bigger problems down the road. As the structures in the subacromial space are repeatedly impinged, irritation and pain occur leading to edema (swelling or buildup of fluid) and inflammation of the structures and the joint. The edema and inflammation along with continued shoulder impingement then progresses to tendinitis and degeneration of the structures. With inflammation and degeneration, which is also seen in primary impingement, along with further shoulder impingement leads to bone spur formation, and even rotator cuff tears.
Before coming to Physical Therapy, I had pain in my shoulder during my daily routines: dressing, opening and closing doors, carrying bags, exercising and sleeping. The PT’s here were extremely helpful strengthen the muscles that were giving me problems. They manually helped relieve tension in my back, neck and arm. They explained exactly what they were doing in “patient friendly” terms. Most importantly, they were personable and cared to ask about how I was doing whenever I visited. Hopefully I won’t need PT services in the future…But if I do I would definitely come back to Total Performance. Thank you to everyone who works here! Colleen Hildebrandt
What do I do once I figure out what the cause of my shoulder pain is?
- Take Advil/Aleve/Anti-Inflammtories to reduce the pain, take the edge off just to be able to function.
- If you have taken Advil for more than 2 weeks, you are at risk for serious stomach complications. And yes we all know someone who has taken Advil and Aleve for months (and it may even be you) and has had no problems. If you continue to take Advil to ‘take the edge off’ you are putting yourself in danger of serious complications and not just with your shoulder, it is with your stomach and the damage that happens cannot be reversed.
- You’re taking Advil because you don’t have time or money or both to go to the doctor or physical therapist. You think that by taking the Advil to reduce the pain, hoping it will go away, you are saving time and money. In reality by taking Advil for more than 2 weeks, it will cost you tens of thousands of dollards more in hospital bills to be able to treat the stomach issues and that won’t even address the shoulder pain. And it will cost you weeks away from work as you recover from your trip to the hospital. Where as just to go to the physical therapist to treat your shoulder pain, you can do this after work, before work or on your lunch hour, if you damage your stomach with too much anti inflammatories, you will be forced to take days and weeks to repair the damage.
- If you have been taking Advil or any anti inflammatories for more than 2 weeks consecutively, you are putting yourself at severe risk of stomach damage.
- Ignore it. It will go away.
- While we can’t go to the doctor for every ache and pain as we get older otherwise we would never leave. Waking up with aches and pains is part of every day life when you get older. No doubt. But living in pain is not.
- 2 weeks is the rule. 2 weeks is what you give the same pain that shows up day after day where you can be convinced that no home remedy will fix it. You can no longer ignore it.
- Ignoring pain that goes on for more that 2 weeks is like ignoring a leak in the roof. At first it starts off like a drip and can be ignored or dealt with with a bucket placed underneath drip. And it may be able to go on for a few days or weeks or month with no real increase in the drip but now you have had exposure to water for a month. While you could have called a roofer to deal with the drip right then and there it would save you time and money. But you ignored it and waited a few months. Now you have a larger problem, costing more time and money. The same is true for your shoulder. If you ignore it, the longer you ignore it, the more time and money it is going to cost in the long run.
- Ignoring a shoulder problem can cost you tens of thousands of dollars and while dealing with it right away may have cost some initial investment it would have been resolved with no surgery and no time away from any activities.
- Handle it
- Taking time when your shoulder starts hurting will allow you to save time and money. If you deal with the shoulder pain when it comes on, it prevents any compensation issues come up that would need to be dealt with. It would be a limited amount of time and money.
- If you deal with shoulder pain as it comes up, you can schedule appointments as it makes sense for you, before work, after work or during lunch. The time that it will take to heal will be far less than if your shoulder pain leads to surgery and will require no time off of work.
What happens if the pain doesn’t go away with the at home treatment?
- You need to see a physical therapist.
- And not just one that gives exercises. Exercises alone will not heal this. This needs hands on treatment.
- Let’s talk about how physical therapy can be used to address the issue.
- First it is important to address one’s posture, which can be done quickly and easily in one session. With proper posture, your joints, muscles, and tendons are in a better position to function without over working.
- It is necessary to avoid shoulder movements that aggravate your shoulder pain.
- It is important to strengthen the rotator cuff muscles to hold the humerus properly in place.
- Strengthening of the muscles that attach to the shoulder blade (trapezius, serratus anterior, rhomboids, levator scapula, and latissimus dorsi) which affect shoulder motion is needed to have the shoulder blade in the optimal position for the shoulder joint to achieve full motion.
- A physical therapist understands that stability and control of motion are just as vital if not more so than strength.
- Physical therapists can recognize any compensatory movements you may be using that are contributing to the pain as well as introduce exercises that will increase shoulder stability.
- If your capsule is too tight and causing pain, physical therapists can use various joint mobilizations to decrease the capsule’s stiffness. Shoulder strength, stability and control of motion along with modifying activities that aggravate your shoulder pain in the beginning phases of the inflammatory process are key. Addressing these issues will allow for full, pain free shoulder range of motion and prevent larger problems from happening.
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