Shoulder problems


 

The shoulder complex is made up of four joints.

These joints comprise of the ball and socket joint, two joints where the collar bone meets the sternum at one end and the shoulder blade at the other end. The final ‘joint’ is where the shoulder blade moves on the rib cage.

This is not a traditional joint in the sense that the shoulder blade does not come in to direct contact with the ribs due to complexity of soft tissues between the two bones.

The main joint of the shoulder is classified as a ball and socket joint. Typically ball and socket joints offer stability due to the congruency of the bones, this is the case in the hip joint, however the shoulder is designed for mobility rather than stability. As a result the ball and socket joint represents a golf ball sitting on a golf tee. Along with this is the fact that the socket (the shoulder blade) also moves allowing for vast degrees of movement. The main function of this mobile joint is to place the hand in appropriate positions to carry out particular tasks.

The ball and socket joint relies heavily on soft tissues such as ligaments, muscles and tendons to provide the stability and prevent excessive movements and dislocations.

 

Why do I have shoulder pain?

Due to the complexity of the shoulder there are numerous structures that can give rise to pain. An understanding of the location of pain, the aggravating movements and the time of onset of the symptoms can help make a diagnosis. Pain can be present due to damage or on-going irritation of structures in the shoulder however this is not always the case. Pain can be present in the absence of structural damage and can be termed persistent pain.

As there are a number of possible causes of shoulder pain, a thorough examination by a healthcare professional may be required to make an accurate diagnosis.

 

How can I help myself?

There are a number of things that you can do to help manage your pain before seeking help from a medical professional. Below are some ways that you may wish to try to help manage your shoulder pain.


 

I have just injured myself …

In an acute injury the tissues often need time to settle and therefore a period of relative rest may be required. This does not mean that the arm should be immobile but rather activities involving the arm such as sporting activities, lifting and possibly work (depending on the nature of your occupation) should be modified or avoided.

It may be appropriate to manage your symptoms with appropriate pain relief. You can discuss what medication is most appropriate for you with a pharmacist at your local pharmacy. If these medications do not provide adequate relief then you may need to see a GP to discuss prescription pain medications.

 

I have had a problem for over 3 months that is not getting better …

If symptoms persist for more than 3 months this still does not mean that there is damage to the structures in the shoulder. We know that there are a number of reasons as to why pain can persist for longer than three months without structural damage. If this is the case then there are ways to manage the symptoms:

  • Commence gentle exercise – this could be specific for the arm or general cardiovascular exercise. The NHS recommends 150 minutes of moderate aerobic exercise and 2 to 3 days of strengthening exercise per week for people between the ages of 19 and 64 years of age. Muscles and joints need regular movement to remain healthy.

     
  • Pain medication – Pharmacists at a local pharmacy will be able to advise you on over the counter pain medications that will be most appropriate to you. If these do not provide adequate relief then you may need to speak with a GP to discuss prescription medications.

 

When should I seek medical attention?

If you have sustained a trauma to the shoulder which is accompanied by heavy bruising, high levels of pain and a reduced ability to move the shoulder then the injury may warrant further investigations and a trip to the local walk-in-centre or A & E may be required.

If following a trauma the shoulder has felt like it has come out of joint and you are now struggling to move the shoulder you should seek medical intervention to ensure that the shoulder properly relocated following the injury.

If shoulder pain and restriction of activities of daily living continue to be problematic then a review with your local general practitioner may be required to discuss future management options.

 

What treatments are available?

Often the first line of treatment is through self-help – (see section How can I help myself? For more details)

Medical treatment will vary depending on your symptoms and likely diagnosis. Often your general practitioner will refer you directly to physiotherapy where exercise therapy, manual therapy and taping may be of benefit.

Occasionally a review with an Extended Scope Practitioner or Orthopaedic Consultant is required which may lead to further treatment options such as Injections or surgery.

 

How do I get help?

If you wish to seek further advice and help in the diagnosis and management of your shoulder pain then you will need to make an appointment to see your GP. Your GP can then make a decision with you about what would be the next steps going forward in managing your pain. At this time your GP may consider sending you for investigations including x-ray, or they may wish to refer you to the Surrey Integrated Musculoskeletal service at Ashford & St Peter’s Hospitals, or to a physiotherapist.

 

Helpful links

There are a number of websites that you may find useful regarding taking care of your neck and shoulders:

Link to website
 

NHS Choices

NHS Choices was launched in 2007 and is the official website of the National Health Service in England.

 
Link to website
 

Shoulder Doc

Lennard Funk established ShoulderDoc.co.uk in 2002. Since then it has become the most popular Shoulder & Elbow information website on the internet, receiving over 100,000 hits and 5,000 new visitors per day.

 
Link to website
 

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