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Shoulder pain can be caused by various factors, including injury, overuse, arthritis, and nerve-related issues. One contributing factor to shoulder pain may be muscle loss or atrophy, which refers to a decrease in muscle mass and strength. This can occur due to various reasons, such as malnutrition, age, lack of physical activity, or certain medical conditions. When muscles atrophy, they can cause weakness and a decrease in function, potentially leading to shoulder pain and discomfort. However, it is important to note that shoulder pain has multiple potential causes, and a comprehensive examination by a healthcare professional is necessary to determine the specific cause and appropriate treatment.
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What You'll Learn
Rotator cuff injuries
There are two main causes of rotator cuff tears: injury (acute) and wear (degeneration). Acute injuries occur suddenly, such as falling on an outstretched arm or lifting something too heavy. Chronic injuries, on the other hand, develop over time due to overuse or repetitive wear and tear. Athletes who perform overhead activities, such as tennis players and baseball pitchers, are particularly vulnerable to overuse tears. Painters, carpenters, and others who do overhead work are also at a higher risk for rotator cuff tears. In addition, people who do repetitive lifting or have certain manual jobs are also susceptible to rotator cuff injuries.
The symptoms of a rotator cuff injury include pain and weakness when lifting the arm, especially above the shoulder level, and discomfort when sleeping at night while lying on the affected shoulder. The pain may be mild at first, but it can become more intense and persistent if left untreated.
Treatment options for a rotator cuff injury vary depending on the severity of the injury. Non-operative treatments, such as physiotherapy, activity modifications, analgesia, and anti-inflammatories, are typically attempted for three to six months. If the pain persists or becomes worse, surgery may be considered, such as arthroscopic (keyhole) rotator cuff repair.
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Arthritis
There are several types of arthritis that can affect the shoulder:
- Osteoarthritis: The most common type of arthritis, caused by the breakdown of cartilage due to wear and tear, injury, or chronic use. It typically affects older individuals and causes pain and stiffness that worsen over time.
- Rotator cuff tear arthropathy: This type of arthritis develops after a large rotator cuff tear, causing the humeral head to rub against other bones.
- Rheumatoid arthritis: An inflammatory form of arthritis where the immune system attacks the joints, causing pain, swelling, and inflammation. It typically affects the hands and feet first but can spread to the shoulders.
- Infectious arthritis: This type of arthritis is caused by bacteria, viruses, or fungi spreading through the bloodstream to the joint. It usually affects only one joint and causes rapid onset of intense swelling, pain, and fever.
- Reactive arthritis: A chronic form of arthritis that occurs following an infection of the genital, urinary, or gastrointestinal system. It often affects large joints such as the shoulders, hips, and knees.
Treatment options for shoulder arthritis vary depending on the type and severity of the condition. Non-operative treatments include pain-relieving home remedies such as ice, heat, and exercises. In more severe cases, surgery may be recommended, such as shoulder replacement or reverse shoulder replacement, to improve range of motion and reduce pain.
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Parsonage-Turner syndrome
The syndrome is named after British neurologists Maurice Parsonage and John Turner, who first described the condition in 1948. PTS is also known as brachial neuritis, brachial plexus neuritis, brachial plexus neuropathy, idiopathic brachial plexopathy, neuralgic amyotrophy, and amyotrophic neuralgia.
The exact cause of PTS is unknown, but it is thought to be related to an abnormality in the immune system. The disorder typically occurs in otherwise healthy individuals, and its severity can vary widely from person to person. PTS can be challenging to diagnose, as its symptoms are similar to other more common conditions such as cervical radiculopathy or cervical spondylosis. However, modern electrodiagnostic and imaging tests can help distinguish PTS from other disorders.
There are usually three phases of Parsonage-Turner syndrome. Phase 1 is the acute pain phase, characterised by severe and sudden pain that typically affects one shoulder. Phase 2 is characterised by progressive weakness, reflex changes, and sensory abnormalities. Phase 3 involves the shoulder girdle musculature and proximal upper limb muscles.
Healthcare providers can offer various treatment options to help manage pain and muscle weakness in individuals with PTS. While some patients may recover without treatment, early recognition, accurate diagnosis, and close follow-up care are important for a satisfactory outcome.
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Poor shoulder posture
One common example of poor shoulder posture is "rounded shoulders" or "forward shoulders", where the shoulders are hunched forward and the head juts out past the chest. This can be caused by any activity that requires looking down and forward for extended periods, such as sitting and texting constantly.
The risks of rounded shoulders include increased stress on the shoulder joints, which can cause pain in the neck and upper back. Additionally, the forward posture can cause a lack of space in the lateral and/or anterior area of the subacromial space of the shoulder, leading to potential injury and limited independence, especially in older adults.
To correct poor shoulder posture, it is recommended to work with a physical therapist or knowledgeable practitioner who can recommend specific stretches and exercises to improve posture and strengthen weak muscles. Some examples of these exercises include:
- Pectoral Stretch: This stretch targets the tight pectoral muscles across the chest and front of the shoulder.
- External Shoulder Rotation Stretch: This stretch opens up the shoulder and externally rotates it, counteracting the strong internal rotation often associated with forward posture.
- Posterior Capsule Stretch: This stretch targets the posterior capsule on the back of the shoulder, which becomes tight when the shoulder sits forward for extended periods.
- Upper Trapezius Stretch: This stretch helps to loosen the often-tense muscles on top of the shoulders, which can cause soreness and pain leading from the top of the shoulder blade to the neck.
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Bursitis
Shoulder pain can be caused by several factors, including muscle damage, tendon inflammation, arthritis, and bone damage. One condition that can cause shoulder pain is bursitis, an inflammation of the bursae, the fluid-filled sacs that cushion the shoulder joint. This condition is often the result of injury, overuse, or infection, causing swelling and pain.
The most common causes of bursitis are injury, overuse, or infection. Hobbies and professions that involve repeated stress on the shoulder, such as baseball, tennis, knitting, weight training, painting, and music, can increase the risk of developing bursitis. Additionally, certain medical conditions, such as rheumatoid arthritis, diabetes, and gout, can also make individuals more susceptible to bursitis.
The diagnosis of bursitis typically involves a physical examination, including testing the location of pain, muscle strength, and the range of motion in the shoulder joint. Radiography, MRI scans, and fluid testing may also be employed to rule out other potential causes and confirm the diagnosis.
Treatment options for bursitis include rest, ice, over-the-counter pain relievers, anti-inflammatory medications, corticosteroids, and physical therapy. In some cases, cortisone injections or surgery may be recommended. The key to preventing and managing bursitis is reducing strain on the shoulder joint and avoiding activities that cause pain.
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Frequently asked questions
Shoulder pain can be caused by a variety of factors, including:
- Injury or accident
- Overuse injuries, such as bursitis or a SLAP tear
- Arthritis
- Rotator cuff issues, such as tendinitis or a tear
- Bone spurs
- Frozen shoulder
- Parsonage-Turner syndrome, a rare neurological condition
Muscle loss, or muscle atrophy, can be identified by a decrease in muscle mass and strength. This can be caused by a lack of physical activity, leading to disuse atrophy. If you suspect muscle atrophy, consult a healthcare professional for a diagnosis and treatment plan.
Treatment for shoulder pain due to muscle loss may involve:
- Physical therapy to stretch and strengthen the muscles
- Strength training or high-intensity interval training (HIIT) to rebuild muscle mass
- Addressing the underlying cause of muscle loss, such as malnutrition or nerve damage
