The shoulder is the most movable joint in the human body. A group of four muscles and their tendons called the rotator cuff, give the shoulder its wide range of motion.
Swelling, damage, or bone changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or moving it forward or behind your back. We see a lot of patients complaining of shoulder pains. It’s not surprising because it’s estimated that 70% of people will suffer from shoulder pain at one stage in their lives. And another statistic that’s come out is that once you have shoulder pain almost 50% of patients will still have it 12 months after the onset of the pain. So it’s something that persists for a long, long time once you have it.
We show you a few tests so you can find out if you have a shoulder problem, what’s causing the shoulder problem ’cause we need to know what’s causing it first before we can give you any help before you can give yourself any help with it. We’re giving you a few tests to find out which structure is causing the shoulder pain.
Shoulder pain Causes
We’re gonna go from top to bottom.
- So the first structure to cause you shoulder pain is your neck.
Shoulder pain can arise from your neck, especially if you’re suffering from radiculopathy which is essentially a nerve that is being pinched in the neck. And you know when you have radiculopathy because you have this choosing pain from your neck into your shoulder, into your elbow, into your arms, sometimes even to your fingers. And the test you can do is what we call the Foraminal Compression Test. And what you need to do, so say my right shoulder is the affected side. You just need to turn your head to the right and then tilt your head backwards, and if that reproduces your shoulder pain, this can also give you pain between your shoulder blades.
If that reproduces it, then most likely your shoulder pain stems from your neck, so something needs to be done with your neck. - The second structure that can cause shoulder pain is a structure that we call the brachial plexus, and that’s a structure, an anatomical structure. It consists of nerves and blood vessels and it runs essentially from your neck into your shoulder and it can get compressed here, it can be compressed by a muscle or it can be compressed by the clavicle or it can be compressed by the first rib even. And the test we need to do to determine if the brachial plexus is the cause of your shoulder pain is what we call the Roos Test.
Now, with the Roos Test, what you need to do is stick your arms up like this, 90 degrees on the shoulder, 90 degrees in your elbows, then pull your arms back a little bit so you pull your arms a little bit, and then what you do for three minutes is you open and shut your hands.
Now, this test is positive if you have a heaviness or a weakness in the arms or if you get numbness and tingling in your hands. Now, you will get tired when you do this. You’re looking for real heaviness and weakness in the arms for three minutes. If that’s positive, then your shoulder pain might be caused by a compression of the brachial plexus.
Third structure Shoulder Pain Problem
The third structure that can cause a shoulder problem is a tear in one of your rotator cuffs muscles.
So the rotator cuffs muscles are muscles that surround the joint and keep the joint in place.
And we’ll give you the two most common ones.
The commonest tear of a muscle in the rotator cuff is in the muscle called the supraspinatus and what we do for this one is the empty can test.
So what you do with this is you straighten out your arm, you point your thumb towards the ground so you got a 30-degree angle front here and then with the other hand, you apply a little bit of pressure, and you resist it. And if this is sore, then most likely you’ve got a tear in one of the rotator cuff muscles called the supraspinatus.
The other test we can do for another muscle part of the rotator cuff is the infraspinatus. And what you do, the test that you do to test if you have a tear in this muscle is you put your elbow into your side, you turn your arm out a little bit, you hold it here and with the other hand, you pull, and you see if this inflicts you pain in your shoulder.
Now, if it does, it’s an infraspinatus tear causing your shoulder problem.
Forth structure Shoulder Pain Problem
Another structure that might cause you an issue is the AC joint, and the AC joint is located on top of your shoulder.
So you go, if you come up from your upper arm, you feel like a hard structure, a bony bit, and you go in about half an inch, and you feel a little bit of a dip, and that’s the AC joint, and that’s commonly affected with people who push weights, weightlifters and stuff, especially with shoulder presses, up and down. And also, we see a lot of traumatic events, for example, with cyclists when they land, when they fall off the bike, when they land on the shoulder, you often see here we’re almost like a step defect like your shoulder is a bit lower than your clavicle.
So the test you can do to determine if your pain is caused by the AC joint is the pull apart test and what you do is interlock your fingers. And you just pull apart as hard as you can, and if you get a little bit of an ache on top of your shoulder, it’s probably an AC joint. Something can be done about it.
We can help you with it but that’s where your problem comes from, the AC joint. It could also be a bit of osteoarthritis. You need to be a bit older for that, maybe having had a trauma in the past in your shoulder. A lot of grinding goes on. We’re not talking about the occasional clicking when you move your arm but it’s the grinding stuff.
That is a bit of a telltale sign as well with osteoarthritis. And you can have an impingement. Impingement is one of the tendons within the shoulder joint in the area which gets impinged.
So when your shoulder decreases its space and the tendon becomes stuck essentially. Now, the test you can do for that on the right side is to put your right hand on your left shoulder and then raise your arm, and if this is sore, then you’re much likely got an impingement in the shoulder itself, or you can do the drop arm test where the arm is, you lift the arm using the other hand, all the way up and you bring it down, and a drop arm test just means you get to a stage where it gets sore and you can’t keep it up, you can’t keep your arm up itself. You need to go, like that. You have this painful arc. That’s a positive sign as well for an impingement.
What Is Frozen Shoulder?
Frozen shoulder, or its other term, adhesive capsulitis, is a relatively common condition affecting typically women between ages of 40 and 60, that comes on for no good reason.
Frozen shoulder is classically described in three phases.
The first phase is known as the freezing phase. Clinically patients complain primarily of pain at that point, and not so much stiffness.
The second phase is the frozen phase, and at that point, the pain often diminishes, but the shoulder can be markedly stiff.
Patients will eventually enter the thawing phase, and in many cases, frozen shoulder or adhesive capsulitis is a self-limiting condition, meaning that eventually, it does get better, sometimes completely on its own. But that process can take sometimes up to two years or more, but if you can make that diagnosis early, which can be tough, you may be able to avoid that process of stiffness.
We would recommend as a first step seeing your primary care doctor and discussing the problem, and at that point, the next step may be a referral to physical therapy or even evaluation by an orthopedist.
At the first visit, a patient can expect, first of all, and perhaps most importantly, a thorough history. That’s critical to making an accurate diagnosis.
Secondly is a thorough physical examination of the shoulder.
And generally, between the history and the physical examination, you should have a good sense of what’s going on. So in terms of treatment, for patients who are in that initial freezing phase, inflammatory phase, or having a lot of pain, anti-inflammatory medication can be helpful. Gentle, and we think the key is gentle physical therapy, either under the direction of a skilled physical therapist or sometimes even just self-directed at home, can be beneficial to help maintain range of motion.
We also routinely employ the use of intra-articular corticosteroid injections, which is an injection of corticosteroid that’s done directly into the shoulder joint, so if the patient is not getting better over a certain period, they may be a candidate for some type of intervention.
A surgical procedure is performed, it’s called an arthroscopic capsular release, so the procedure’s done arthroscopically through small incisions, and what’s done is under arthroscopic visualization, the stiff and fibrotic capsule is cut and released.
The bottom line is you have shoulder pain, and it’s affecting your daily living, we think it’s time to get checked out, initially, perhaps by your primary care physician, but certainly if the pain’s persisting and it seems like something is going on and it’s not just getting better on its own, it may be time to get checked out by orthopedics.
