Shoulder Pain

Why is my shoulder hurting?

Shoulder pain can arise when your shoulder is overly-mobile, or too stuck (the opposite). It can also be due to an overuse of or a trauma to the shoulder.
The estimated prevalence of shoulder complaints in Singapore is 7% – 34% with about 14.7 new cases per 1000 patients per year seen in clinics. [¹]
Most shoulder pain can mainly be classified into 4 categories: tendon inflammation, instability, osteoarthritis (OA), and fracture. (Fig. 1)

Categories of shoulder pain, ranging from dislocation, overuse/traumatic injuries, and or too unstable

Fig. 1 Categories of shoulder pain

 

Where are… your shoulders?

Before diving further into common shoulder conditions, let us take a quick look at the shoulder’s anatomy!

  • The shoulder joint is a ball and socket joint (Fig. 2), which is made up of the scapula (shoulder blade) and the humerus (upper arm bone) (Fig. 3)

Image of the ball and socket joint located in the shoulder

Fig. 2: Image of the Ball and Socket joint 

Image of shoulder anatomy bones including the humerus and scapula

Fig. 3: Image of shoulder anatomy (bones)

  • The shoulder is the most mobile joint in the human body! It has 6 degrees of freedom (i.e., can move in 6 different directions), and is stabilized via muscles and other passive structures (e.g., ligaments). However, with great mobility comes great instability – the shoulder joint is highly susceptible to injuries due to its mobile nature.
  • Four rotator cuff muscles (i.e., supraspinatus, infraspinatus, teres minor, subscapularis). The tendons of these muscles insert themselves onto different bony structures of the shoulder joint, hence forming a “cuff” (Fig. 4 and Fig. 5) around the shoulder to stabilize the mobile joint.

Four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis)

Fig. 4 Image of the rotator cuff

Four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis)

Fig. 4 Four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis)

image depicting the rotator cuff muscles and how they hold the humerus in place

Fig. 5. Another image depicting the rotator cuff muscles and how they hold the humerus in place

  • Your arm is not stuck to your body! It is connected to the torso via the different structures mentioned above. Other surrounding musculature (i.e., deltoid, pectoralis, latissimus dorsi, rhomboids) (Fig. 6) and a fibrous capsule (Fig. 7) also helps to hold the shoulder joint in place. The shoulder capsule has 4 “walls” to it: top, bottom, front and back. These “walls” prevent the shoulder socket from shifting out of place.

Image of the shoulder muscles (deltoid, pectoralis, latissimus dorsi, rhomboids)

Fig.6 Image of the shoulder muscles (deltoid, pectoralis, latissimus dorsi, rhomboids)

Shoulder capsule

Fig. 7 Shoulder capsule

What are some common problems that your shoulder can experience?
Listed below are common conditions of the shoulder that cause pain. Do note that this list is not exhaustive.

  • Overuse injuries:
    • Tendon inflammation
    • Rotator Cuff impingement
    • Osteoarthritis
  • Traumatic injuries:
    • Shoulder dislocations
    • Shoulder fractures
  • Others:
    • Frozen Shoulder

Different conditions will lead to different types of pain/discomfort in the shoulder. For example, shoulder impingement can cause pain at the top/outer side of the shoulder (Fig. 8) that can be worsened by lifting the arm overhead and/or putting the arm behind the back.

Image of area of pain on the shoulder

Fig. 8 Image of area of pain on the shoulder

Traumatic injuries such as fractures or dislocations will likely present with sharp pain and an inability to move the affected arm.
Frozen shoulders are likely to result in generalized deep aching pains around the shoulder joint(s) accompanied by reduced shoulder range of motion in all directions.

What should I do if I have shoulder pain?

Here are a few simple stretches and exercises that you can try out at home to ease off the pain and discomfort. These exercises aim to relax the muscles surrounding the shoulder, improve joint mobility, and strengthen the muscles. If you suspect you have an injury and/or a loss of integrity in the shoulder joints/muscles, please do not attempt the exercises and seek a doctor’s or physiotherapist’s advice.

Hands behind back chest stretch

Girl doing shoulder stretch

  1. Stand tall with legs hip-width apart.
  2. Roll your shoulder backward with hands clasped.
  3. Lift your chest bone up and at the same time gently pull the arms back, feel a gentle stretch across the front of your chest
  4. Hold the stretch for around 30 seconds, and repeat 3 to 5 times.

Pendulum exercises

  1. Stand with legs hip-width apart and stagger your feet for balance.
  2. With the unaffected arm supported on a table/firm surface, allow the other arm to hang towards the floor.
  3. Gently rock your body front to back, as well as side to side, using your body weight.
  4. Let the momentum of the body swing the affected arm freely. Ensure the muscles around the shoulder are relaxed.
  5. Perform the exercise for about 30 seconds for one plane (e.g., front to back), then switch to the other plane (e.g., left to right). Repeat this for 3 sets.

Shoulder rolls

  1. Stand/sit upright with arms comfortably by your side.
  2. Slowly bring your shoulder (blades included!) backwards – up to your ears, back, and downwards, circling it around. Perform 8 to 10 rotations for 3 sets. Remember to take a short break in between each set.
  3. Once you are done, you can roll your shoulder forward, repeating 8 to 10 rotations for 3 sets, with short breaks in between the sets.

Scapula retraction

  1. Stand or sit comfortably.
  2. Gently draw your shoulder blades in towards the spine, squeezing the muscles in between the shoulder blades, and feeling the front of your shoulder open. Take note to not shrug your shoulders.
  3. Slowly release the squeeze and return your shoulder back to its original position.
  4. Perform this 8 to 10 times and repeat it for 3 sets. Take a short break between each set.

Most shoulder pain responds well to conservative treatments, and physiotherapy can help with improving such conditions. Generally, a combination of manual therapy and therapeutic exercises will be sufficient to reduce pain and return the affected shoulder to its full function.

If you have any queries or are unsure on what to do, Contact us at +65 9755 3516 via WhatsApp to set up a consultation with one of our friendly therapists! Remember to follow us on our socials – Instagram and/or Facebook for the latest updates.

References:
[1] De Yang Tian, J., & Hwee Chye Tan, A. (2014) Shoulder Impingement Syndrome, A Common Affliction of the Shoulder: A Comprehensive Review. Proceedings of Singapore Healthcare, 23 (4). https://journals.sagepub.com/doi/pdf/10.1177/201010581402300406