Five common shoulder problems and how to treat them

Your shoulder is a complex joint that gets put through a lot every day. Whenever you get dressed, brush your teeth or lift something, you’re using it. The bones, tendons, ligaments and muscles that make up your shoulder can develop problems, especially as you get older.

Here are five common shoulder problems, how to spot them and how to treat them.

1. Frozen shoulder

Frozen shoulder happens when the lining around your shoulder joint (the capsule) becomes thick and inflamed.

It causes pain inside your shoulder joint and in your upper arm. The pain can be bad enough to stop you sleeping at night. As it progresses, your shoulder will get stiff and harder to move.

Frozen shoulder can improve with time, though it can take up to two years for some people. If you've got a severe case, treatment can speed up your recovery.

How is it treated?

As the first line of treatment, painkillers and anti-inflammatories can help reduce the pain and improve your range of movement.

Hydrodistension may also be an option. This involves injecting a small amount of saltwater into the capsule to stretch it and improve the range of motion. It is a simple, quick and low-risk procedure that can be done in an imaging department.

If these treatments aren’t effective, keyhole surgery is an option. Your surgeon will release the thick and inflamed capsule and free up your shoulder. Many patients enjoy a significant improvement in their pain and stiffness after recovering from surgery.

2. Rotator cuff tear

Your rotator cuff is a group of four tendons and muscles that wrap around your shoulder joint. They control movement in your shoulder and keep the end of your upper arm bone snugly in its shoulder socket.

The tendons that attach the muscles to the bone can weaken with age and overuse, making them more likely to tear. Tears can be small or large, partial or complete. 

If you get a rotator cuff tear, you’ll typically feel pain and weakness in your upper outer arm that gets worse as you reach away from your body. You may also find it difficult to raise your arm above shoulder height. Symptoms will come on gradually unless it’s a result of an injury.

How is it treated?

Your rotator cuff tendons naturally wear down over time, causing minor tears — these usually do not require treatment. However, if you’re in pain or feel weakness in your shoulder joint, then you should see your GP for treatment.

Painkillers and anti-inflammatories should help. Physiotherapy to improve your posture and build strength in your core and shoulders will give your body the best chance of healing quickly.

In more serious cases or if physiotherapy isn’t effective, surgery may be recommended. The repair can be done using keyhole surgery; the torn tendon will be attached back onto your bone. You will normally spend four to six weeks wearing a sling and then gradually work your way up to performing all of your everyday activities. 

As you get older, healing becomes more difficult. If you’re over 70, you may decide not to have surgery as it may be challenging to heal properly after surgery. In younger people, surgical outcomes are usually better.

3. Shoulder arthritis

Shoulder arthritis happens when the cartilage that lines and protects the shoulder’s ball and socket joint wears out. It leaves the surfaces of the two bones rubbing against each other, causing pain and stiffness.

You’ll feel an ache inside your shoulder that gets worse over time. It will usually feel worse when you move your joint and you may feel a grinding sensation (crepitus). Your shoulder pain may also keep you up at night.

How is it treated?

Painkillers and anti-inflammatories should help you with the pain. Steroid injections can help too, but they may become less effective over time. Physiotherapy can help keep your shoulder mobile and strong in the early stages, but it can’t stop arthritis progressing.

For severe arthritis, shoulder replacement surgery is the most effective treatment. Your worn-out joint surfaces are replaced with prosthetic components to give you a brand new ball and socket joint. You’ll be left with a 10-15cm scar on your shoulder and will need to stay in hospital for two to three days.

Outcomes are good and up to 90% of replacement shoulder joints last more than 10 years.

4. Shoulder bursitis

Inside each of your shoulders are fluid-filled sacs called bursae, which help your rotator cuff tendon glide smoothly over the bones in your joint. Bursitis occurs when these sacs become inflamed, causing pain. 

Bone growths called spurs can trigger bursitis. However, bursitis is most often caused by overuse of your shoulder joint and wear and tear. Poor posture and rotator cuff injury also increase your risk of shoulder bursitis. 

You’ll usually get an aching feeling over your upper outer arm that comes on slowly. It will hurt more when you reach away from your body or behind your back, and it can stop you from sleeping at night.

How is it treated?

Bursitis can usually be effectively treated with physiotherapy and a steroid injection. However, for severe bursitis or bursitis that keeps coming back, surgery can be performed to drain the bursae or in rare cases, remove them. 

5. Shoulder dislocation

When a shoulder is dislocated, it can tear tissue around the socket, damage the bone and stretch the ligaments. It usually happens as a result of an impact during sports, eg a rugby tackle, but can also be caused by falling on your shoulder or being in an accident.  

A complete dislocation is usually obvious and you should go to A&E for treatment. A partial dislocation (a subluxation) is less obvious and in most cases will work its way back into the socket on its own.

How is it treated?

Once the top of your arm bone is secured back into the shoulder socket, you’ll need to wear a sling for a week or so and then begin physiotherapy to regain mobility and strength in your shoulder.

If you’ve dislocated your shoulder as a result of an injury, there’s a high chance it will dislocate again. You may need keyhole surgery to fix this.

Some people have a bone reconstruction surgery (Latarjet procedure) to mend the damage inside their shoulder. This leaves a 5-7cm scar over the front of your shoulder. A piece of bone near the shoulder is taken and used to repair the damaged joint bone. After surgery, you’ll need to wear a sling for four to six weeks and start physiotherapy to recover. The outcomes are usually very good, with about 90% of people regaining stability of their shoulder joint.