If you’re in your twenties or thirties, shoulder pain is usually caused by a sports injury or other trauma, which can lead to complete dislocation or partial dislocation (subluxation) of your shoulder joint, or problems with your collarbone and shoulder bone joint (acromioclavicular joint), which connects your collarbone and shoulder bone.
If you’re in your fifties or sixties, shoulder pain is usually caused by tears in your rotator cuff — a group of muscles and tendons that support and stabilise the ball-and-socket joint of your shoulder. Tears often occur after an accident, injury or fall.
If you’re in your seventies, the most common cause of shoulder pain is arthritis.
Although shoulder pain can occur at any age, there are still certain risk factors that make it more likely to happen.
Your risk of shoulder pain increases if you play certain sports, including racket sports (eg tennis, badminton), volleyball, golf, basketball and cricket. Similarly, physical activities that involve repetitive overhead movements also increase your risk, such as weightlifting and bench pressing.
Many of these activities are part of a healthy exercise routine and therefore their benefits most often outweigh the risks of shoulder pain. However, you can still reduce your risk of shoulder pain by being aware of the normal movement and rhythm of your shoulder.
Shoulder pain could be a result of improper or poor training practices, wearing improper gear, or incorrect warm-up or stretching practices, all of which could lead to abnormal movement that affects the stability of your shoulder. If you notice any shoulder pain, you should therefore stop and if needed, see your GP. You can also see a physiotherapist or sports physiotherapist to help strengthen your shoulder to avoid future injury.
Falls can lead to fractures in the bones of your shoulder joint, partial or complete dislocation, and damage to your acromioclavicular (AC) joint.
Falls while cycling is a common cause of collarbone fractures and AC joint injuries. These are on the rise as more people take to cycling.
Certain occupations or hobbies
Any jobs that involve repetitive overhead movements increase your risk of shoulder injury and pain. Builders, carpenters and other tradespeople are therefore at increased risk, as well as anyone who does a lot of gardening or DIY.
Treatment for shoulder pain depends on the underlying cause. Bursitis and tendonitis are often treated with painkillers, non-steroidal injections and physiotherapy. However, shoulder pain caused by previous partial or complete dislocation, rotator cuff tears and arthritis may all need surgery at some point.
After a partial or complete dislocation of your shoulder joint, you may still feel ongoing pain after the ball and socket are back in place. This is due to instability in your shoulder joint. Surgery can restore stability by repairing the labrum (bumper), a thick ring of tissue that is attached to the rim of the socket part of your shoulder joint. This is performed through a keyhole surgery. Significant bone loss to the socket and ball of the shoulder joint would need open surgery to repair bone defects and stabilise the shoulder.
Rotator cuff tears can be caused by injury or can be degenerative. Those caused by injury need to be repaired with surgery, while those that are degenerative tend to only be operated on if non-surgical treatment hasn’t worked. Surgery involves reattaching the rotator cuff to the bone. This is achieved through keyhole surgery where the surgeon repairs the rotator cuff with sutures and anchors.
Shoulder arthritis is first treated with a variety of non-surgical options, including rest, changing your activities, physiotherapy, taking non-steroidal anti-inflammatory drugs (eg ibuprofen), applying heat or cold packs and steroid injections. However, if these treatments are no longer effective, your doctor may recommend surgery. Surgery ranges from shoulder arthroscopy to remove tissue that is causing pain to shoulder replacement surgery.
A fracture or separation of the AC joint also requires surgery if non-surgical treatments haven’t worked.
Every surgery comes with risks, commonly including complications from general anaesthesia, infection, bleeding, nerve damage and pain. In terms of shoulder surgery, there is also the risk of arthritis, stiffness, tightness and frozen shoulder.
Risks of shoulder replacement surgery include infection, damage to nerves and blood vessels, pain, stiffness, shoulder dislocation, fractures related to the artificial joint (periprosthetic fracture) and the need for further surgery.
Risks of surgery to treat shoulder pain after a dislocation include a failure of the surgery to stabilise the shoulder joint resulting in further dislocations. Similarly, with surgery to repair torn rotator cuffs, there is a risk of re-tearing, pain, stiffness as well as frozen shoulder.
These risks are generally small and your surgeon will discuss both the risks and benefits of your surgery with you, so you can make an informed decision.
With proper rehabilitation and physiotherapy after shoulder surgery, most patients can find relief from their previous symptoms.
Surgery to treat shoulder pain is only the first half of the story. In order for surgery to be effective in the long term, physiotherapy is essential to restore your range of movement, and prevent pain and stiffness.
Immediately after your surgery, you will need to rest your shoulder and wear a sling. However, you should still use your wrist and elbow. As you heal, you need to increase your shoulder movement based on guidance from your physiotherapist. You will need to practice exercises to strengthen your shoulder and restore full movement under supervision of the physiotherapist.
Recovery from shoulder surgery varies depending on the underlying condition. Surgery to treat major rotator cuff tears and shoulder replacement surgery can take six to eight weeks before you can return to all of your normal activities, including driving.
Technology to stabilise shoulder joints after dislocation continues to improve, with the use of anchors that aren’t metal (suture anchors) and stronger tapes for stabilisation.
Shoulder surgery that involves adding bone has also seen improvements, with the use of synthetic or donor bone so bone doesn’t need to be taken from elsewhere in your joint.
Shoulder replacement surgery has benefitted from newer short stem implants, 3D navigation technology, virtual planning of the surgery, the use of patient specific instrumentation to perform the surgery, and improved selection of the appropriate implant.
These advances in treatment are currently available here at Spire Healthcare and continue to improve the success and effectiveness of shoulder surgery for our patients.
Mr Jagwant Singh is a Shoulder and Elbow, Upper Limb Consultant at Spire London East Hospital specialising in sports injuries, arthroscopy, and elbow and shoulder surgery. He is also actively involved in research, has been involved in numerous clinical trials and has published his research extensively in peer-reviewed journals.