19 April 2018
I’m sure many of us would start by naming the hips and knees as common joints in the body where people suffer pain, and you wouldn’t be wrong in doing so. However shoulder pain is also a significant complaint amongst the population. As the occurrence of painful joints increases with age, the costs to healthcare and work places through employee absence are likely to increase in parallel with the predicted increase in life expectancy.
So I spoke to Mr Sunil Garg, Consultant Orthopaedic Surgeon at Spire Norwich Hospital about the common and painful condition.
How does the shoulder work?
The shoulder is the most mobile joint in the body. Movement takes place at the main shoulder joint as well as the shoulder blade, which moves over the back of the chest. The shoulder joint is a ‘ball-and-socket’ style joint which allows a very wide range of movement. The joint is surrounded by a tough, fibrous sleeve called the capsule; the inner layer of this, the synovium, produces fluid to nourish and lubricate the joint. A group of four muscles and their tendons make up the rotator cuff which plays a very important part in the working of the shoulder, helping to move it and hold the joint together.
What are the causes of shoulder pain?
Shoulder problems may be part of a general condition such as rheumatoid arthritis or osteoarthritis. Problems in the neck, for example, may cause pain which is actually felt in the shoulder, this is known as ‘referred pain’. When the problem does originate in the shoulder joint the pain is often felt over the front of the shoulder or in the upper part of the arm and there are a few possible causes:
- Inflammation of, or damage to, the bursa, muscles and tendons around the shoulder especially within the rotator cuff – referred to as shoulder impingement
- Inflammation in the capsule of the shoulder joint - Frozen shoulder
- Damage to the bones and cartilage, which may be caused by arthritis.
Who is at risk of developing shoulder pain?
Although nothing has been proven, overhead activity of the shoulder, especially repeated activity is a risk factor for shoulder impingement. Examples include painting and overhead sports such as tennis. Hairdressers, decorators and electricians may have a higher risk of shoulder impingement pain too.
What is your advice to someone suffering with shoulder pain?
Many shoulder problems will improve with medications such as Ibuprofen. However if their pain is not settling after two weeks I would encourage them to make an appointment with their GP. Their GP will ask a series of questions and ask which movements give most pain because this will be a good indication of where the problem is. A referral for an X-ray or an ultrasound scan may be very helpful in understanding what is going on in the shoulder. Magnetic resonance imaging (MRI) is only needed in certain situations and may be carried out if your GP suspects a complex problem in the shoulder, or when further, more specialised treatment is planned.
How is shoulder pain treated?
The vast majority of shoulder problems will benefit from physiotherapy. Almost everyone will benefit from specific exercises which will concentrate on easing any stiffness and strengthen muscles around the shoulder. Transcutaneous electrical nerve stimulation (TENS) or heat/cold therapy, may also help to ease pain and in some cases steroid injections into the shoulder by a specialist may give some relief by reducing the inflammation and allowing the shoulder to move more comfortably.
Will surgery help?
Most shoulder problems improve without the need for surgery, at least to a point where they do not cause too much pain or interfere too much with your daily life.
But some conditions can be helped by surgery. If an operation is needed it can often be performed using keyhole techniques. Keyhole techniques (also called arthroscopy) require a smaller incision than conventional surgery. They can be used to find out more about your problem or to carry out a variety of treatments. The advantage of keyhole surgery is that the scar is smaller and it is less painful than conventional operations because there are fewer disturbances of the tissues. Surgery is not often necessary in the treatment of shoulder pain, but in some cases it can be very helpful, but is not the answer for everyone.
Can the shoulder joint be replaced?
Shoulder joint replacement is well established and can be very successful for several conditions. These are used mainly for osteoarthritis and rheumatoid arthritis when severe pain restricts movement and use of the shoulder. In shoulder replacement operations a metal head with a long stem replaces the upper part of the upper arm bone with a plastic ‘cup’ fitted into the socket of the shoulder blade.
A shoulder replacement is very good for removing the pain and providing better use of the arm. Some people regain more movement than others.
Physiotherapy and exercises after the operation are important to help you regain movement gradually.
As with any operation it is important that you are given a realistic idea of what you can expect to gain as well as any particular risks. If you are in any doubt you should make sure you discuss this with your surgeon before the operation.
For further information or to make a private appointment please contact one of the team on 01603 255 614. Further details regarding consultant Orthopaedic surgeon Mr Sunil Garg can be found on his consultant profile at www.spirenorwich.com.
All surgery carries an element of risk and the content of this page is provided for general information only. It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.