Shoulder pain and discomfort: common complaints and treatments

Summer is finally here and with the improved weather more people will be playing sports such as tennis, cricket and rugby. Unfortunately, increased activity also leads to a higher risk of sustaining shoulder injuries – both sports and non-sports related.

The shoulder consists of a complex arrangement of bones, joints and muscles. As an intricate part of the body, the balance of how the shoulder works can be easily upset, resulting in shoulder pain. But how and why do most minor shoulder injuries come about, and what treatment options are available? Mr Ali Al-Sabti, Consultant Orthopaedic Surgeon at The Holly Private Hospital, explains.

Posture, positioning and pain

There are many conditions that can affect the shoulder causing a combination of pain, weakness and stiffness. The main cause of non-traumatic shoulder pain is poor positioning and poor movement quality. How do you reach up to that kitchen cupboard? Do your shoulders raise up to your ears to get that cup off the shelf? Doing this once in a while might be OK, but constant and regular movements with poor posture can result in pain and stiffness.

Age-related complaints

Certain shoulder problems occur more frequently at a particular age.

• In the under-40s, instability of the shoulder – joint dislocation or feeling like it is popping out of joint – is fairly common. This usually happens post-injury but can start happening without any obvious trigger.
• For 40-60 year olds, frozen shoulders and subacromial impingement are the most common causes of pain. A frozen shoulder is a painful, stiff shoulder usually starting without injury. Subacromial impingement causes pain down the side of the arm, usually worse with lifting the arm up or twisting.
• In the over-60s, damage to the rotator cuff muscles (deep shoulder muscles that help move and stabilise your shoulder) is common. This can either be wear and tear of the muscle or the detachment of the muscle to the bone (rotator cuff tear)

Treatment: non-surgical

An accurate diagnosis is vital when it comes to shoulder issues. Standard X-rays can help establish a diagnosis in the majority of cases, at which point the decision may be to treat with an exercise programme, injections, or to refer to an orthopaedic surgeon for further review.

Injections of steroid (Cortisone) are performed for both shoulder diagnosis and treatment. It’s worth bearing in mind however that a noticeable improvement can take weeks and even months.

Treatment: surgical options

There are some conditions that require prompt surgical intervention. Common types of shoulder surgery include:

• Shoulder arthroscopy: a minimally-invasive procedure that involves a small incision. A tiny camera is inserted to enable the doctor to locate and identify any damage.
• Rotator cuff surgery: Overuse or injury can cause damage to the rotator cuff, which can be repaired with surgery. Depending on the type and extent of the damage, rotator cuff surgery can involve a larger open incision or smaller incisions to allow arthroscopic access to the damaged area.
• Shoulder arthritis: For severe cases of shoulder arthritis, infected parts of the shoulder might be removed and replaced with an artificial material.
• Fracture repair: Sometimes when a fracture takes place in the shoulder, the fractured bones are knocked into a position that will require surgery to move them back into place. Depending on the nature of the fracture, this type of surgery may be done as an open incision or arthroscopically.

Mr Ali Al-Sabti has clinics at The Holly Private Hospital every Wednesday and alternate Thursdays. To book an appointment call 020 3925 1323.