Treatments for shoulder pain
Mr Steve Gwilym, Consultant Orthopaedic Surgeon
How common is shoulder pain?
As many as two thirds of people experience shoulder discomfort at some point during their lives. The most mobile joint in your body, the shoulder is made up of bones held in place by muscles, tendons, and ligaments. They’re all designed to work together to allow the shoulder to move freely in many different directions. This allows you to do everything from raising your arms over your head to throwing a ball and scratching your back. Unfortunately, this mobility comes at the expense of stability, which leaves the shoulder vulnerable to injury.
What is causing my shoulder to hurt?
The most common causes of shoulder pain are related to the tendons that surround the shoulder joint (the rotator cuff tendons), which become inflamed or tear. Frozen Shoulder is a very common cause of severe pain and stiffness in the shoulder.
Increasingly active lifestyles put a lot of strain on the shoulders, which may result in pain through over-use damage or acute injury. Shoulder pain can also arise from arthritis, although this occurs less often in the shoulder than in other joints.
Why is my shoulder pain worse when I’m in bed at night?
Most shoulder problems are made worse when people are in bed at night. This can happen either when you first lay down to try and get to sleep or when you roll onto your shoulder in the middle of the night. Being prevented from sleep or being woken from sleep can be very disruptive and is often a reason for people to seek help with their shoulder problems.
No-one knows why it is that shoulder pain often gets worse when the patients lay down to go to bed at night. However, it is a very consistent feature which again, fortunately, resolves in the majority of cases when the treatment is complete.
What treatments are available for shoulder pain?
There is a broad range of treatments that can be used to treat shoulder pain, ranging from advice, simple pain killers, specialist physiotherapy, therapeutic injections and surgery. The most important factor is the correct diagnosis at the beginning. For this you will need a thorough assessment of your shoulder involving consultation and examination.
These assessments are usually supported by medical imaging which can involve x-rays, ultrasound scans, CT scans or MRI, depending on what is found at the time of your assessment. Almost three quarters of patients with shoulder pain are treated without surgery. Non-operative treatment relies heavily on the close interaction between the shoulder specialist, and the physiotherapists involved in your care.
What sort of surgery might I need?
Shoulder surgery can involve either minimally invasive keyhole surgery or more traditional ‘open’ surgery.
Can I have a steroid injection?
Steroid injections, combined with local anaesthetic, can be very helpful in trying to diagnose shoulder problems. It is important to ensure that people do not have this treatment too frequently or use this treatment as a substitute for a longer-acting solution, such as surgery, for certain conditions.
Around half of the patients I see with shoulder problems ultimately have an injection into the joint and for the vast majority it is a problem-free solution to their shoulder pain.
When should I seek medical help?
Some shoulder pain resolves itself within a couple of weeks with simple pain medications. However, if you experience shoulder pain without a history of injury that lasts for more than a few weeks then we recommend that you seek medical attention.
If your shoulder pain came on after an injury or accident you should have an assessment of the bones and tendons of the shoulder much sooner.
You can find more information on rotator cuff disorders here.