A Practical Guide to Shoulder Pain:

Learn How to Self-Diagnose and Treat Issues
The shoulders are a wonderful piece of the human body. They are so versatile, and allow us to accomplish so many of our daily tasks. However, our shoulders often undergo a lot of stress which lead to tightness and injuries.

This guide is designed to help those with tightness or pain in the shoulders. Section 3 will help you figure out what it is that is causing the problem (self-diagnosis), whilst section 4, follows it up with tips and exercises (self-treatment).
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Whilst we always recommend consulting a medical professional, many people have found these techniques to be very helpful, sometimes noticing improvements in as little as a few minutes. Keep reading to eliminate your pain today.

1. Getting to Know the Amazing Shoulder Joint

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The shoulder is a marvelously intricate, mobile and versatile part of the human body. The complex arrangement of bones and ligaments in the shoulder joint allows you to extend and rotate your shoulders and arms through an incredibly wide and useful range of motion.

But that same complexity also makes it very vulnerable to injury and pain, and diagnosing where the actual problem is can be tricky.

So, in order to help you understand the pain, let’s take a very brief tour of the shoulder:

Your shoulder is made up of three bones: the clavicle (or collarbone), the scapula (or shoulder blade), and the humerus (or upper arm bone) as well as associated muscles, ligaments and tendons.

The ligaments attach bones to other bones, and the tendons attach bones to muscles. So far so good.

Now, there are actually four four joints in the shoulder. The one that most of us are talking about when we say “the shoulder joint” is called the glenohumeral joint in anatomy text-books. It sits right between the ball-shaped end of the humerus bone and the outer edge of the scapula. This is where most of the shoulder’s incredible mobility comes from. It’s also the part of the shoulder that often works hardest, and it’s the most common source of pain.

If you want to take a closer look inside the shoulder, there’s a great app created by the folks at Human Biodigital that shows the human body in 3D. Some of the images here are screenshots from the site.

2. Common Causes of Shoulder Pain

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You can injure your shoulder quite easily while you’re working or training, or even by seemingly harmless but repetitive movements. Even slouching behind your computer for hours on end could cause it. There are also diseases that cause pain that can travel to the shoulder. These include diseases of the spine, liver, heart, or gallbladder.

Shoulder pain is most often from an injury – like a strain or a tear – caused by repetitive sports movements. It can come from throwing a ball over and over, as you might do in baseball, for example. Golf and tennis strains are also big culprits, or it can even happen during improper weight training.

As you get older, the wear and tear on this part of the body can weaken the structure of the shoulder, especially if you’ve allowed your muscles to atrophy from lack of exercise. The blood supply is quite poor in this area, and smoking can make it much worse. That’s why it’s important to keep the muscles strong and fit, and to regularly move and rotate your shoulder.

Jobs where you’re constantly lifting your arms above your head, like painting for example, can really put a strain on the shoulders, especially if you’re lifting heavy objects all the time.

Something else to keep in mind is that pain can be transferred (or ‘referred’) from one area to another. A shoulder pain might indicate a problem in the neck or the vertebrae – or vice versa. The pain can radiate outwards, and even shoot down your arm, weakening your grip.

3. Common Types of Shoulder Problems

Usually a pain in the shoulder will be little more than a nuisance, originating from a mild inflammation in a tendon or a slight strain from exercise. But it can also be extremely painful, and even life-threatening. In fact, a pain in the shoulder is one of the symptoms of a heart attack, especially when it’s accompanied by shortness of breath and dizziness.

The guidelines for self-examination which follow should be understood in this light – it’s always important to get the opinion of a trained medical professional.

However, for the milder types of shoulder complaints, this guide can really help you pinpoint the problem and then help you treat yourself effectively.

Rotator Cuff Pain

Right inside the shoulder’s ball joint is what’s called the rotator cuff. Pain here could indicate a tear or inflammation (tendinitis) of the ligaments. Your range of movement can become limited because of fluid accumulation within the joint that goes along with the inflammation.

Sometimes the muscles do not make the proper tiny adjustments within the joint to allow the humeral head to move smoothly. Arthritis and calcium deposits that form over time can likewise be very painful, and limit your range of motion.
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If the onset of pain is sudden, it’s likely a tear, but if the pain developed gradually it’s more likely tendonitis. The four major muscles attached to the rotator cuff are the Supraspinatus, Infraspinatus, subscapularis and the Teres minor.
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Pain in the rotator cuff can radiate outwards to these muscles, or any of the other muscles that help move and stabilize the shoulder. These include the deltoid, teres major, corachobrachialis, latissimus dorsi, and pectoralis major.

Here are some videos that may help determine the issue of your pain.

Impingement and Bursitis

Right inside the shoulder’s ball joint is what’s called the rotator cuff. Pain here could indicate a tear or inflammation (tendinitis) of the ligaments. Your range of movement can become limited because of fluid accumulation within the joint that goes along with the inflammation.
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Shoulder impingement is when the top of the shoulder blade (called the acromion) rubs, or "impinges" on, the rotator cuff tendons and bursa. The Bursae are tiny sacs of fluid that protect the joint from the friction that would be caused by bone grinding on bone. When these sacs are injured it can cause Bursitis, and it often goes hand-in-hand with impingement.

It will often occur as a result of an injury, such as a fall or a hit, where the shoulder gets compressed. Another common cause is a bony abnormality of the acromion, which can narrow the sub-acromial space. In other words – if your bones have abnormal spurs or protrusions from injuries or osteoarthritis.

If you experience pain while lifting your arm up in front of you until it’s above your head, this can indicate that you might have an impingement. The following video explains it.

Video Link (This video has some scratchy sound, but it’s a good explanation):

Biceps Tendonitis

Tendonitis can also easily develop in the biceps tendon, just like the tendons in the rotator cuff. The biceps tendon is a strong cord-like structure that connects the powerful biceps muscle of the forearm to the bones of the shoulder. This will tend to create pain in the front of the shoulder.
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Have a look at this clip.

SLAP Tear or Labrum Tear (Instability of the shoulder)

SLAP is an acronym for "superior labral tear from anterior to posterior”. It can be a lot more painful than just a little slap, though.

The labrum is a tough, white ring of cartilage around the cup of the ball and socket shoulder joint.
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The labrum can be torn in a number of different ways, and each of those ways has its own name. It’s quite involved. Basically, though, with a SLAP tear the shoulder can become unstable or dislocated.

Here’s how to find out if this is what’s causing your pain:

AC Joint Separation

Another one of the four joints in your complicated shoulder is called the acromioclavicular joint. That’s a mouthful, so let’s call it the “AC” joint to keep it simple. This joint can become ‘separated’ when the collar bone separates from the shoulder blade.
This often happens when you’re involved in an accident, receive a direct blow during contact sports, or if you fall directly on the "point" of your shoulder. Ouch.

Here’s how to check if that’s what’s causing the pain:
The labrum can be torn in a number of different ways, and each of those ways has its own name. It’s quite involved. Basically, though, with a SLAP tear the shoulder can become unstable or dislocated.

Here’s how to find out if this is what’s causing your pain:

Frozen Shoulder

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Frozen Shoulder can be a real killer. It’s an extremely painful condition where the shoulder is completely or partially unmovable. The shoulder joints are encased in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens, restricting its movement. It's more likely to occur in people who have diabetes. Often it’s when the shoulder has had to be immobilized for a long time – after surgery or an arm fracture.

It might even start quite unexpectedly, possibly a long time after the injury that set it off in the first place, and it can continue for a long time too. There are actually three stages of Frozen Shoulder:

Freezing

During the "freezing" stage your shoulder gradually becomes more and more painful and hard to move. It can last anywhere from 6 weeks to 9 months.

Frozen

During this stage you might experience less pain, but your shoulder is still difficult to move. It can last from four to six months, and everyday activities like washing your hair or reaching for something on the top shelf can be difficult.

Thawing

This can take up to 2 years, and it can be challenging to say the least. Slowly but surely your shoulder returns to normal or close to normal strength and mobility.

Here’s how to test for frozen shoulder:

4. Techniques to Relieve Shoulder Pain

First Aid

If you’ve just injured your shoulder, the first step is to try to reduce the pain swelling, and to immediately stop moving the joint.

  • Put ice on the injured area for 20 minutes, four to eight times per day, in different areas. You can use a cold pack, ice bag, or a plastic bag filled with crushed ice wrapped in a towel.
  • A sling can help keep the arm stable. Don’t move your shoulder for 48 hours, if possible.
  • Medicines such as aspirin and ibuprofen can also help reduce the pain and swelling, but this is just a short-term solution.
  • The first, and most important treatment for a shoulder injury is rest. After a couple of days you can gently and gradually start working the area to stimulate recovery, and
  • You can use a hot compress only once the swelling has subsided.

Exercises

Your shoulder may still feel stiff and painful for a long time afterwards. Rehabilitation will take time and patience. The following treatments work well to relieve pain and promote mobility in the long run.

Foam Roller

The foam roller technique is sometimes also called Self-Myofascial Release. For this you’ll need an inexpensive foam roller and a mat to lie on. A softer foam roller can be used when you’re just starting out to avoid putting too much pressure on a tender, painful shoulder. There are low, medium and high density foam rollers, and some with grids or knobs.

What you’re doing here is basically a deep self-massage. You can feel when you’re hitting those painful areas – the tight knots and trigger points, and you can control the pressure you’re using. Sometimes the most painful area isn’t the source of the problem. Because of pain transference, you might find that rolling over a related muscle will provide relief from pain elsewhere.

Lie down on a mat and place the foam roller under your shoulder, and gently massage the tender areas by pushing your body forwards and backwards using your legs. As you’re rolling, relax your body and breathe deeply. Concentrate on the tight knots that you feel as you’re going along.
The broad, even surface of the roller might not allow you to really target all those pressure points deeper in the shoulder. In this case, a trigger ball might be a great alternative.

Trigger Ball

In this technique you’re doing very much the same thing as with the foam roller, but instead you’re using a ball. Because it has a smaller surface you can really get into those tight corners.

You can lie on a mat, or you can even use it while standing and leaning up against a wall. Move around and explore all your pressure points until you find the spot that brings relief. A little pain is good, and can really relieve the muscle knots, but if it’s too painful you’re probably pressing too hard, and might be doing more damage than good.

Different sizes of balls work well for different areas. Many people use a tennis ball or lacrosse ball, or even a medicine ball.

Gua Sha

This ancient technique has recently come to the attention of Western science in a big way. It has its roots in Traditional Chinese Medicine, and it’s related to Accupuncture and Accupressure – both of which can also treat shoulder pain. The benefit of gua sha, however, is that you can use the technique on your own quite effectively without needing special training.

Using the proper gua sha tool and a lubricating oil or ointment, you ‘scrape away the pain’. It helps free up tension and releases the pain, and helps rid your body of toxins at the same time. For more information visit our gua sha page

Other kinds of exercises to help relieve shoulder pain include:

Prevention

The old saying goes: “Prevention is better than cure,” and this is certainly true where it comes to shoulder pain. Because the shoulder is so complex, getting rid of a problem can take a long time, and it can be complicated. It’s far better to avoid the problems by keeping your muscles and joints in good shape.

A good preventative program will include:
  • Rotating the shoulder through the full range of motion regularly.
  • Stretching often
  • Strengthening the arm, rotator cuff, back and neck muscles with regular exercise.
  • Keeping a good posture
  • Avoid improper weight training such as lateral raises above 90 degrees.

5. More Useful Resources for Shoulder Care

· A simple online self-diagnosis tool from https://www.shoulderdoc.co.uk/article/355

· A useful flowchart to pinpoint the probable cause of pain and identify the problem from http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/shoulder-problems.html

· An interactive graphical 3D model of the body with a searchable interface at https://human.biodigital.com/index.html

Further reading

Sources for this information include some of the following website (All retrieved 01 April 2016). You can check out the links to further information:

http://www.healthline.com/symptom/shoulder-pain

Shoulder Anatomy


http://www.md-health.com/Shoulder-Blade-Pain.html

http://www.stoneclinic.com/rotator-cuff-tear

http://www.nhs.uk/Conditions/shoulderpain/Pages/diagnosis.aspx

http://orthoinfo.aaos.org/topic.cfm?topic=a00065

http://www.medicinenet.com/shoulder_pain/symptoms.htm

Chronic Shoulder Pain: Part I. Evaluation and Diagnosis http://www.aafp.org/afp/2008/0215/p453.html

https://breakingmuscle.com/strength-conditioning/understanding-the-shoulder-and-bulletproofing-it-from-injury

http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/shoulder-problems.html

http://www.physioadvisor.com.au/7662950/shoulder-pain-diagnosis-shoulder-injury-diagnosi.htm

https://www.shoulderdoc.co.uk/article/1370
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