A painful shoulder is a common GP presentation and can be due to a variety of causes. Effective management relies on accurate diagnosis and tailored treatment.
Causes:
- Rotator Cuff Disorders: Including tendinitis, bursitis, and rotator cuff tears.
- Shoulder Impingement Syndrome: caused by a structural narrowing of the subacromial space
- Overuse or Strain: Due to repetitive movements or heavy lifting.
- Calcific Tendinitis: Calcium deposits in the tendons of the rotator cuff.
- Frozen Shoulder (Adhesive Capsulitis): Characterized by stiffness and pain in the shoulder joint.
- Arthritis: Osteoarthritis or rheumatoid arthritis affecting the shoulder joint.
- Trauma: Fractures, dislocations, or sprains of the shoulder.
- Referred Pain: From neck or other areas.
Diagnosis:
- Clinical History and Physical Examination: Assess pain characteristics, range of motion, and functional limitations.
- Imaging:
- X-Rays: Detect fractures, arthritis, and changes in joint space.
- Ultrasound: Assess the rotator cuff and bursae.
- MRI: Detailed view of soft tissues including rotator cuff tears.
Differential Diagnosis:
- Neck Pathologies: Cervical radiculopathy can mimic shoulder pain.
- Biceps Tendinopathy: Pain in the front of the shoulder.
- Glenohumeral Disorders: Like arthritis or instability.
- Thoracic Outlet Syndrome: Compression of nerves/blood vessels in the shoulder region.
- Heart Problems: Myocardial infarction can sometimes present as shoulder pain.
Management:
- Conservative Treatment:
- Rest and Activity Modification: Avoid activities that exacerbate pain.
- Physiotherapy: Exercises to strengthen and improve the range of motion.
- Pain Management: NSAIDs, paracetamol, or topical analgesics.
- Corticosteroid Injections: For inflammation reduction.
- Frozen Shoulder Management:
- Prolonged Physiotherapy: Emphasis on stretching and mobility exercises.
- Corticosteroids: For severe pain and limited motion.
- Rotator Cuff Tears:
- Surgical Repair: Considered in full-thickness tears or if conservative treatment fails.
- Arthritis:
- Joint Protection Strategies: Weight management, gentle exercise.
- Disease-modifying Agents: In rheumatoid arthritis.
- Rehabilitation: Focus on restoring function, strength, and flexibility.
- Education and Self-care: Educating patients on proper shoulder use and ergonomics.
Surgical Interventions:
- Considered when conservative measures fail or in cases of severe injury or dysfunction. Options include:
- Arthroscopic Surgery: For rotator cuff repairs, decompression, or removal of loose cartilage.
- Shoulder Replacement: In severe arthritis or complex fractures.
When to Refer:
- Severe injuries like fractures or dislocations.
- Suspected rotator cuff full-thickness tears.
- Lack of improvement with conservative treatment.
- For specialized interventions like injections or surgery.
Follow-up:
Regular monitoring of progress, pain levels, and functional abilities is crucial. Adjust treatments as needed based on response and recovery progress.