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Why Is My Shoulder Aching ?
There is a big list of causยญes for Shoulยญder pain. Few of these causยญes are not origยญiยญnatยญing from the shoulยญder joint itself, known as; Referred pain. The causยญes of Shoulยญder pain might difยญfer from one perยญson to anothยญer accordยญing to genยญder, age, lifestyle, occuยญpaยญtion and genยญerยญal medยญical condition. Before we disยญcuss this list, we would like to enuยญmerยญate few facts about the Shoulยญder joint. 1- It is comยญposed of an articยญuยญlaยญtion between the Humerus Head and the Gleยญnoid ( part of the Scapula ). 2- It has the biggest range of motion of any joint in the body. 3- It is the most comยญmonยญly disยญloยญcatยญed joint, with anteยญriยญor disยญloยญcaยญtion being the most common.
Causes Of Shoulder Pain
1- Shoulder Arthritis
A prevaยญlent cause of shoulยญder pain, espeยญcialยญly in oldยญer peoยญple. Age is just a numยญber, but in genยญerยญal, by 50โ60 years, arthriยญtis becomes a comยญmon cause of joints pain ( Shoulยญder, hip, knee, etc.). Arthriยญtis can be idioยญpathยญic ( no cause ) or secยญondary to sysยญtemic disยญease, trauยญma, etc. Disยญcrimยญiยญnaยญtor: Usuยญalยญly, the pain increasยญes with activยญiยญty and decreasยญes with rest unless the arthriยญtis is advanced, leadยญing to the ongoยญing conยญstant pain.2- Rotator Cuff Diseases
Rotaยญtor cuff patholยญoยญgy is comยญmon among younger and oldยญer patients. A specยญtrum of disยญeases affect the Rotaยญtor cuff as; impingeยญment, inflamยญmaยญtion, parยญtial or full tears. Disยญcrimยญiยญnaยญtor: With impingeยญment or small tears, the pain is usuยญalยญly at the extreme range of motion as the musยญcles impinge on the bony strucยญtures. In big tears, the pain could be conยญstant and assoยญciยญatยญed with much decrease in range of motion, plus night pain could occur.3- The Long Head Of The Biceps Muscle
The biceps musยญcle has two heads; long and short ones. The long head is intra-articยญuยญlar, meanยญing it runs in the joint. This long head can get inflamed ( synยญovitic ) or even get torn; it will cause anteยญriยญor shoulยญder pain and upper arm pain in both cases. Disยญcrimยญiยญnaยญtor: Pain is usuยญalยญly locatยญed in the anteยญriยญor aspect of the shoulยญder, just disยญtal to the joint ( on the upper arm ).4- Labral Injuries
The labrum is the soft tisยญsue linยญing around the gleยญnoid. It helps to proยญvide staยญbilยญiยญty by increasยญing the depth of the gleยญnoid ( socket ). Labral injuries can be acute or chronยญic. Chronยญic injuries ( also known as degenยญerยญaยญtive ) can cause deep shoulยญder pain with range of motion. Acute injuries are more comยญmon in younger patients; this could be due to a sinยญgle trauยญmatยญic event or ongoยญing repetยญiยญtive load to the joint. Disยญcrimยญiยญnaยญtor: Deep joint pain which could be assoยญciยญatยญed with clickยญing, espeยญcialยญly in casยญes of acute injuries in younger patients or could be assoยญciยญatยญed with the senยญsaยญtion of instaยญbilยญiยญty in acute casยญes secยญondary to disยญloยญcaยญtion ( in this case, it might be a painยญless senยญsaยญtion of instaยญbilยญiยญty with an almost full range of motion ). In oldยญer patients with chronยญic degenยญerยญaยญtive labral injuries, the pain is mild and simยญiยญlar to arthritยญic pain.5- Acromioclavicular Joint Arthritis
The acromioยญclavยญicยญuยญlar joint is a small joint with very litยญtle motion locatยญed anteยญriยญorยญly and on top of the main shoulยญder joint ( Glenoยญhumerยญal joint ). This articยญuยญlaยญtion is between the Acromion ( part of the scapula/shoulder blade ) and the Clavยญiยญcle ( colยญlar bone ). This joint might get arthritยญic ( narยญrowยญing of the space ), causยญing pain very well localยญized anteยญriยญorยญly yet can be perยญceived as shoulยญder pain. Disยญcrimยญiยญnaยญtor: Localised point of pain/tenderness over the joint on the anteยญriยญor aspect of the shoulยญder region. This is usuยญalยญly not assoยญciยญatยญed with decreased range of motion nor night pain if it occurs in isolation.6- Nerve Pain
Few nerves run around the shoulยญder as; Axilยญlary, Suprasยญcapuยญlar, and Infraยญscapuยญlar nerves. Impingeยญment of any of these nerves around the shoulยญder would cause pain ( usuยญalยญly sharp shootยญing pain ). Disยญcrimยญiยญnaยญtor: Sharp shootยญing pain ( rather than aching pain ), referred down to the arm.7- Brachial Plexus Injury
The brachial plexus is the bunยญdle of nerve trunks and cords arisยญing from the neck and feedยญing the whole upper extremยญiยญty down to the finยญgerยญtips. Brachial plexus injuries due to sysยญtemic disยญeases or secยญondary to trauยญma will cause shoulยญder pain. Disยญcrimยญiยญnaยญtor: As in nerve pain, sharp shootยญing pain with weakยญness in the musยญcles involved and decreased senยญsaยญtion in the affectยญed derยญmatomes in the arm/forearm/wrist and hand.8- Neck Pain
Also called referred pain since the patholยญoยญgy is not origยญiยญnatยญing from the Shoulยญder joint itself. This is a prevaยญlent cause of pain that could be thought of as shoulยญder pain, yet the shoulยญder is non-pathoยญlogยญic, yet it just perยญceives the pain. Neck patholoยญgies as degenยญerยญaยญtive disc disยญease, spinal stenoยญsis, foramยญiยญnal stenoยญsis ( foraยญmen where the nerve root exits the spinal cord ) or paraspinal musยญcle spasm can cause neck and shoulยญder pain. This pain can be assoยญciยญatยญed with numbยญness, tinยญgling and maybe weakยญness down to the hand levยญel, which is very uncomยญmon in true shoulยญder pain when the patholยญoยญgy origยญiยญnates from the joint. Disยญcrimยญiยญnaยญtor: Pain in the neck and/or the paracยญerยญviยญcal musยญcles that might be increased with neck range of moveยญments, plus pain/numbness and tinยญgling radiยญatยญing down the arm.9- Infection
This is uncomยญmon withยญout preยญdisยญposยญing facยญtors as shoulยญder surgery, open fracยญture or underยญlyยญing immunoยญcomยญproยญmised disยญease, yet it can also occur sponยญtaยญneousยญly. This can be preยญsentยญing as celยญluliยญtis or shoulยญder joint infecยญtion. It is usuยญalยญly assoยญciยญatยญed with redยญness, swelling, decreased shoulยญder range of motion, fever etc. Disยญcrimยญiยญnaยญtor: Conยญstant aching pain even at rest assoยญciยญatยญed with skin redยญness, swelling, and sysยญtemic changes as fever and chills.10- Inflammation
For examยญple; Burยญsiยญtis ( which is difยญferยญent from the infecยญtion since there is no pathogen). It is inflamยญmaยญtion of the tisยญsue either inside the shoulยญder joint or in subยญacroยญmiยญal space or extra-articular. The intra-articยญuยญlar usuยญalยญly presents as the rotaยญtor cuff patholยญoยญgy, while the extra-articยญuยญlar could present with redยญness and swelling. Disยญcrimยญiยญnaยญtor: Like rotaยญtor cuff patholยญoยญgy, the superยญfiยญcial burยญsae can present with redยญness and swelling plus focal localยญized pain.11- Frozen Shoulder ( also known as Stiff Shoulder )
It can occur withยญout any reaยญson but is more comยญmonยญly present after shoulยญder surgery, more in females, diaยญbetยญics, breast canยญcer treatยญment, carยญdioยญvasยญcuยญlar disยญeases, myocarยญdial dysยญfuncยญtion, thyยญroid dysยญfuncยญtion, and sedenยญtary life. Disยญcrimยญiยญnaยญtor: Decreased range of motion usuยญalยญly starts with exterยญnal rotaยญtion defiยญcienยญcy, and pain increasยญes with the range of motion. The pasยญsive range of motion will be equalยญly affectยญed as well.12- Scapular Pain
This can be due to few reaยญsons as trauยญma or dyskยญiยญneยญsia ( altered scapuยญlar posiยญtion and motion ). Dyskยญiยญneยญsia can be due to; Kyphoยญsis, clavยญicยญuยญlar fracยญture maluยญnion or nonunion, or scapuยญlar winging. Disยญcrimยญiยญnaยญtor: Usuยญalยญly, there is either hisยญtoยญry of trauยญma or deforยญmiยญty on physยญiยญcal examination13- Trauma
This could lead to fracยญtures ( proxยญiยญmal humerus fracยญture, scapuยญlar fracยญture, Acromioยญclavยญicยญuยญlar joint sepยญaยญraยญtion etc.), disยญloยญcaยญtions or soft tisยญsue injury. If treatยญment of any of these was ignored or misยญmanยญaged, this might lead to Shoulยญder pain. Disยญcrimยญiยญnaยญtor: Hisยญtoยญry of trauยญma, if you had a fall or acciยญdent, you should be checked by a medยญical docยญtor (i.e. donโt ignore your first injury, occaยญsionยญalยญly we see injuries weeks or months after the iniยญtial inciยญdent, which someยญtimes lead to subยญopยญtiยญmal outcomes).14- Muscular
The musยญcles around the shoulยญder can get fatigued over time. This can be due to ageยญing or ongoยญing abnorยญmal posture. A comยญmon disยญease in this catยญeยญgoยญry is called; Upper Cross Synยญdrome, where the neck, upper back, shoulยญder, or chest musยญcles become deformed and acquire difยญferยญent non-anatomยญic posiยญtions leadยญing to a change in the dynamยญics and evenยญtuยญalยญly ongoยญing pain. Disยญcrimยญiยญnaยญtor: This usuยญalยญly occurs in peoยญple who susยญtain cerยญtain posiยญtions for long hours as; sitยญting on a desk in the wrong way for a long time, bikยญing, driยญving etc.15- Systemic Disease
A big list of disยญeases that can lead to joint pain as; Inflamยญmaยญtoยญry Arthriยญtis, Fibromyalยญgia, Mulยญtiยญple Scleยญroยญsis, etc. ( the list goes on ). Even carยญdiac conยญdiยญtions as a heart attack can present with left shoulยญder pain. Disยญcrimยญiยญnaยญtor: Hisยญtoยญry of sysยญtemic disยญease ( If you have a known medยญical conยญdiยญtion, you can review its clinยญiยญcal picยญture and talk with your doctor ).
Very interยญestยญing topยญic. Thank you.