Shoulder pain — when to see a doctor

The shoulder is one of the most critical musculoskeletal formations in the body.  Every time you raise your cup of coffee, reach for a book on a high shelf, wave HELLO to someone, you use the complex joint of your shoulder. Nearly every movement we use with our hands and arms impacts the shoulder, because the human shoulder is the most mobile joint in the body. [1] This mobility provides the upper extremity with tremendous range of motion. Yet, the anatomical design that makes this joint so versatile also makes it vulnerable and shoulder pain can turn a simple act like brushing your hair in a hurtful event.

The shoulder can move in so many directions because it is a shallow ball-and-socket joint, in which the “ball” (the top of the upper arm bone) is larger than the socket it fits into.

This puts the shoulder at risk for instability, making it the most commonly dislocated joint in the body. Its unique anatomy also makes it susceptible to sprains and separations, as well as a variety of overuse injuries. Some of the factors that predispose the shoulders to injury are inherited anatomical differences, while others are behavioural.

Annually 1% of adults are likely to consult with new shoulder pain.^[2]

In the majority of the cases, shoulder issues are overuse injuries. Some problems surround the muscles in the shoulder, whereas others are actually about the joint connections themselves. 

The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases. ² Rotator cuff injuries are most often caused by overhead repetitive motions, often in conjunction with manual labor or sport.

But shoulder pain isn’t always caused by a problem in the shoulder joint – problems in the neck can cause pain that’s felt over the shoulder blade or in the upper outer arm.

When to see a doctor?[3]

Shoulder pain accompanied by difficulty breathing or a sense of tightness in the chest may be a symptom of a heart attack and requires immediate medical attention.

Seek immediate medical attention if your shoulder pain is caused by an injury and is accompanied by:

·     A joint that appears deformed

·     Inability to use the joint or move your arm away from your body

·     Intense pain

·     Sudden swelling

Make an appointment with your doctor if your shoulder pain is accompanied by:

·     Swelling

·     Redness

·     Tenderness and warmth around the joint

A few tips to improve your shoulder mobility and ease shoulder pain:

·     Don’t work through sharp pain this is your bodies way of telling you to stop what you are doing. Some dull achy pain especially if arthritis may be ok to work through gently.

·     Warmup your body and shoulders before strength training.

·     Start with shoulder mobility exercises and then move to strengthening and stretching. 

You have three parts of your shoulder the front (anterior deltoids), the middle (lateral deltoids) and the back (posterior deltoids). We are often strong in the front of our shoulders but very weak in the middle and backs. Focus on strengthening the back and sides of your shoulders and stretching the front of your shoulders.

[1] ^{Quillen DM, Wuchner M, Hatch RL. Acute shoulder injuries. Am Fam Physician. 2004 Nov 15. 70(10):1947-54.} 

[2] ^{Murphey RJ. Shoulder pain. BMJ Clin Evid. 2010; 2010: 1107.}

[3] ^{Mitchell C et al. Shoulder pain: diagnosis and management in primary care  BMJ. 2005 Nov 12; 331(7525): 1124–1128.}