Shoulder Pain

Overview

Pain in the left arm, shoulder, and jaw is one of the symptoms of a heart attack, and will not be addressed here. Many people have shoulder pain unrelated to a heart attack, and this type of pain can occur in either or both shoulders. Although there are numerous causes of shoulder pain, they can be placed into four groups: muscle pain; nerve or joint pain; pain from traumatic injury; and pain from several systemic diseases.

The shoulder is composed of several muscles: the upper arm bone (humerus), the scapula (shoulder blade) and the clavicle (clavicle). The scapula and clavicle form the pectoral girdle from which the arms are suspended. The socket for the arm bone is a very shallow ball and socket joint, from which the arm is easily dislocated. Tendons and ligaments attach muscles to bones, and cartilage helps to form the joint. A bursa is a fluid-filled sac that reduces the friction of muscles sliding over bone. The central nervous system and nerves direct the action of the muscles. Thus shoulder pain can arise from any of several components: muscles, tendons, ligaments, cartilage, bones and nerves.

Causes

Traumatic injuries to the shoulder include strains and sprains, ruptured tendons, torn cartilage, a broken arm, a dislocated shoulder, a frozen shoulder, and a rotator cuff injury (injury to the muscles that are involved with rotating the upper arm).

Conditions affecting the nerves or central nervous system can cause shoulder pain. These include ankylosing spondylitis (a disease in which narrowing of the cavity that contains the spinal cord pinches upon the cord and spinal nerves), injury to the brachial plexus (the network of nerves supplying the shoulder and arm muscles), and shingles and spinal cord injuries that can damage nerves to the some of the muscles of the shoulder.

Pain can arise from inflammations of components of the shoulder, such as inflammation of the bursae (bursitis), muscles (dermatomyomyositis, polymyositis and polymyalgia rheumatica) and tendons (tendinitis). Inflammatory shoulder pain can also arise from several types of arthritis (inflammations of the joints) including osteoarthritis (wear and tear arthritis), rheumatoid arthritis (an autoimmune disease), and septic arthritis from massive bacterial infections

A variety of miscellaneous conditions such as cancer, multiple sclerosis, and other conditions can cause shoulder pain.

Symptoms and Diagnoses

A physician seeking to evaluate shoulder pain will want to know the location and type of the pain. Is it a deep-seated, continuous, or intermittent pain. Does it worsen with movement? Pain located over the outside of the shoulder may indicate a rotator cuff injury, tendonitis or bursitis. Pain located over the top of the shoulder is more likely to be associated with the joint where the scapula meets the clavicle. The physician will ask about the range of motion possible in the affected shoulder. Can the arm be elevated above shoulder level, and is full range of rotation possible? The doctor may order x-rays to examine the bones, an MRI to examine soft tissue and nerves, or various tests of muscle function .  Continue reading for Prevention information . . .

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