Chronic Shoulder Pain

What is chronic shoulder pain?

Shoulder pain is defined as chronic when it has been present for longer than six months. Shoulder pain may arise from the shoulder joint itself or from any of the many surrounding muscles, ligaments or tendons. Shoulder pain that comes from the joint usually worsens with activities or movement of your arm or shoulder.

Various diseases and conditions affecting structures in your chest or abdomen, such as heart disease or gallbladder disease, also can cause shoulder pain. Shoulder pain that arises from another structure is called referred pain. Referred shoulder pain usually doesn’t worsen when you move your shoulder.

What are the causes?

The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes:

  • Avascular necrosis
  • Brachial plexus injury
  • Broken arm
  • Broken collarbone
  • Bursitis
  • Cervical radiculopathy
  • Collar or upper arm bone fractures
  • Dislocated shoulder
  • Frozen shoulder
  • Hiatal hernia
  • Impingement
  • Osteoarthritis
  • Pinched nerves (also called radiculopathy)
  • Polymyalgia rheumatica
  • Rheumatoid arthritis
  • Rotator cuff injury
  • Shoulder joint instability
  • Separated shoulder
  • Septic arthritis
  • Sprains and strains
  • Strains from overexertion
  • Tendinitis from overuse
  • Tendon rupture
  • Thoracic outlet syndrome
  • Torn cartilage

How Are Neck and Shoulder Pain Diagnosed?

  • X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis-like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.
  • MRI: Magnetic resonance imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements, as well as problems with the tendons and ligaments.
  • Myelography/CT scanning: This is sometimes used as an alternative to MRI.
  • Electrodiagnostic studies: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnose neck and shoulder pain, arm pain, numbness and tingling.

What are the treatments?

The treatment of soft tissue neck and shoulder pain often includes the use of anti-inflammatory medication such as ibuprofen (Advil or Motrin) or naproxen (Aleve or Naprosyn). Pain relievers such as acetaminophen (Tylenol) may also be recommended. Depending on the source of pain, drugs like muscle relaxers and even antidepressants might be helpful. Pain also may be treated with a local application of moist heat or ice. Local corticosteroid injections are often helpful for arthritis of the shoulder. For both neck and shoulder pain movement, exercises may help. For cases in which nerve roots or the spinal cord are involved, surgical procedures may be necessary. Your doctor can tell you which is the best course of treatment for you.

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