Shoulder Pain: Causes and Treatment Options

Shoulder issues

Hello, Doctor: Last year, while throwing a child up in the air and catching them, I experienced severe pain in my left shoulder that almost made me drop the child.
Since then, any similar movements have caused pain.
I have been receiving treatment at a rehabilitation clinic (heat therapy, electrical stimulation, and manual therapy), which initially did not show significant improvement, but it also did not worsen.
However, earlier this year, I inadvertently bore weight with my left hand and felt intense pain again.
Since then, my condition has progressively deteriorated.
Simple actions like reaching forward to wash my hands or drinking water cause a sensation of my hand getting stuck or pain.
When I place my hands on my hips, I experience sharp pain near the shoulder area of my upper arm.
I also feel similar sharp pain while riding a bike, and at work (in an office setting), I experience stabbing pain behind my shoulder.
When lying down to sleep, I feel pressure behind my shoulder, and lying on my side causes pain in my left shoulder, while lying face down also feels strange in my left shoulder.
Since the beginning of this year, I have noticed a sensation of my bones moving or shifting with my movements, and there have been a few instances that frightened me, making me worry that my arm might dislocate.
Recently, over the past month, I occasionally feel a swelling sensation from my upper arm to my shoulder, and when my left arm is hanging naturally, I experience numbness (but not when exerting force).
I have continued rehabilitation and have also consulted an orthopedic doctor at the hospital, where I only had an X-ray taken, which showed no issues.
They only prescribed medication.
I would like to ask the doctor what possible problems I might have.

Joi, 30~39 year old female. Ask Date: 2019/04/07

Dr. Shi Guozheng reply Orthopedics

It is possible that there is a soft tissue injury within the shoulder joint.
The soft tissues include ligaments, tendons, and the labrum, among others.
If rehabilitation does not lead to improvement, further evaluation may be necessary.
An MRI (Magnetic Resonance Imaging) is a diagnostic test that can be considered.

Reply Date: 2019/04/07

More Info

Shoulder pain can be a complex issue, especially following an injury or trauma, such as the one you described while catching a child. The symptoms you are experiencing—sharp pain during specific movements, a sensation of locking or catching, and discomfort while lying down—are indicative of several potential underlying conditions.

Possible Causes of Shoulder Pain
1. Rotator Cuff Injury: The rotator cuff is a group of muscles and tendons that stabilize the shoulder and allow for a wide range of motion. Injuries can range from tendinitis to partial or complete tears. Given your description of pain during overhead activities and the sensation of catching, a rotator cuff injury is a strong possibility.

2. Shoulder Impingement Syndrome: This occurs when the tendons of the rotator cuff become irritated and inflamed as they pass through the shoulder joint. Symptoms often include pain during lifting or reaching overhead, and it can sometimes feel like the shoulder is catching or locking.

3. Labral Tear: The labrum is a cartilage structure that helps stabilize the shoulder joint. A tear can occur due to acute injury or repetitive overhead activities, leading to pain, instability, and a feeling of catching.

4. Bursitis: Inflammation of the bursa (a fluid-filled sac that reduces friction between tissues) can also cause pain and limit movement. This is often associated with rotator cuff injuries.

5. Cervical Radiculopathy: Given that you also experience pain radiating down your arm and sensations of numbness, it’s worth considering whether a cervical spine issue (like a herniated disc) could be contributing to your shoulder pain.

Treatment Options
1. Physical Therapy: Continuing with physical therapy is crucial. A physical therapist can provide targeted exercises to strengthen the shoulder muscles, improve flexibility, and enhance range of motion. Techniques such as ultrasound therapy, electrical stimulation, and manual therapy can also be beneficial.

2. Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. If over-the-counter options are insufficient, your doctor may prescribe stronger medications.

3. Corticosteroid Injections: If pain persists despite conservative treatment, corticosteroid injections into the shoulder joint can provide significant relief by reducing inflammation.

4. Surgery: If conservative measures fail and your quality of life is significantly affected, surgical options may be considered. This could include arthroscopic surgery to repair a torn rotator cuff, remove bone spurs, or repair a labral tear.

5. Activity Modification: Avoiding activities that exacerbate the pain, especially overhead movements, is essential. Gradually reintroducing these activities under the guidance of a healthcare professional can help prevent further injury.

6. Ergonomic Adjustments: Since you mentioned that you work in an office setting, ensuring that your workstation is ergonomically sound can help reduce strain on your shoulder. This includes adjusting your chair height, monitor level, and keyboard position.

When to Seek Further Medical Attention
If your symptoms worsen or if you experience significant weakness, persistent numbness, or an inability to perform daily activities, it is crucial to follow up with an orthopedic specialist. They may recommend advanced imaging studies, such as an MRI, to assess for any soft tissue injuries that may not be visible on X-rays.

In conclusion, shoulder pain can stem from various causes, and understanding the underlying issue is key to effective treatment. Continuing with physical therapy, managing pain with medication, and considering further evaluation by a specialist will be essential steps in your recovery process.

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