Content Editor

Shoulder 
Advice and information for patients
The shoulder is one of the most sophisticated and complicated joints in the body.

It the most mobile joint in the body; no other joint goes through the same range of movement as the shoulder does, allowing us to reach our hands into all sorts of positions. It therefore has to balance its mobility, with strength and stability. In order to achieve this, it relies on co-ordinated movements through several bones and muscles.

As well as movement at the shoulder joint itself (a ball and socket joint), movement also needs to occur at either end of the collar bone. The shoulder blade needs to travel around the rib cage and the spine needs to be sufficiently flexible. 
Stiffness in any of these joints can affect how the shoulder moves and can potentially contribute to any symptoms you may feel. Ligaments are arranged in such a way as to help support and control the movement of the shoulder as it travels through its large range of motion. Numerous muscles have to work in a co-ordinated manner to produce and control the movement at the shoulder, if any of these muscles are weak or injured, this can also affect or cause shoulder symptoms. 

Shoulder pain
Shoulder pain can often result from a simple strain or sprain. 

Strains are injuries to muscles or tendons and sprains are injuries to ligaments. Such soft tissue injuries may be caused by a specific injury (eg falling onto an outstretched hand and jarring your shoulder) or may gradually build up over time. The shoulder can sometimes become painful during activities such as dressing/undressing, reaching up to a shelf, washing your hair, pushing/pulling. There are several potential causes of shoulder pain. Sometimes a specific group of muscles and tendons, called the rotator cuff, can cause symptoms, if they are weak, get injured or tear. In some people, the shoulder moves around a bit too much – this is something we term as instability. Often the right exercises and advice can help improve these symptoms.  Sometimes the capsule, the sleeve that sits around the shoulder joint, can tighten up and restrict movement – this is known as a frozen shoulder. Sometimes osteoarthritis can develop in the joints of the shoulder complex, causing pain and stiffness. 

Most shoulder pain has a simple cause and clears up within a few days. Sometimes it lasts a few weeks. However, even more persistent problems, such as rotator cuff injuries or osteoarthritis can be self-managed successfully.


How can I help myself to get better?
Minor injuries, such as mild sprains and strains, can often be initially treated at home using a protection, rest, ice regime for the first two or three days after onset:
  • Protection – protect the affected area from further injury; for example, avoid the painful activities that may have caused the injury if this is easily traced.  However do not stop moving altogether as this will likely cause your shoulder to stiffen up.
  • Rest – rest the shoulder for two or three days only.  Resting the arm for a short time may help any inflammation or discomfort to settle.  However resting beyond two to three days may lead to the surrounding muscles becoming weaker which will not be helpful in the longer term.
  • Ice – should you notice any swelling or tenderness around the joint, apply an ice pack to the affected area for about 15 minutes every two to three hours.  This may help to reduce the swelling and give  some pain relief.  A bag of frozen peas, or similar, will work equally as well. 
    • NB  please be sure to wrap the ice pack / frozen peas in a moist towel or similar to avoid direct contact with the skin.
Contrary to popular beliefs, it is good to stay active when you have pain in your soft tissues or joints. Try to reduce the amount of activity (rather than stopping it altogether) that may be exacerbating your symptoms for a short period, until the pain settles. You should then aim to slowly work back up to your previous activity level.  If exercising does not affect your symptoms or improves them, try to stay as active as possible.
  • Some basic exercises can be useful in easing your shoulder pain and to help it move better.  These simple shoulder exercises from ARC UK may be a useful starting point. 
  • Pain relief  through  medication may be useful – however it is essential that prior to using pain-relieving medication that you check with either your GP or pharmacist that you are OK to use them - even if they are over-the-counter type medications such as paracetamol, ibuprofen or creams that you can buy at the chemist.
When should I see my doctor or physiotherapist?
Many episodes of shoulder pain get better or improve on its own, or with the self-management approaches as discussed above.

However you should seek medical advice for the following: 
  • After a sudden traumatic injury such as a fall onto a hard surface, a high impact injury or a sudden twisting or wrenching injury.
  • If the pain is severe or the shoulder is hot, red or very swollen
  • If you have tingling or numbness down the arm
  • If you develop acute shoulder pain at the same time as feeling unwell or if you develop a fever similarly to the onset of your shoulder pain, it is possible you may have developed and infection of the joint, so you should see your doctor immediately/the same day.  If  you  are  unable to  see your  doctor  you  may  need to  attend at your local Walk-in Centre or Accident and Emergency.
The Healthy Living Teams in Knowsley and St Helens provide tailored support and guidance to local people who would like to be more physically active.