Our modern, active lives often put strain on our shoulders when we carry out physical activities and exercise. You don't have to be a tennis player with a big serve to suffer from shoulder pain. It is one of the most common problems that orthopaedic specialists report their patients as having when they come to see them.

Mr Simon Moyes, Consultant Orthopaedic Surgeon at Cromwell Hospital, answers our questions about shoulder pain. 

Common causes of shoulder pain 

The most common cause is something called rotator cuff or impingement syndrome. Impingement means catching or rubbing – and, in this case, the impingement is of the tendons of the rotator cuff against structures in your shoulder.

Impingement syndrome is a combination of symptoms and signs and there are various conditions that can cause it. One of the most common causes is overhead sports, such as tennis, squash, and overhead weight training.

Bone spurs (osteophytes) caused by aging or over use of the acromioclavicular joint can reduce the space between the acromion and cuff tendon, the latter joint being directly above the rotator cuff tendons.

Symptoms of shoulder impingement

Symptoms of impingement normally include pain and weakness in the shoulder muscles. Pain is mainly felt over the outer deltoid muscle, when lifting the arm over the head, out to the side, or reaching up behind your back. 

Impingement will typically cause pain at night, making sleeping difficult when rolling onto this side.  Pain may also be experienced at the front or side of the shoulder with overhead activities including swimming, throwing, or racquet sports.

Treatment for shoulder impingement

Shoulder impingement syndrome can be treated in a number of ways. Normally the condition can be eased with oral anti-inflammatory medicine, such as ibuprofen, and courses of this can be taken for up to six weeks if found to be effective.

In addition, physical treatments such as stretching of the joint and physiotherapy to open up the joint and strengthen up the cuff muscle is sensible. If these measures don't work, then an ultrasound guided cortisone injection into your subacromial space is usually effective.

Fortunately, about 85 to 90% of patients will see benefit from these non-operative treatments. In about 10% of cases, other treatment is required.

Surgery for shoulder impingement

In resistant cases of impingement syndrome, particularly when you are starting to get tearing or partial tearing of the tendon, keyhole (arthroscopic) surgery may be used to decompress the inflamed tendons. This involves removing the part of the bone which is rubbing on the tendon and removing any arthritic tissue from the acromioclavicular joint which is rubbing on the tendon. This will usually resolve symptoms.

If the tendon is torn, then this is usually repaired using keyhole surgery. If the surgery is simply a decompression procedure or resection arthroplasty of the acromioclavicular joint, patients are able to start moving their arm almost immediately and a sling is only needed for the first two or three days. If a tear of the tendon is repaired, a sling needs to be used for four weeks and there is a longer recovery period.

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