Shoulder pain is a common problem and can cause pain into the upper arm, sometimes referring as far down the arm as the wrist. It is rarely due to serious damage and does not benefit from excessive rest. Keeping your shoulder moving as much as is comfortable will prevent it from ceasing up and causing further problems.
Shoulder impingement syndrome (Rotator cuff tendinopathy)
This condition is usually caused by wear and tear to the tendons in the shoulder (“tendinopathy”), which causes them to become painful and swollen. The swelling of the tendons can then cause them to be pinched between the two bones in your shoulder, causing more pain when raising the arm or lifting. Although this can be a very painful condition, completely resting the shoulder is not helpful and will cause the muscles and tendons to become weaker and the shoulder to stiffen up. Continuing to use your arm will not cause more wear to the tendons and you should try and use your arm as normally as possible.
This condition can be improved by doing specific exercises for the shoulder, which stimulates the body to repair the tendons, reduce swelling and prevent pinching of the tendons. Your physio will recommend which exercises will be best for you and you can find videos of these exercises here. The exercises should be done so that they do not make your pain a lot worse, as although this is not harmful, it will take longer for your shoulder to improve if you aggravate your symptoms. This condition usually improves with exercise alone, although this can take between six and twelve weeks. Occasionally an injection is required if pain does not settle with physiotherapy.
Adhesive Capsulitis (Frozen shoulder)
Frozen shoulder is caused when the capsule that surrounds your shoulder joint becomes inflamed. This causes the soft tissues around the shoulder to stick together (“adhesions”) causing pain and limiting the movement of the shoulder. The condition usually resolves eventually, although this can take a long time (up to 18 months). Performing regular exercises can help to stretch the tight tissues out more quickly and your physiotherapist will advise you on the most appropriate exercises to perform. You can find videos of these exercises here. The exercises should be performed to slight discomfort. It is normal for your shoulder to be a little bit sore after doing the exercises, however, if your shoulder is so sore that the pain interferes with your day-to-day activities you should perform them a little bit more gently. If the pain in your shoulder is very severe or stops you sleeping, an injection into the joint may be useful to help to control the pain and allow you to carry out your exercises.
Physiotherapy is required after most shoulder surgery to help you regain your movement and strength. The type of exercises you need to do will depend on the surgery that you have had and your physiotherapist will give you a personalised exercise programme. In general, you should not push your shoulder into too much pain in the first few weeks after surgery, although this will be necessary for some operations (for example if you have had a manipulation under anaesthetic). If you are unsure about how hard to push your exercises, please discuss this with your physiotherapist. Further information about shoulder surgery can be found here.
Upper limb fractures (broken bones in the arm)
Fractures to the bones in the arm can either be managed conservatively (usually immobilised in a sling or plaster) or through fixing them surgically. Your orthopaedic surgeon will decide which option is best for you, based on your x-ray or scan findings. Once the surgeons are happy with how the fracture is healing you will usually be referred to physiotherapy to help you get the movement and strength back into your arm.
Because broken bones have to be immobilised in order to heal, it is usual for the joints around the fracture to become stiff and the muscles to become weak. This can cause pain in around the joint initially, however this usually improves once you get things moving. Once your fracture has healed you should try and use the arm as normally as possible, however, you may have to gradually re-introduce more difficult activities (e.g. heavy lifting). If you have any concerns about specific activities, discuss this with your physiotherapist. Occasionally, broken bones can cause a condition called Complex Regional Pain Syndrome (CRPS). If you have developed this condition please click here for more information.
Osteoarthritis (arthritis) is caused by the gradual thinning of the smooth cartilage that lines all of our joints. This is a normal process that happens as we get older, however, it can cause joint pain and stiffness. Using the affected joint will not cause more wear and in-fact too much rest will cause more pain and stiffness in the joint and weakness in the surrounding muscles.
Although arthritis cannot be cured, symptoms can be improved by keeping active and performing regular exercise. Exercising keeps the muscles around the joint strong and flexible which can help to reduce pain and maximise your functional ability. Losing weight can also help with pain from arthritis. If you would like advice about diet and weight loss, community health trainers can give practical advice and support with this. Further information about arthritis can be found here on the Arthritis Research UK website.