ARM PAIN & SHOULDER PAIN 

Arm and shoulder pain and injuries are common.

Problems with the shoulder and arm can affect all aspects of life from getting dressed to driving a car and even working productively.

There are a few reasons for shoulders being prone to injury and pain; one reason is because the shoulder joint can move around in so many ways and is the most mobile of all the joints. Another reason is because the actual shoulder joint has a very small surface contact area, which means that the joint is unstable and open to injury. This explains why the shoulder muscles are so very important in securing and stabilising the shoulder joint.

Shoulder pain and arm pain can often be related to problems in the neck or even back. It’s important that whoever assesses the pain makes sure that the pain is not being caused by neck problems.

Most of the time more than one cause for the pain may occur at the same time, which can then make assessing and managing shoulder pain and arm pain more complex.

ARM & SHOULDER PAIN SYMPTOMS

Sometimes shoulder pain and arm pain can occur suddenly or it can occur slowly. Shoulder pain and arm pain can also occur immediately after an injury or the onset of symptoms can be delayed.

Symptoms may include; deep pain, sharp pain, or a stiff shoulder, pain radiating down into the arm or up into the head. There might be tingling, numbness and pins and needles. There may be pain between the shoulder blades.

Sometimes people can be very unwell if there is a more serious cause like an infection or fracture of the spine.

SHOULDER PAIN CAUSES

When shoulder experts assess shoulders a few things need to be considered because pain in the shoulder could be caused by a number of problems in or around the joint. A few causes of shoulder pain:

• Shoulder joint pain can occur for several reasons:

  • The actual shoulder joint (glenohumeral joint) can cause pain due to osteoarthritis, other forms of arthritis or it could be caused by a frozen shoulder (adhesive capsulitis shoulder) which is hardening of the tissue around the joint. Frozen shoulders occur commonly and can at times be hard to diagnose because sometimes a frozen shoulder can occur without a trigger or injury and may even follow illness or disease in other parts of the body.

  • The AC joint (acromioclavicular joint) nearby the shoulder joint can also develop arthritis and cause pain. The shoulder pain is usually experienced around the front and top of the shoulder.

  • Shoulder inflammation can also be the cause. Some joints have fluid filled sacs (bursa) that help reduce friction. When the sacs become inflamed, they can be painful (bursitis shoulder pain). This bursa lies below the AC joint.

• Shoulder muscle pain

  • Muscles around the shoulder (rotator cuff) are complex and can be a source of pain. These muscles can become weak or develop overuse tears (shoulder rotator cuff pain).

• Shoulder tendonitis is where tendons like the bicep tendon joins the shoulder causing shoulder inflammation. As it gets inflamed, it produces a stiff shoulder that limits movement. Biceps tendonitis causes pain in the front of the shoulder and also down the front of the arm.

• Myofascial pain

  • This is pain that occurs because of problems with the surrounding muscles, ligaments and tendons of the shoulder. The muscles may develop discrete little tight knots (taut bands) that are called myo-fascial trigger points. Trigger points are hyperirritable spots in the covering (fascia) surrounding muscle and can be very painful and quite debilitating. When a trigger point is touched or examined, it can cause exquisite pain in and around the area.

• Referred pain

  • Referred pain is where pain in one part of the body can be felt in another part of the body that is nearby. This occurs when different parts of the body share the same nerves to send signals to the spine and brain. This is a fairly common problem and can cause shoulder pain. Neck problems like cervical (neck) facet joint arthritis or disc prolapses can both contribute to spinal nerves being compressed where they leave the spinal column (pinched nerves). This compression condition is called cervical foraminal stenosis and can cause radiating pain anywhere down the shoulder, arm or hand. This is a referred pain and can also be felt in the shoulder. A whiplash injury to the neck can sometimes also refer pain to the shoulder.

• Shoulder nerve pain

  • Sometimes neurological problems can cause shoulder pain. Neurological causes might include shingles (Zoster), post herpetic neuralgia, complex regional pain syndrome (CRPS), or even some brain conditions.

  • Another common cause of nerve pain is neck problems like cervical (neck) facet joint arthritis or disc prolapses can both contribute to spinal nerves being compressed where they leave the spinal column (pinched nerve in shoulder or pinched nerve in neck). This compression condition is called cervical foraminal stenosis and can cause radiating pain anywhere down the shoulder or arm. When the compression occurs in the spinal column itself, this may be called cervical spinal stenosis and if the compression is serious it can compress the spinal cord itself, which is called myelopathy. Myelopathy is when the compression of the spinal cord starts causing symptoms, such as weakness or problems with coordination in the arms, hands, legs, or even feet. Another type of nerve compression can occur in the space between the collarbone and first rib (thoracic outlet). This is called thoracic outlet syndrome and can be caused by trauma, repetitive injuries, pregnancy and anatomical defects, such as having an extra rib.

• Sensitisation

  • Sometimes a problem in the nervous system called sensitisation can occur. This is when the pain, usually a nerve pain seems to be spreading up into the body and or down into the arm, or even into the other side of the body. People with sensitisation can even have sensitive skin and even light touch using a brush can be exquisitely painful.

• Post-surgical pain

  • After an operation or surgery pain can sometimes persist even after the tissue has had sufficient time to heal. This can occur in up to 25% of all surgeries and sometimes the persistent pain can be intolerable and debilitating. Post-surgical pain can be caused by almost any type of operation, and can be caused by many things, including nerve injury or scarring, ongoing inflammation or infection, muscle weakness and stiffness. This is a complex pain condition and should be assessed and managed by pain specialist physicians in conjunction with the operating surgeons.

Chronic shoulder pain treatment is provided when pain has been present for longer than 3 months and most treatments that have been tried have not helped. Treatment dependents on what is causing the pain and should be delivered by pain specialists physicians and their team of experts.

ARM PAIN CAUSES

Arm pain could be linked to shoulder pain or be a problem on its own. A significant proportion of chronic arm pain can be cause by problems in the neck, which can refer pain down the arm. Some unique causes of arm pain may include:

• Arm pain causes: all the causes of shoulder pain above can cause arm pain, particularly nerve pain in arms.

• Elbow pain causes might include elbow joint pain, tennis elbow and golfers elbow.

• Hand pain causes may be arthritis in hands and wrist and other nearby joints.

• Finger pain causes may be arthritis in fingers causing swollen finger joints, stiff finger joints, finger tendon problems or even nerve pain.

• Wrist pain causes may also include carpal tunnel syndrome.

• Serious causes of arm pain may include heart conditions like angina or even a heart attack (myocardial infarction).

WHO GETS SHOULDER PAIN AND ARM PAIN?

Anyone can get shoulder pain and arm pain and it can occur at any age although some people are more likely to develop shoulder pain and arm pain.

Here are a few risk factors that might make the development of shoulder and arm pain more likely:

• Older age

• Lack of exercise and low fitness level

• Being overweight

• Certain jobs or activities that require heavy lifting, pushing or pulling, particularly when it involves repetitive movements of the spine.

WHAT ARM PAIN AND SHOULDER PAIN TREATMENT IS AVAILABLE? 

Treatment of the shoulder and arm pain depends on if the problem is acute (meaning it only occurred recently i.e. days and weeks) or if the problem is chronic (meaning it has been present for more than 2-3 months).

ACUTE SHOULDER PAIN OR ARM PAIN TREATMENT 

• Simple treatments like hot or cold packs, physical activity, exercise and physical therapy.

• Pain medications like anti-inflammatories and anti-spasm medications to provide pain relief.

If pain is long lasting (chronic pain), debilitating and has not been responding to treatments an assessment should be made by a pain management specialist, who can assess and treat most types of chronic pain.

TYPES OF TREATMENT

• Medications to reduce the pain

  • These may be simple over the counter medications or can be medications prescribed by your pain specialist. Medications might include muscle relaxants or nerve pain medications (neuropathic pain medications). Sometimes analgesic compound creams are used to ease pain.

• Pain interventions

  • Injection therapies can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain.

  • It includes interventional therapies like nerve blocks (medial branch nerve, third occipital nerve, cervical nerve roots, greater and/or lesser occipital nerves) radiofrequency ablation (RFA), pulsed radiofrequency (PRF) and epidural and nerve root steroid injections. Sympathetic nerve blocks can also be performed.

  • Some of these therapies can be focused on various structures that might be causing or making the pain worse like the glenohumoral joint, the acromio-clavicular joint, the subacromial bursae, muscle trigger points, the brachial plexus, the spinal nerve roots and other nerves around the shoulder. Platelet-rich plasma (PRP injections) can also be used in some locations around this area.

• Nerve stimulation or neuromodulation techniques

  • Advanced pain reduction strategies may include spinal cord stimulation for severe neck pain. Some forms of spinal cord stimulation are high frequency stimulation (HF10), tonic stimulation, multi-waveform stimulation, burst DR stimulation and even DRG stimulation.

• Surgery

  • Generally recommended when tests show structural changes, which need corrective surgery. When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. These are typically performed by an orthopaedic surgeon. Types of surgery might include, arthroscopy, stabilisation surgery, decompression surgery joint replacement surgery.

• Rehabilitation

  • Most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This is when the best results occur.

WARNING SIGNS OF MORE SERIOUS ARM & SHOULDER PROBLEMS

In some instances, shoulder pain and arm pain can indicate more serious problems. These problems might include cancer, fractures, infection, severe nerve compression (pinched nerve) and ankylosis spondylitis. 

• If there is cancer in the bones of the spine, this usually means metastases (the cancer has spread to the spine).

• Fractures of the spine can be caused by a direct hit, fall, accident but sometimes can occur without trauma, called spontaneous fractures. Spontaneous fractures, usually can occur in elderly people with osteoporosis or those who may be taking steroid medications that weaken the bone.

• Infections of the spine tend to occur if patients have a weakened immune system from any cause or medical condition. Sometimes infections of the spine can occur if there is an infection elsewhere in the body. People with spinal infections usually feel unwell and can have sweats and a fever.

• Nerve compression, called myelopathy, where there is a dangerous compression of the spinal cord in the neck. Myelopathy could cause symptoms that might include, weakness or problems with coordination in the arms, hands, legs, or even feet.

• Ankylosing spondylitis is progressive arthritis of the spine and can cause widespread inflammation, pain and stiffness throughout the spine.

Seek urgent and specialist medical advice if:

• Sudden, unrelenting, disabling and severe shoulder pain and or arm pain

• Recent weight loss.

• Recently injury or fall.

• Signs of infection are present like fever or feeling unwell, the area is red, hot or swollen.

• Numbness or tingling of the arm

• Weakness in arms and or legs

• Problems with bladder or bowel function

• Stiffness is worsening

• Pain does not settle by itself after a few days or weeks