Introduction
Non-traumatic shoulder pain is a frequent complaint, often resulting from a variety of musculoskeletal conditions.
Common Causes of Non-Traumatic Shoulder Pain
1. Rotator Cuff Related shoulder pain/tendinopathy
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- Description: This condition involves irritation, inflammation, or degeneration of the tendons of the rotator cuff muscles (supraspinatus, infraspinatus, subscapularis, and teres minor). It is a leading cause of shoulder pain, particularly in individuals over 40 or those involved in repetitive overhead activities and gym goers.
- Symptoms: Gradual onset of pain, often worsened by overhead movements or lifting, with weakness.
2. Degenerative Rotator cuff tears
- Can affect any of the RC tendons, most commonly affects supraspinatus leading to significant weakness into abduction and external rotation, these patients will have very poor active range but usually full passive range of motion. Depending on age, lifestyle and physical demands, these patients can recover well with Physiotherapy however some may require orthopaedic intervention.
3. Frozen Shoulder (Adhesive Capsulitis)
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- Description: Frozen shoulder is a condition characterized by pain and stiffness due to inflammation and thickening of the shoulder capsule. It typically develops slowly and can last for months to years, affecting a person’s ability to move the shoulder.
- Symptoms: Pain and significant stiffness, particularly with external rotation and abduction, limiting day-to-day activities.
4. Osteoarthritis of the Glenohumeral Joint
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- Description: Degenerative changes in the glenohumeral joint which causes pain, stiffness, and reduced mobility. The stiffness will be general and not in a capsular pattern like frozen shoulder
- Symptoms: Gradual stiffness and pain in the shoulder joint, worsened by movement.
5. Sub Acromial Pain Syndrome
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- Description: A cluster of symptoms classified by anterior shoulder pain which is usually worse with flexion and abduction above 90 degrees, patient will usually present with a painful arc of movement. The cause of this subacromial pain can be multifactorial. This can usually be differentiated from AC joint pain using palpation of the joint reproducing the symptoms.
- Symptoms: Pain and discomfort when lifting the arm or reaching overhead
Conclusion
The management of non-traumatic shoulder pain relies on a comprehensive conservative approach, with a strong emphasis on exercise therapy, manual techniques, and pain management. Early intervention through physiotherapy and activity modification, combined with education, can significantly improve outcomes for most individuals suffering from shoulder pain. Collaboration between GPs and physiotherapists is key to ensuring a holistic and effective treatment plan.
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