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Understanding Chronic Shoulder Pain

Shoulder pain is a widespread issue affecting people of various ages and backgrounds in Singapore. In today's fast-paced world, people engaging in repetitive or strenuous activities may be more susceptible to shoulder discomfort. Occupations that involve repetitive overhead movements, such as those in construction or sports, can contribute to the development of shoulder pain. Additionally, the ageing process may bring about wear and tear on the joints, increasing the risk of shoulder-related problems. This discomfort can vary widely in its nature and duration, creating a need to distinguish between acute and chronic shoulder pain.

Difference Between Acute and Chronic Shoulder Pain

Acute shoulder pain typically arises suddenly and is often associated with a specific incident or injury. This type of pain can result from trauma, such as a fall or sudden impact, causing immediate discomfort and restricted mobility. Acute shoulder injuries may involve sprains, strains, dislocations, or fractures.

Chronic shoulder pain, on the other hand, persists over an extended period, ranging from weeks to months or even years. Unlike acute pain, chronic shoulder discomfort may not have a clear, singular cause and can be influenced by various factors, such as repetitive stress, overuse, or underlying medical conditions. 

Common Injuries Contributing to Shoulder Pain

A. Rotator Cuff Injuries

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, providing stability and enabling a wide range of motion. Composing the supraspinatus, infraspinatus, teres minor, and subscapularis muscles, the rotator cuff plays a pivotal role in lifting, rotating, and moving the arm.

Causes

Rotator cuff injuries can arise from various factors, with the most common being:

Trauma: A sudden impact or force on the shoulder, such as a fall or collision.

Overuse: Repetitive overhead motions or excessive strain on the shoulder, common in activities like pitching, swimming, or weightlifting.

Age-related degeneration: Gradual wear and tear of the tendons due to ageing, making them more susceptible to injuries.

Symptoms

Pain: Persistent pain, particularly when lifting or rotating the arm.

Weakness: Difficulty in lifting or holding objects, indicating muscle weakness.

Limited Range of Motion: Reduced ability to move the arm freely, especially overhead.

Crepitus: A crackling or popping sensation during shoulder movement.

Sleep Disturbances: Discomfort that may disrupt sleep, especially when lying on the affected shoulder.

B. Frozen Shoulder (adhesive capsulitis)

Frozen shoulder, clinically known as adhesive capsulitis, is a condition characterised by the gradual onset of pain and stiffness in the shoulder joint. This disorder primarily affects the capsule, a connective tissue surrounding the shoulder joint, leading to inflammation and the formation of adhesions. This results in restricted movement and persistent pain, impacting daily activities.

Factors Leading to Frozen Shoulders

Inflammatory Response: The exact cause of frozen shoulders is not always clear, but inflammation within the shoulder joint is a common trigger. This inflammation can result from various factors, including trauma, surgery, or systemic conditions such as diabetes.

Immobility or Lack of Use: Prolonged immobility or limited use of the shoulder joint, often due to injury, surgery, or prolonged periods of inactivity, can contribute to the development of adhesive capsulitis.

Systemic Diseases: Certain medical conditions, such as diabetes, autoimmune diseases, or cardiovascular disorders, have been linked to an increased risk of developing frozen shoulders.

Age and Gender: People between the ages of 40 and 60, and women more frequently than men, are more susceptible to developing frozen shoulders.

Previous Shoulder Trauma: Any history of shoulder injury, surgery, or trauma can increase the risk of developing adhesive capsulitis.

C. Shoulder Impingement Syndrome

Shoulder impingement syndrome is a common orthopaedic condition that occurs when the tendons of the rotator cuff muscles become compressed or irritated as they pass through the subacromial space. This space is located beneath the acromion, the bony prominence of the shoulder blade. The impingement typically occurs during shoulder movements, leading to irritation, inflammation, and discomfort.

Activities and Conditions Contributing to Impingement

Overhead Activities: Repetitive overhead activities, such as reaching, lifting, or throwing, can contribute to impingement syndrome. Athletes involved in sports like swimming, baseball, or weightlifting may be particularly susceptible.

Poor Posture: Maintaining poor posture, especially with rounded shoulders or a forward head position, alters the alignment of the shoulder joint. This misalignment increases the risk of impingement during routine movements.

Muscle Imbalances: Weakness or imbalance in the muscles surrounding the shoulder, especially the rotator cuff muscles, can lead to abnormal joint mechanics and impingement.

Bone Spurs: Over time, the development of bone spurs on the acromion can reduce the available space for the rotator cuff tendons, contributing to impingement.

Trauma or Injury: Previous shoulder injuries or trauma, such as dislocations or fractures, can alter the joint's anatomy and contribute to impingement.

Ageing: As people age, natural wear and tear on the shoulder joint can lead to changes in the structures, increasing the risk of impingement.

D. Labral tears

The labrum is a ring of cartilage that surrounds the socket of the shoulder joint, enhancing its stability and providing support for the shoulder's range of motion. It acts as a cushion and helps keep the humeral head securely within the socket during movements.

Causes and consequences of labral tears

Trauma: Acute injuries, such as dislocations or heavy falls on the outstretched arm, can cause labral tears. Trauma-related labral tears are often seen in athletes involved in contact sports.

Repetitive Overuse: Continuous overhead activities, common in sports like baseball, swimming, or weightlifting, can lead to gradual wear and tear of the labrum, eventually resulting in tears.

Anatomical Variations: Some people may have structural abnormalities in the shoulder joint, making them more susceptible to labral tears.

Age-Related Changes: Over time, the labrum may degenerate as part of the natural ageing process, making it more prone to tears.

Instability: People with shoulder instability, where the joint is overly loose, are at an increased risk of labral tears.

Conclusion

Common injuries leading to chronic shoulder pain encompass rotator cuff injuries, frozen shoulder (adhesive capsulitis), shoulder impingement syndrome, and labral tears. These conditions can arise from a combination of factors, such as traumatic incidents, overuse, and underlying anatomical issues. Recognising the distinctive characteristics of each injury is crucial for accurate diagnosis and tailored treatment. Encouraging people experiencing shoulder pain in Singapore to seek timely medical attention is vital for early diagnosis and intervention. Timely care can prevent the progression of acute injuries into chronic conditions, preserving shoulder function and minimising long-term discomfort.