Shoulder
Shoulder Pain
The shoulder gives up stability to gain range of movement, which is why it goes wrong in so many different ways. Night pain that stops you sleeping on that side is the symptom that most often brings people in, and it usually points somewhere specific.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
What tends to cause it
- Rotator cuff problems. Pain on the outer upper arm, weakness reaching overhead, and pain lying on that side at night. Ranges from irritation to a full tear.
- Frozen shoulder. Pain first, then progressive stiffness in every direction, including when someone else moves the arm for you. More common in diabetics, and it typically runs a long course.
- Instability. A shoulder that has dislocated, or that feels like it is slipping. Usually younger patients, often after a first dislocation in sport.
- Arthritis. Deep, aching pain with grinding and gradual loss of movement.
- Acromioclavicular joint problems. Pain right on top of the shoulder, worse reaching across the body.
- Referred pain from the neck. Common, and often missed. Pain that travels below the elbow, or comes with pins and needles, points here.
Frozen shoulder and a rotator cuff tear feel similar to the person experiencing them but need almost opposite treatment, which is a large part of why an examination matters.
When it needs seeing sooner
- The shoulder is out of joint after an injury. That needs an emergency department, not a clinic appointment.
- You cannot lift the arm at all after a fall, particularly over the age of sixty.
- The shoulder is hot, swollen and you feel unwell.
- There is numbness, weakness or coldness in the hand.
- Shoulder pain comes with chest tightness, sweating or breathlessness. That needs emergency assessment for the heart, not the shoulder.
How it gets assessed
Examination separates what you cannot do from what you will not do because it hurts. The key distinction is between a shoulder that is stiff in every direction even when moved passively, which suggests a frozen shoulder or arthritis, and one that moves freely when someone else moves it but cannot be lifted actively, which points at the rotator cuff.
The neck is examined as a matter of routine, because it is a common source of shoulder pain and treating the wrong structure wastes months.
X-rays show arthritis, bone spurs and old fractures. Ultrasound and MRI show the cuff tendons. Instability with any history of repeated dislocation usually needs a CT scan to measure bone loss, because that changes which operation would work.
What treatment usually looks like
The large majority of shoulder problems are managed without surgery, and the physiotherapy is specific to the diagnosis rather than generic shoulder exercises.
- A structured programme for the rotator cuff and the muscles controlling the shoulder blade
- For frozen shoulder, a stretching programme, and an injection early on where pain is limiting progress
- Activity modification, particularly reducing overhead loading for a period
- Anti-inflammatory medication for a defined period
- Injections in selected cases, to make rehabilitation possible rather than as treatment on their own
Surgery is discussed for a cuff tear that is not healing and is causing real weakness, for a shoulder that keeps dislocating, for arthritis that has stopped responding, and for a frozen shoulder that has not moved after a long and genuine trial of everything else.
Common questions
Why does it hurt so much more at night?
Lying down removes the pull of gravity that holds the shoulder in a comfortable position by day, and the space the cuff tendons pass through narrows. Night pain is the most reliable indicator of a cuff problem, and it is usually the symptom that improves first with treatment.
How long does a frozen shoulder take?
Longer than anyone wants to hear. Left alone it typically runs eighteen months to three years through painful, stiff and thawing phases. Treatment aims at shortening that and making it bearable, and it does help, but the honest answer is that it is measured in months.
Can I still exercise with shoulder pain?
Usually yes, with adjustments. Continuing to load an irritated shoulder overhead will keep it irritated, but stopping everything weakens the muscles that support it. Specific advice depends on the diagnosis.
Does a tear always need repairing?
No. Many tears, particularly partial and long-standing ones in older patients, do well with physiotherapy alone. Repair is considered when a tear is recent, when weakness rather than pain is the main problem, or when a proper course of physiotherapy has not worked.
Related procedures
Where an operation does turn out to be the right answer, these are the ones this problem most often leads to.
Not sure what is causing it?
That is what a consultation is for. Bring any imaging you already have, and any plan you have been given elsewhere.