Millions of people around the world have shoulder pain. A study found that 67% of the general population will have shoulder pain at some point in their lives. Debilitating symptoms can range from mild to severe and are caused by a variety of issues. This includes overuse, injury, or disease.
In this article, the Joy & Grace team talks about the steps you can take to evaluate the pain in your shoulder and what to expect during a visit to the doctor.
How Do You Evaluate Shoulder Pain?
Evaluating your shoulder pain is important in order to determine the cause and get the best treatment. If you are experiencing shoulder pain, it is always best to make an appointment with your doctor for an evaluation. However, you may start assessing your shoulder pain right at home to get a head start.
When doctors assess pain, they usually start with questions that follow the acronym S.O.C.R.A.T.E.S. We know it can get overwhelming when you are bombarded by a series of questions, especially when you’re in pain. You might even give an inaccurate picture of what you are experiencing. So, here’s a quick guide on what information to take note of before visiting a doctor:
Site: First, you should take note of the location of the pain. In this case, it is obviously the shoulder, but you can still be more specific on what area of the shoulder is actually painful.
Onset: You then take note of when the pain started. It is important to remember any accidents, such as a fall or a bump, no matter how minor they may seem. Also, try to remember what you were doing when the pain started.
Character: Next, you should assess the type of pain you are experiencing. Is it sharp, dull, burning, aching, or throbbing? Is the pain constant, or does it come and go?
Radiation: Then identify other areas of the body where the pain is traveling. Does the pain radiate down your arm or neck?
Associated Symptoms: Your doctor may also want to know if you have any other symptoms, such as weakness, numbness, or tingling in the affected area.
Also, take note of any medical conditions you may have that could be contributing to the shoulder pain, especially heart disease or cancer.
Time: Take note of how long you’ve had the pain and whether it appeared suddenly or gradually.
Exacerbating and Relieving Factors: Identify any activities or movements that make the pain worse or better.
Severity: We know everyone’s pain tolerance is different, but try to rate your pain on a scale of 1 to 10.
What Should A Complete Shoulder Examination Include?
After taking note of your pain’s characteristics, you can visit a doctor to assess your shoulder pain thoroughly. A complete shoulder examination is an important part of diagnosing injuries and disorders of the shoulder.
This examination is best done by a doctor, but you can also try it yourself or have someone help you. A thorough shoulder examination includes the following:
Inspection. The doctor will observe how you move and carry your shoulders, taking note of any swelling, scarring, and bruising. They will also look for any decrease in the size of your muscles or deformities. "Scapular winging” may also be present and suggest abnormalities in the muscles supporting your shoulder blade.
Palpation. The doctor may use light and deep palpation to detect tenderness or deformity. The physician will press on the joints and muscles of your shoulder, neck, upper arm, and chest.
Strength and Range of Motion. The shoulder should be examined for active, passive, and resisted range of motion. Active range of motion involves moving the shoulder through a range of motions without the doctor's help.
Passive range of motion involves the doctor moving the shoulder for you. While the resisted range of motion involves you pushing against the doctor’s hand as you move the shoulder. Aside from testing the shoulder’s range of motion, these tests can also help assess the strength of your shoulder.
After a complete shoulder examination, the doctor may suggest imaging tests to get a complete picture of your condition.
What Is the Normal Shoulder Range Of Motion?
Before identifying any abnormalities in range of motion (ROM), it’s essential to understand what the shoulder is normally capable of. Normal shoulder ROM is important for activities of daily living, such as reaching and lifting. It is also essential for many sports and recreational activities.
The normal shoulder range of motion is determined by the joint's ability to move freely and without pain through a series of movements. Generally, the shoulder can move in the following motions:
- Flexion. Shoulder flexion is the ability to raise the arm up in front of the body. To do this, raise your arms as high as they can go, starting with your palms against your side. Shoulder flexion has a normal range of motion of 180 degrees.
- Extension. Shoulder extension is the ability to reach behind you. When you start with your palms next to your body, the normal range of motion for shoulder extension is between 45 and 60 degrees.
- Abduction. Shoulder abduction is the ability to move the arm away from the middle of your body. This is when you raise your arms to your sides.
When your hands are at your sides, a healthy shoulder has an abduction range of about 150 degrees. This puts your arms and hands straight above your head.
- Adduction. Shoulder adduction is the ability to move your arm toward the middle of your body as if you are trying to hug yourself.
Shoulder adduction usually moves between 30 and 50 degrees, depending on how flexible you are and your body composition. It may be hard to move your arms inward if you have a very muscular chest or arms.
- Internal Rotation. Internal rotation of the shoulder is the ability to rotate the arm inwards. Just imagine you’re bringing the two front halves of a jacket together to button or zip it up. Internal rotation of a healthy shoulder usually has a ROM of 70 to 90 degrees.
- External Rotation. External rotation of the shoulder is the ability to rotate the arm outwards. Now, imagine you’re opening up the two front halves of a jacket you’re wearing after unbuttoning or unzipping it. External rotation of a healthy shoulder usually has a ROM of 90 degrees.
The shoulder can move beyond these ranges, but it is important to note that doing so can cause pain or discomfort. It is essential to maintain normal shoulder ROM to prevent pain and injury and to maintain proper shoulder function.
How Do I Know If My Shoulder Is Injured?
If you’ve been experiencing pain in your shoulder, you may wonder if you have a shoulder muscle injury. These injuries can be caused by a variety of factors, including repetitive motions, overexertion, and trauma.
Without stating the obvious, the most common sign of a shoulder muscle injury is pain. This can range from a dull ache to a sharp, stabbing sensation.
You may also experience weakness in the shoulder, which can make it difficult to move your arm. Other symptoms may include swelling, tenderness, and a decreased range of motion.
What Are The Common Forms Of Shoulder Injury?
There are different types of shoulder injuries, ranging from mild to severe. The common forms of shoulder injuries are:
1. Rotator Cuff Tear.
Rotator cuff tears are one of the most common shoulder injuries affecting the muscles and tendons of the rotator cuff. The rotator cuff is a group of muscles and tendons that keep the head of your upper arm (humerus) within the socket of your shoulder joint.
Rotator cuff tears occur when the muscles and tendons of the shoulder joint are damaged, leading to pain and a decrease in range of motion. Treatment typically includes rest, physical therapy, and sometimes surgery.
2. Shoulder Impingement Syndrome (SIS).
SIS occurs when the bones of your shoulder joint "pinch" the nerves of your rotator cuff, leading to pain and difficulty in lifting the arm.
We have an in-depth article that talks about rotator cuff tears and shoulder impingement syndrome here.
3. Shoulder Dislocation and Instability
This occurs when the head of your humerus is forced out of its socket, leading to pain and instability. Aside from shoulder pain, you may feel as if your shoulder is out of place.
4. Tendonitis
Tendonitis is an inflammation of the tendons surrounding the shoulder joint. This is usually caused by repetitive and overhead motions, such as throwing a ball.
5. Labral Tears
Labral tears are tears in the cartilage that lines the socket of the shoulder joint and can be caused by a traumatic event or overuse.
6. Strains and Sprains
Shoulder strain and sprain are common injuries caused by overuse or trauma to the shoulder joint and muscles.
Shoulder strain occurs when the muscles and tendons of the shoulder become overstretched or torn. This is usually due to repetitive use or a sudden force or impact.
Meanwhile, a shoulder sprain occurs when the ligaments that connect the bones in the shoulder joint are overstretched or torn.
7. Bursitis
Shoulder bursitis is an inflammation of the bursa, a fluid-filled sac that acts as a cushion between a bone and a tendon or muscle. And as you can guess, bursitis is also caused by repetitive motions or constant pressure on the shoulder.
8. Frozen Shoulder
Frozen shoulder, or adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. If you have a frozen shoulder, you often experience a limited range of motion, as if your shoulder is literally frozen in place.
If you have a frozen shoulder, you may have difficulty doing normal activities such as reaching overhead or behind the back. It can be a very painful and debilitating condition that can last for months or even years.
What Are The Special Tests For The Shoulder?
The shoulder is a complex joint that is vulnerable to injury and overuse. Special tests for the shoulder are used to assess the shoulder joint's range of motion and integrity. However, it is important to note that special tests alone cannot diagnose a disease or condition. They should be used with other tests, such as X-rays or MRI scans.
Here are some of the special tests commonly used to assess shoulder disorders. We won’t be listing all of them since most of them overlap in purpose, and we’ll be stuck here forever if we do.
The Apley Scratch Test
The Apley scratch test is another good way to measure the range of motion in the shoulder. In this test, you’ll be asked to extend your arm out in front of you, and then reach behind your head and touch the top of the opposite shoulder blade. This is used to measure abduction and external rotation.
To test for internal rotation and adduction, you will be asked to reach behind your back and touch the lower part of the opposite shoulder blade. When measuring external rotation, your arms should be at your sides and the elbows should be bent 90 degrees.
Sulcus Sign
The sulcus sign tests for shoulder instability. With your arm in a neutral position, the examiner pulls down on the elbow or wrist while looking for a depression in the shoulder area. When there is depression, it means that the humerus isn't moving as well as it should, which means that your shoulder joint isn't stable enough.
Clunk Sign
In the clunk sign test, you will be lying down. The examiner will put one hand on the back of your shoulder, over the point where your upper arm meets your shoulder, and put the other hand on the humerus, above your elbow.
They will fully lift your arm over your head. Then the doctor will push it forward with their hand over the head of the upper arm while rotating your humerus outward with the other. You may have a tear in the labrum if the shoulder makes a clunk or grinding sound.
The Neer’s Impingement Sign
The Neer’s impingement sign is used to test for shoulder impingement syndrome, which is a common cause of shoulder pain. This test assesses the subacromial space. The subacromial space is the space between your shoulder joint and a bony protrusion of the shoulder blade called the acromion.
In Neer's test, you will be asked to turn your forearm so that your thumb points downwards (pronate). And then, the doctor will passively bend your arm until it is over your head.
This move makes the subacromial space smaller and brings back pain if there is shoulder impingement.
Yergason's Test
Yergason’s test is used to assess inflammation of the tendons of the biceps. First, the doctor will ask you to bend your elbow 90 degrees and turn your forearm so that your palm faces downwards (pronate). Then the doctor will apply resistance by holding your hand and asking you to turn your forearm so that your palm faces upwards (supinate).
The doctor will then palpate the tendon of the biceps for any tenderness or popping sensation. The test is positive if it causes any pain.
The Drop Arm Test
This is also known as the Codman’s test and is used to assess for a rotator cuff tear. This test can show if the supraspinatus muscle is too weak. The supraspinatus muscle is the one in the rotator cuff that is most often torn.
The doctor will raise your arm until it is 90 degrees away from the side of your body. Then you will attempt to put your arm back in a neutral position with the palm facing down. If your arm suddenly falls or hurts, the test is considered positive.
The Empty Can Test
The Empty Can test is thought to be one of the best ways to find tears in the rotator cuff. It looks for weakness in the supraspinatus muscle, just like the drop arm sign. You will be asked to straighten the affected arm all the way out to the side so it is parallel to the ground.
Then you will turn your arm around so your palm faces backward and your thumb faces down. The doctor will then push down on your arm while trying to fight against it. If you feel pain when you try to resist the downward pressure, it could be a sign that your rotator cuff is torn.
The Gerber’s Or Lift Off Test
The Lift Off test will assess for any problems in the subscapularis muscle, which is in front of your shoulder and is also part of the rotator cuff. The doctor will ask you to put the painful arm behind your back and rest the back of your hand on your lower back.
You will then attempt to get your hand off your back. A rotator cuff tear can cause pain or weakness when raising the hand.
The Belly Press Test
The belly-press test is used to find the subscapularis muscle and see if it is torn or doesn't work right. It is often used instead of the lift-off test when the lift-off test can't be done due to pain or a limited range of motion in the shoulder's internal rotation.
You can either sit or stand with your elbow bent to 90 degrees and your palm on your upper abdomen. The doctor will then ask you to rotate your arm inwards in order to press your palm against your stomach.
If you bend your wrist, bring your shoulder closer to your body, or extend it, then something might be wrong with your subscapularis muscle. This unintentional movement will cause your elbow to fall behind the trunk.
The Apprehension Test
The Apprehension test is used to assess shoulder instability. For this test, you will be asked to lie on your back on the examination table. The doctor will then bend your elbow 90 degrees and pull the shoulder away from the body (abduct) at a 90-degree angle as well.
The doctor will then press down on the wrist with one hand to externally rotate your shoulder. The test is positive if you feel any fear of dislocation the more the doctor presses down on your wrist.
The Relocation Test
After a positive result on the anterior apprehension test, the relocation test is done right away by applying force on your shoulder. Pain or worry going away is a sign of shoulder instability.
The Hawkins-Kennedy Impingement Test
The Hawkins’ impingement sign is used to assess for rotator cuff tendinitis. To do this test, you will bend your elbow and shoulder 90 degrees. The doctor will hold your arm at the level of the elbow so that your upper limb can be as relaxed as possible.
Then, the doctor will turn your shoulder inward while at the same time bringing your arm across your body. If the test causes pain, then it may be an indication of shoulder impingement.
Cross-Arm Test
People with a dysfunctional shoulder often have shoulder pain misdiagnosed as impingement syndrome. With the cross-arm test, the acromioclavicular joint is isolated by raising the hurt arm to a 90-degree angle.
When the arm is actively pulled towards the center of the body, the acromion is forced into the end of the clavicle. The test is positive when there is pain near the shoulder joint
The Bear Hug Test
The Bear Hug test also assesses your subscapularis muscle. You will put the palm of the painful arm on the opposite shoulder, making sure that the fingers are spread out, and the elbow is in front of your body.
The doctor will then attempt to pull your hand away from your shoulder while you try to resist. The test is positive if you can’t keep your hand against your shoulder.
The Hornblower’s Sign Test
The Hornblower’s sign test is used to detect a tear in the teres minor muscle. You can either sit or stand while the doctor bends your arm at a 90-degree angle and also bends your elbow to a 90-degree angle. Then, the doctor will ask you to rotate your arm backwards against the doctor’s hand. If you can’t do an external rotation, the test is positive.
The Speed’s Test
Finally, Speed’s test is used to assess any damage to the tendons of the biceps. It also assesses your shoulders for tears in the labrum, the ring of cartilage that surrounds your shoulder joint.
In this test, you will be asked to bend your elbow and supinate your forearm fully. Then you will move your shoulder forward against the doctor’s resistance. At the same time, the doctor should feel the front of the joint to see if it is tender. If the move caused pain, it would be a sign of biceps tendinopathy.
What Are Red Flags For Shoulder Pain?
While the pain in your shoulder may be caused by minor injuries or overuse, there are certain “red flags” that could mean a more serious problem. Knowing the red flags can help you determine when to seek medical attention and avoid further damage or disability.
So make sure to take off the rose-colored glasses and keep an eye open for these red flags:
- Sudden or severe pain
- Pain that radiates down the arm, into the neck, or jaw
- A complete loss of strength or range of motion
- A visible deformity
- A history of trauma
- Fever
- Night sweats
- Weight loss
- Cough or difficulty breathing
- Swelling and redness
If you experience any of these symptoms, it’s crucial to seek medical attention right away.
When Should I Be Worried About Shoulder Pain?
This depends on your symptoms and your medical history, especially the onset and characteristics of the pain.
Severe shoulder pain that appears suddenly may indicate a more serious injury. If you experienced a traumatic injury, such as a fall or car accident, you should seek medical attention immediately. Other causes of acute shoulder pain include a dislocated shoulder or a rotator cuff tear.
Chronic shoulder pain is a different story. This type of pain is usually mild and appears gradually over a period of weeks. It is due to overuse or repetitive use of the shoulder joint and is often the result of activities such as tennis, golf, weight lifting, or throwing.
You may resolve chronic shoulder pain by simply resting and taking a break from activities that cause the pain. But if the pain persists for more than a few weeks, it is important to see a doctor for a proper diagnosis and treatment.
In some cases, shoulder pain can be caused by an underlying medical condition, such as arthritis. Shoulder pain may even be a symptom of a heart attack. If you have a family history of these conditions, you must know the signs and symptoms and seek medical advice if you experience any of them.
Finally, if you experience shoulder pain accompanied by fever, chills, or night sweats, this may indicate an infection. An infection can be a severe complication, and you should seek medical attention immediately.
How Do You Describe Shoulder Pain To The Doctor?
When describing shoulder pain to your doctor, it is important to be as specific as possible. Although we mentioned these earlier, a quick recap wouldn’t hurt. Start by taking note of the location and when it started.
Then tell the doctor whether it is a dull ache or a sharp, stabbing sensation. Also, mention if the pain is localized to a specific spot or radiates towards a different area.
Finally, note any other symptoms you are having. Are you experiencing weakness or numbness? Is it difficult to move your shoulder or arm? Do certain activities make the pain worse?
Be sure to mention any other medical conditions you have and any medications you are taking. This will help your doctor better understand the source of your shoulder pain.
You can ensure you get a correct diagnosis and the best possible treatment by providing your doctor with as much information as possible.
Takeaway
When it comes to evaluating shoulder pain, it is essential to understand how the shoulder functions. It is important to pay attention to the type, intensity, and duration of the pain and any other symptoms that may be present. It is also important to seek medical advice if the pain persists.
A comprehensive shoulder evaluation should include a physical exam, imaging tests, and other tests as needed.
Treatment depends on what's causing the problem and can be as simple as making some changes to your lifestyle or as intensive as surgery. Shoulder pain can signify more serious health problems, so if it lasts more than a few days, it's important to see a doctor.
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