Shoulder pain
Shoulder pain most often shows up with overhead movements and at night. You reach for the top shelf and it stabs. You can no longer lie on that side. You raise your arm to a certain height, and beyond that it only goes with the help of your other hand.
The shoulder joint has the largest range of movement of all the joints in the body. Its stability comes mainly from the muscles, not from the shape of the bones, which is why it is sensitive to overload, repetitive movements and injuries.
Shoulder pain does not always come from the shoulder. Some of it comes from the cervical spine and occasionally from internal organs, so a description of the circumstances in which the pain occurs is more important than its location.
What the common causes are
The most common are problems with the rotator cuff, the group of tendons that guide and hold the shoulder. These include inflammation, impingement under the acromion, partial or complete tendon tears and calcification, in which calcium builds up in the tendon and pain can come on suddenly and very severely.
Frozen shoulder is something different. Mobility decreases gradually and in all directions, even when someone else moves the shoulder. It is more common in people with diabetes and after a long period of keeping the shoulder still.
Other causes include wear of the joint, instability after a previous dislocation, bursitis and injuries after a fall onto an outstretched arm.
When not to book an appointment but to seek help immediately
If you have pain in the shoulder or left arm accompanied by pressure in the chest, shortness of breath, a cold sweat or nausea, call 112. Shoulder pain can be a sign of a heart event and telling the difference by how it feels is not reliable.
After a fall or blow with a visibly changed shoulder shape, inability to move the arm, or a numb, cold and pale arm, go to an emergency department. A suspected dislocation or fracture is not a condition for planned care.
You also need an immediate assessment if you have a fever with a red, swollen and very painful shoulder, as this may be an infection of the joint.
What the examination involves
The examination begins with a conversation: when the problems started, whether there was an injury, which movements hurt, what eases the pain and how you sleep. These answers tell the orthopaedic surgeon a lot even before they touch the shoulder.
This is followed by a clinical examination assessing range of movement, strength and stability of the joint, with tests that distinguish between the different causes. The cervical spine is also checked, because pain often travels from there into the shoulder.
Whether imaging is needed, and which kind, is decided by the doctor at the examination. X-ray imaging is available at Medicinski center Ljubljana. MRI is not a routine test and makes sense when its result would change the treatment decision.
You receive the findings and the proposed next steps in a written report. The orthopaedic examination is self-pay, you do not need a referral, and appointments are booked with the clinic that runs the service.
What helps
For most rotator cuff problems, the core of treatment is guided physiotherapy with a gradual strengthening programme. This is not an add-on to treatment but the treatment itself, and results take several weeks of consistent work.
Painkillers are used for a short time and, at the doctor's discretion, also an injection of an anti-inflammatory medicine, which calms the pain enough for exercise to be possible at all.
Complete rest of the shoulder does not help most people and makes a frozen shoulder worse. Adjusting the load means avoiding movements that hurt, not stopping movement.
Surgical treatment is considered for some injuries, especially fresh tendon tears in younger people, recurrent dislocations and when consistent physiotherapy does not bring progress within a reasonable time.