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All About Shoulder Pain: Diagnosis to Treatment in a One-Stop-Clinic

Shoulder pain is an affliction that transcends age, profession, and lifestyle. Whether you're a young athlete, a middle-aged professional, or a senior enjoying retirement, the likelihood of encountering shoulder discomfort or dysfunction at some point is high. Navigating the myriad causes and treatments can be daunting. That's where this guide comes in, offering you a comprehensive look into the common conditions causing shoulder pain, their diagnostic pathways, and the best treatments available today. Moreover, we shed light on the concept of a one-stop-clinic – an integrative approach to shoulder pain management that promises efficiency, accuracy, and relief.

male patient with shoulder pain

Impingement Syndrome

Definition: When tendons of the rotator cuff muscles get trapped beneath the acromion during arm movement, they get compressed, causing pain. Causes:

  • Overhead activities: Athletes, painters, or electricians often strain their shoulders.

  • Structural issues: A curved or hook-shaped acromion increases risk.

  • Age-related changes: Wear and tear can narrow the subacromial space.

Clinical Findings & Symptoms:

  • Sudden pain when lifting the arm.

  • Difficulty or pain while sleeping.

  • Pain progression without any injury.

Diagnosis: A detailed examination detects impingement signs. Yet, ultrasound scans play a pivotal role. This real-time imagery provides invaluable insights, revealing inflammation or tears causing impingement.

Treatment Options: Primary treatments include rest, physiotherapy, and NSAIDs. Persistent cases may benefit from corticosteroid injections. If non-surgical approaches fail, arthorscopic (keyhole) surgery might be considered.

Frozen Shoulder (Adhesive Capsulitis)

Definition: A debilitating stiffness in the shoulder joint due to inflammation and fibrosis. Causes:

  • Immobilisation: Not moving the arm post-surgery or injury can trigger it.

  • Medical conditions: Diabetes or thyroid problems increase the risk.

  • Autoimmune factors: Sometimes, the body's immune system attacks shoulder tissues.

Clinical Findings & Symptoms:

  • Pain starts subtly but intensifies over months.

  • Movement restriction worsens, making daily tasks challenging.

  • Night-time exacerbation of pain.

Diagnosis: Ultrasound scans reveal a thickened joint capsule, confirming the diagnosis alongside clinical findings. MRI can exclude other issues. Treatment Options: While NSAIDs manage pain, Ultrasound guided injections of corticosteroids reduce inflammation and pain. Physical therapy restores movement, but resistant cases might need shoulder hydrodilatation or surgery.

Rotator Cuff Tears

Definition: A breach in one or more rotator cuff tendons, leading to pain and functional loss. Causes:

  • Trauma: An accident or sudden strain can cause an acute tear.

  • Degeneration: Aging-related wear and tear lead to progressive degeneration.

Clinical Findings & Symptoms:

  • A deep-seated shoulder ache.

  • Sleep disturbances due to pain.

  • Weakness, especially during lifting or rotating the arm.

Diagnosis: Clinical tests offer preliminary insights. However, ultrasound scans excel in providing a granular view, visualising the tear's location and extent.

Treatment Options: Shoulder pain from mild tears often improves with rest and physiotherapy. For pain management, NSAIDs or corticosteroid injections are potent. Severe cases warrant surgical attention.

Tendonitis of the Shoulder

Definition: When overuse or trauma inflames shoulder tendons, or calcification develops. Causes:

  • Repetitive strain: Overhead activities or starting a new sport can overburden tendons.

  • Abrupt activity: Suddenly increasing activity without conditioning.

  • In some patients with calcific tendonitis, the cause is unknown.

Clinical Findings & Symptoms:

  • Pain localised to the shoulder's front or side.

  • Difficulty in sleeping on the affected side.

  • Night pain (in calcific tendonitis)

  • Aggravation with overhead motions.

  • Tenderness and mild swelling.

Diagnosis: Clinical palpation identifies the inflammation, but ultrasound scans visualise the inflamed, thickened, or torn tendons.

Treatment Options: Apart from rest and NSAIDs, persistent cases benefit from corticosteroid injections. Resistant tendonitis might need surgical correction. Persistant Calcific tendonitis can be treated with ultrasound guided needling (Barbotage procedure).

Acromioclavicular Joint (ACJ) Arthritis & Shoulder Joint Arthritis

Definition: Cartilage degeneration at the shoulder's acromioclavicular or ball-and-socket joint.


  • Past trauma: Old injuries can lead to arthritis in the long term.

  • Natural wear and tear: Aging affects joint integrity.

  • Autoimmune issues: Rheumatoid arthritis affects the shoulder joint.

Clinical Findings & Symptoms:

  • Chronic, progressively worsening pain.

  • A grinding shoulder sensation.

  • Tenderness and swelling over the joint.

Diagnosis: Xrays are the first modality of imaging and Ultrasound scans offer insights into the soft tissue outside the joint. MRI scans provide details into the intraarticular cartilage, joint lining and joint space, and any osteophyte growth, complementing clinical evaluations.

Treatment Options: NSAIDs and physiotherapy are foundational. Injections with corticosteroids or hyaluronic acid can alleviate pain. Advanced arthritis might necessitate joint replacement.

The One-Stop-Clinic Experience

Our one-stop-clinic isn't just a healthcare facility; it's a healthcare journey. From the moment you step in, you're greeted by a seamless blend of professionalism, advanced technology, and patient-centric care:

  • Doctor Assessment: Here, an experienced specialist takes the time to deeply understand your issue. They go beyond a mere clinical examination – they aim to understand the context, taking a comprehensive medical history, your lifestyle, and the specific triggers for your pain. They'll discuss your symptoms, any previous treatments, and your expectations. They will then perform a comprehensive clinical examination of the shoulder, the neck and the rest of the arm.

  • Ultrasound Scanning: This isn't just a procedure; it's a visual dialogue between the doctor and your shoulder. It offers dynamic and detailed imagery of the soft tissues, letting doctors confirm the diagnosis. You're also involved in this step, with doctors explaining the visuals, ensuring you understand your condition.

  • Shoulder Injections: If required, and after discussing potential benefits and risks, specific injections might be administered. This could range from corticosteroids for inflammation management to hyaluronic acid for improving joint function. The process is performed with the utmost precision and care, ensuring minimal discomfort.

  • Personalised Recovery Plan: Post-diagnosis, it's not just about treatment. It's about rehabilitation and prevention. A tailored plan might involve physical therapy sessions, specific exercises, dietary recommendations, and regular follow-ups.

  • Continued Support: Our relationship doesn’t end once you leave the clinic. We're there for your post-treatment journey, answering queries, offering support, and ensuring your road to recovery is smooth.

When it comes to shoulder pain, knowledge is empowering. Understanding your condition and the available treatments, combined with the unparalleled care at our one-stop-clinic, ensures that you're not just on the path to recovery, but also prevention and improved overall health.

About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.


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