Shoulder pain

Overview of Shoulder pain

During the evaluation of shoulder disorders, the examiner should carefully note any history of trauma, fibromyalgia, infection, inflammatory disease, occupational hazards, or previous cervical disease.[2]

Shoulder pain may originate in the Glenohumeral or acromioclavicular joints, sub acromial (subdeltoid) bursa, periarticular soft tissues (e.g., fibromyalgia, rotator cuff tear/tendinitis), or cervical spine. [2]

Indian epidemiology then other

Causes

• Shoulder pain is referred frequently from the cervical spine but may also be referred from intrathoracic lesions (e.g., a Pancoast tumor) or from gallbladder, hepatic, or diaphragmatic disease. [2]
• Sub acromial bursitis is a frequent cause of shoulder pain. Whereas OA and RA commonly affect the acromioclavicular joint, OA seldom involves the Glenohumeral joint, unless there is a traumatic or occupational cause. [2]
• Rotator cuff tendinitis or tear is a very common cause of shoulder pain. Nearly 30 percent of the older people will have shoulder pain, with rotator cuff tendinitis or tear as the primary cause.
• Another common cause of shoulder pain is impingement syndrome where the rotator cuff gets caught between the acromion and humeral head .
• Sometimes shoulder pain is the result of injury to another location in your body, usually the neck or biceps. This is known as referred pain. Referred pain generally doesn’t get worse when you move your shoulder. [2]

Other causes of shoulder pain include:[1]

• Arthritis
• Torn cartilage
• Torn rotator cuff
• Swollen bursa sacs or tendons
• Bone spurs (bony projections that develop along the edges of bones)
• Pinched nerve in the neck or shoulder
• Broken shoulder or arm bone
• Frozen shoulder
• Dislocated shoulder
• Injury due to overuse or repetitive use
• Spinal cord injury
• Heart attack

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Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

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Sign & Symptoms

• Typically, there is pain and tenderness of the lower neck and suprascapular area, referred to the shoulder and upper limb area; shoulder movement may be restricted.
• Movement of the cervical spine and shoulder may reproduce more generalized upper back, neck, and shoulder pain.
• Upper limb paranesthesia may occur. [1]

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Diagnosis

• During the evaluation of shoulder disorders, the examiner should carefully note any history of trauma, fibromyalgia, infection, inflammatory disease, occupational hazards, or previous cervical disease.
• In addition, the patient should questioned as to the activities or movement that elicit shoulder pain.
• Shoulder pain may originate in the Glenohumeral or acromioclavicular joints, sub acromial bursa, periarticular soft tissues or cervical spine.
• The shoulder should put through its full range of motion both actively and passively: forward flexion, extension, abduction, adduction, and internal and external rotation. Manual inspection of the periarticular structures will often provide important diagnostic information.
• Glenohumeral involvement best detect by placing the thumb over the Glenohumeral joint just medial and inferior to the coracoid process and applying pressure anteriorly while internally and externally rotating the humeral head. [2]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation

• The examiner should apply direct manual pressure over the sub acromial bursa that lies lateral to and immediately beneath the acromion.
• Rotator cuff tendinitis suggest by pain on active abduction (but not passive abduction), pain over the lateral deltoid muscle, night pain, and evidence of the impingement signs (pain with overhead arm activities).
• The Near test for impingement perform by the examiner raising the patient’s arm into forced flexion while stabilizing and preventing rotation of the scapula. A positive sign is present if pain develops before 180° of forward flexion.
• The drop arm test is abnormal with supraspinatus pathology and demonstrate by passive abduction of the arm to 90° by the examiner. If the patient is unable to hold the arm up actively or unable to lower the arm slowly without dropping, the test is positive.
• Tendinitis or tear of the rotator cuff is best confirmed by magnetic resonance imaging (MRI) or ultrasound. [2]

Treatment

• Treatment will depend on the cause and severity of the shoulder pain. Additionally, Some treatment options include physical or occupational therapy, a sling or shoulder immobilizer, or surgery. [1]
• Your doctor may also prescribe medication such as nonsteroidal anti-inflammatory medications(NSAIDs) or corticosteroids.
• Moreover, Corticosteroids are powerful anti-inflammatory drugs that can be taken by mouth or your doctor can inject into your shoulder. [1]
• Some minor shoulder pain can be treated at home. In detail, Icing the shoulder for 15 to 20 minutes three or four times a day for several days can help reduce pain.
• Besides this, Use an ice bag or wrap ice in a towel because putting ice directly on your skin can cause frostbite and burn the skin.
• Resting the shoulder for several days before returning to normal activity and avoiding any movements that might cause pain can be helpful. In detail, Limit overhead work or activities.
• Other home treatments include using over-the-counter nonsteroidal anti-inflammatory medications to help reduce pain and inflammation also compressing the area with an elastic bandage to reduce swelling.[1]
• Simple shoulder exercises can help stretch and strengthen muscles and rotator cuff tendons. A either physical therapist or occupational therapist can show you how to do them properly.
• If you’ve had previous shoulder issues, use ice for 15 minutes after exercising to prevent future injuries.
• After having bursitis or tendinitis, performing simple range-of-motion exercises every day can keep you from getting frozen shoulder.[1]
• Nonsteroidal anti-inflammatory drugs (in other words; NSAIDs)
• Injection of an anti-inflammatory medicine called corticosteroid
• Physical therapy
• All in all, Surgery if all other treatments do not work. [1]

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Homeopathic Treatment of Shoulder pain

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Shoulder pain:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Belladonna– 

• If you have Bursitis with a feeling of warmth and trembling, along with severe pain, you can take Belladonna.
• Sometimes the area becomes red and with swelling.

Arnica Montana– 

• This treatment is beneficial when Bursitis is linked to severe trauma or discomfort.
• The affected region appears to be red and painful.
• If you have these symptoms, you may try to avoid any touch on the painful area.

Kalmia latifolia– 

• If you have pain that begins in the upper joint (particularly the hip or shoulder) and moves down indicates that you need this remedy.
• Right shoulder bursitis is widespread and spreads to the elbow, wrist, or side.
• Pain and inflammation can come on all of a sudden, sometimes shifting.
• Discomfort is worse from motion, worse at night, and of a neuralgic kind.

Bryonia- 

• When the pain generated by Bursitis or stiff tissue has a stitching or tear-like feel, this medication is a decent choice.
• You may feel that the area is inflamed. 

Ferrum phosphoricum- 

• This remedy can help relieve swelling, specifically in the right shoulder, which can cause pain that progresses to your wrist or even your neck.
• Here you may feel relief with gentle movement and cold massage.

Rhus tox-

• This homoeopathic medication works wonders in the treatment of joint pain.
• This medication eases both acute and chronic muscle pain.
• We use this remedy if there is any stiffness in your joints and a lot of discomforts.
• This homoeopathic remedy addresses a wide range of joint pains, from rheumatoid arthritis to overuse injuries damages.[4]

Calcarea Phos

• Shoulder-joint–Rheumatic pain in the arm near the shoulder-joint cannot lift the arm.
• Shooting and tearing from the shoulder-joint along the whole arm.

Diet & Regimen of Shoulder pain

• Avoid food, drink with caffeine, meat, butter, cheese also milk as that will increase inflammation.
• Increase intake of raw fruits like cherries, papaya, pineapple. Additionally, They contain proteolytic enzymes which in turn help to reduce inflammation.
• Increase intake of omega 3 fats in supplemental form also from fish and walnuts.
• Take 2 tbsp of flax seed powder daily.
• Use ginger also turmeric, liberally in cooking.
• Take magnesium supplements to relax muscles. In detail, Avoid if you have kidney problems.
• Besides this, Try a spoonful of sesame seeds soaked overnight.
• Bromelain is an enzyme found in pineapple, It is a anti-inflammatory also alleviates pain and stiffness.

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References use for Article Shoulder pain

[1]https://www.healthline.com/health/chronic-pain/shoulder-pain

[2]Harrison-s_Principles_of_Internal_Medicine-_19th_Edition-_2_Volume_Sets

[3] A Complete Repertory of the Tissue Remedies of Schussler by S. F. Shannon

[4] https://aisclinic.in/homeopathy-treatment-and-medicine-for-shoulder-muscle-pain/

Frequently Asked Questions

What is Shoulder pain?

It is defined as Physical discomfort of the shoulder, including the joint itself or the muscles, tendons and ligaments that support the joint.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Shoulder pain?

• Belladonna
• Arnica Montana
• Kalmia latifolia
• Bryonia
• Ferrum phosphoricum
• Rhus tox

What causes Shoulder pain?

• Intrathoracic lesions
• Sub acromial bursitis
• Rotator cuff either tendinitis or tear
• Impingement syndrome
• Arthritis
• Swollen either bursa sacs or tendons
• Bone spurs
• Pinched nerve in the neck or shoulder
• Broken shoulder or arm bone

What are the symptoms of Shoulder pain?

• Pain and tenderness of the lower neck and suprascapular area, referred to the shoulder also upper limb area
• Shoulder movement may be restricted
• Movement of the cervical spine and shoulder may reproduce more generalized upper back, neck, also shoulder pain.
• Upper limb paranesthesia