Why does your shoulder hurt when lifting your arm?
If you have shoulder pain with lifting your arm that can be disabling when it comes to your exercise, work, and other activity. So let’s talk about what’s going on when you have pain in the shoulder. The shoulder is an amazing structure in the human body. It allows you to move your arm in a incredibly wide range of motion in multiple planes and to do so with stability. That stability is maintained by layers of tissue working in a highly coordinated fashion throughout that range of motion.
At this stage it’s incredibly important to understand the concept of biotensegrity. The idea of biotensegrity is that when you take multiple individual subunits that are distinct and independent, if you put them in close approximation to one another under tension and compression, you get a stronger overall unit. In other words, the whole is greater and stronger than the sum of its individual parts. In the case of the shoulder the multiple units that are involved include: Multiple joints, the labrum of the shoulder, the ligaments that help to keep the bones connected together, the rotator cuff tendons, the multiple muscles that are involved, the fascial layers in between the muscles and the tendons, and even the nerves that supply the muscles and tendons.
Due to biotensegrity a healthy shoulder allows you to have coordination, stability, and durability even if you have a mild to moderate injury. A shoulder that has had too severe and injury or chronic injury, can then develop instability, chronic inflammation, pain, and functional loss as well.
As a physician how do I determine what structures are injured and what’s the problem? First and foremost there has to be an understanding that shoulder pain and dysfunction is rarely due to just one structure because of the layers and depth of tissue that are involved. It’s frequently a combination of issues and layers that are involved. Furthermore as a physician I will evaluate your history of pain, your injury pattern, examination findings, and correlate with advanced imaging findings.
Imaging findings that helpful include:
Diagnostic musculoskeletal ultrasound is incredibly helpful for looking at the shoulder in a dynamic range of motion, evaluating the rotator cuff tendons, instability related to the ligaments and other soft tissue structures, joint arthritis, and determining whether chronic inflammation is present as well.
X-rays can be helpful if you have had an acute injury and need to evaluate for any sort of bone injury.
MRI is typically most helpful if you are looking for labral injuries or certain types of bone issues as well. MRI has been used typically also for looking at rotator cuff injuries. In reality due to the dynamic nature of ultrasound you can actually get better information about a rotator cuff tear and compare to the other side if you’re using diagnostic musculoskeletal ultrasound in a skilled, intelligent, and nuanced manner.
Based on the structures that have been injured as well as what other conservative treatments have been pursued, additional medical or interventional procedures can be pursued as needed and required.
To sum up, the shoulder is a wonderfully complicated and layered structure. Injuries to it can lead to instability. Instability in turn leads to chronic stress on the injured tissue as well as the surrounding supportive tissues. That in turn leads to chronic inflammation, which then also leads to chronic pain, functional limitation, reduced range of motion, and disability. In a follow-up set of videos I will go through what you can personally do on your own if you have shoulder pain, when you should see a physician, and how a physician can actually help with your shoulder pain as well.
Let me know your thoughts and perspective. In future blog posts you’ll also learn what you can do on your own to treat your shoulder pain, when to see a doctor, and what else can a physician specialist do to help with your shoulder pain.