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Shoulder pain is an extremely common complaint, and there are many common causes of this problem. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you have shoulder pain, some common causes include:
- Bursitis | Rotator Cuff Tendonitis
The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff.
- Rotator Cuff Tear
Rotator cuff tears occur when the tendons of the rotator cuff separate from the bone. Surgery is sometimes necessary for this condition.
- Frozen Shoulder
Also called ‘adhesive capsuliitis,’ this is a common condition that leads to stiffness of the joint. Physical therapy and stretching are extremely important aspects of treatment.
- Calcific Tendonitis
Calcific tendonitis is a condition of calcium deposits within a tendon — most commonly within the rotator cuff tendons. Treatment of calcific tendonitis depends on the extent of symptoms.
- Shoulder Instability
Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition.
- Shoulder Dislocation
A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.
- Shoulder Separation
Also called an AC separation, these injuries are the result of a disruption of the acromioclavicular joint. This is a very different injury from a dislocation!
- Labral Tear
There are several patterns of a torn labrum and the type of treatment depends on the specific injury.
- SLAP Lesion
The SLAP lesion is also a type of labral tear. The most common cause is a fall onto an outstretched hand.
Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery.
- Biceps Tendon Rupture
A proximal biceps tendon rupture occurs when the tendon of the biceps muscle ruptures near the joint.
When do you need to call your doctor about your shoulder pain?
If you are unsure of the cause of your shoulder pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of these conditions must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:
- Inability to carry objects or use the arm
- Injury that causes deformity of the joint
- Shoulder pain that occurs at night or while resting
- Shoulder pain that persists beyond a few days
- Inability to raise the arm
- Swelling or significant bruising around the joint or arm
- Signs of an infection, including fever, redness, warmth
- Any other unusual symptoms
What are the best treatments for shoulder pain?
The treatment of shoulder pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment.
Not all treatments listed here are appropriate for every condition, but may be helpful in your situation.
- Rest: The first treatment for many common conditions that cause shoulder pain is to rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilization can cause a frozen shoulder.
- Hot and Cold Application: Nature Creation hot and cold pads are among the most commonly used treatments for shoulder pain. So which one is the right one to use, ice or heat? And how long should the ice or heat treatments last? Read on for more information about ice and heat treatment.
- Stretching: Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain.
- Physical Therapy: Physical therapy is an important aspect of treatment of almost all orthopedic conditions. Physical therapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity.Some exercises may help you strengthen the muscles around the joint and relieve some of the pain associated with many conditions.
- Anti-Inflammatory Medication: Nonsteroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for patients with shoulder pain caused by problems such as arthritis, bursitis, and tendonitis.
- Cortisone injections: Cortisone is a powerful medication that treats inflammation, and inflammation is a common problem in patients with shoulder pain. Discuss with your doctor the possible benefits of a cortisone injection for your shoulder pain condition.
Heat and ice are the two most common types of passive, non-invasive, and non-addictive therapies. Heat and cold can be used alternatively and are often used as a prelude to exercise therapy.
Hot and cold agents should always be used with caution. It is a good idea to seek the advice of a health care professional prior to use.
Hot Packs and Heat Therapy
Heat therapy induces vasodilation: drawing blood into the target tissues. Increased blood flow delivers needed oxygen and nutrients, and removes cell wastes. The warmth decreases muscle spasm, relaxes tense muscles, relieves pain, and can increase range of motion.
Superficial heat is available in many forms including hot and moist compresses, dry or moist heating pads, hydrotherapy, and commercial chemical/gel packs.
Hot packs in any form should always be wrapped in toweling to prevent burns. Punctured commercial hot packs should be immediately discarded, as the chemical agent/gel will burn skin.
Cold Packs and Cold Therapy (Cryotherapy)
Cold therapy produces vasoconstriction, which slows circulation reducing inflammation, muscle spasm, and pain.
Superficial cold is available in many forms including a variety of commercial cold packs, ice cubes, iced towels/compresses, and forms of hydrotherapy. The duration of cold therapy is less than heat therapy; usually less than 15 minutes. The effect of cold is known to last longer than heat.
Cold or ice should never to applied directly to the skin. A barrier, such as a toweling, should be placed between the cold agent and the skin’s surface to prevent skin and nerve damage. Punctured commercial cold packs should be immediately discarded, as the chemical agent/gel will burn skin.
If not, a recent review article by two University of Washington sports doctors, Matthew Karl, MD, and Stanley Herring, MD, can be your guide. Karl and Herring point out that the application of superficial heat to your body can improve the flexibility of your tendons and ligaments, reduce muscle spasms, alleviate pain, elevate blood flow, and boost metabolism. The mechanism by which heat relieves pain is not exactly known, although researchers believe that heat inactivates nerve fibers which can force muscles into irritating spasms, and that heat may induce the release of endorphins, powerful opiate-like chemicals which block pain transmission.
Increased blood flow occurs in heated parts of the body because heat tends to relax the walls of blood vessels. That’s one reason why sports doctors recommend that you steer clear of the practice of heating up already inflamed joints. Heat appears to be best for un tightening muscles and increasing overall flexibility; the proper tissue temperature for vigorous heating is probably 104 to 113 degrees Fahrenheit (40 to 45 degrees Celsius) and the correct duration of temperature elevation is about five to 30 minutes. Although heating can reduce muscle spasms after a back injury, heat should not be used on sprained ankles or strained
What about cold treatment?
Strangely enough, cold therapy can also reduce muscle spasms, and cold is noted for killing pain, reducing swelling, and lowering metabolic activity. Cold’ s pain-killing effect is caused by its ‘deadening’ of nerve-cell activity; hospital studies show that patients who use cold therapy on injuries tend to require much less pain medication. This effect, though, can sometimes be counterproductive; an athlete who has ‘iced down’ an injured body part may get so much pain relief that he/she returns to activity too soon.
Combined with compression, cold can produce dramatic drops in tissue swelling, because cold initially constricts the walls of blood vessels and compression restricts the amount of blood which can reach an injured body part (another therapeutic intervention, elevation, helps to ‘drain’ a damaged body region of excess fluid). Studies show that cold produces large decreases in oedema (swelling) and better reduction in discomfort, compared to heating.
Cold decreases muscle spasms by making muscles less sensitive to being stretched, and, like heat, cold can be used to treat low-back pain. Research suggests that cold works better for individuals who have had back pain for more than 14 days, while heat may be more effective for those with more recent pain.
The proper duration of cold therapy is currently being hotly debated. Traditionally, doctors have recommended applying cold packs or ice bags to injured areas for 15–30 minutes at a time, but recent research carried out at the University of Brussels indicates that the permeability of Lymphatic vessels decreases after about 10 minutes of cold therapy. Since Lymphatic vessels drain fluid away from injured tissues and thereby relieve swelling, the Brussels researchers recommend that cold be applied to damaged tissues in no longer than 10-minute intervals (however, individuals with large quantities of subcutaneous fat may require longer periods of icing).
Which form of cold therapy is actually most effective? Again, there’s considerable debate, but recent research suggests that ice chips in a plastic bag are most effective, followed by the use of frozen gel packs and blue ice packs, which in turn are superior to chemical reaction packs and inflatable plastic envelopes injected with a gas refrigerant.
The question often comes up as to when it is best to use cold or hot treatment in injuries. Perhaps this can help. When to use ice or heat depends on how long ago the injury occurred.
After you strain a ligament or muscle, it is generally best to use cold (ice or a cold pack) immediately and then for the next day and 1/2. It’s usually wise not to use heat, such as a heating pad, until swelling and bruising has stopped.
Cold is usually used first because it reduces swelling and inflammation. Use Ice for the first 48 hours after an injury. Apply for 20 minutes, remove for 20 minutes, then repeat. Do not apply directly to the skin — put a thin towel over the skin for protection, or freeze a cup full of water, tear off the top rim and move the ice over the injury. This helps control bleeding by constricting blood vessels. Cold acts as a local anesthetic and so relieves pain. Usually the bruising associated with acute inflammation stops within 1 to 3 days. To relieve muscle spasms, minor sprains and strains, it’s usually best to apply cold for 20 minutes intervals at a time every 4 to 6 hours for the first day and a half. Commercial cold packs may be safer than using ice. Prolonged exposure to cold, especially ice, can result in frostbite to tissues. Later in the process, you may relieve pain by applying heat, rather than cold, to your injury.
Use heat 20 minutes at a time at least 24 hours after a minor injury or 48 hours after a more serious one. Place a heat pack directly on the injured area — do not add pressure. Do not apply to broken skin.
Cold reduces inflammation. Apply cold to acute injuries, such as a newly sprained ankle or a pulled muscle.
Heat improves circulation. It’s best for chronic pain, such as from tight muscles or a sore back.
Alternate Heat and Cold if you have soft tissue damage and/or stretched ligaments, such as an ankle sprain. Heat aids in restoring range of motion. Apply cold for 20 minutes per hour as desired for the first 24 hours. The next day, apply warmth for 20 minutes per hour as desired.
Caution: Don’t apply cold for more that 24 to 36 hours or warmth for more than 72 hours, see a doctor.
Use hot and cold when you are suffering from acute pain, if your painkillers are not working. It can be useful before you go to bed or if you wake in the early morning. It may also ease the pain if you feel sore after a treatment.
Cold - Use any of Nature Creation natural therapy packs, which will fit comfortably to the area of pain.
Hot — compress the heated Nature Creation natural therapy packs onto the pain area (follow the instructions included with the pack).
Do not apply either the Nature Creation hot or cold therapy pack directly to your skin but wrap them in a tea towel or similar to prevent burning. Make sure the wrappers are of a similar size.
Cold -> Hot -> Cold
Start with cold and finish with cold. Apply each pack to the area of pain for five minutes and leave 15 minutes before repeating. You can repeat this process as many times as you like, but the first couple of sessions are usually the most useful.
Using hot and cold acts like a local pump cold pushing blood from the area, warm bringing fresh blood into the area, the valves in the veins cause the blood to circulate reducing the level of inflammation in the blood stream. If you can reduce the inflammation this will decrease the pain and help you keep more mobile and recover sooner.
Having that ice pack or hot pack ready to go when you need it is a big benefit. Anything can happen to my body as it’s inevitable something can hurt or an older injury is acting up. I put ice in a bag and wrapped it around my arm or leg with a towel. The ice would melt in 15 minutes making a big mess if the bag did not seal good. And when it was sealed fine I would put it in the freezer and it would freeze as a big solid block, unable to use really.
For a hot pack I would run a cloth under hot water burning my hands doing so or burning them when I rung out the towel. Not to mention it would only stay warm for about 3 minutes so I would repeat the whole process. What a pain– literally.
Now with newer advanced Nature Creation packs things are so much simpler. You can just leave the herb pack in the freezer and
take it out whenever you need it. Thaw it and put it in the microwave for minute you’ve got a hot pack. I leave one Nature Creation hot/cold pack in the freezer and leave another one in the cabinet. This way I always have a cold pack ready to go and the hot pack is ready in just 1 minute.
Best of all, it holds the cold and the heat in for long periods of time. So I don’t have to freeze or scald my hands every few minutes or worry about making a mess and soaking our couch with water.
Another great benefit is that the Nature Creation herb pack is flexible and soft. You can sit against it, lie on it, drape it over your shoulder, back, spine, you name it. Plus, the products carry 1-year craftsmanship warranty.