Front Shoulder Pain Symptoms And Your Treatment Options
Regenexx Treatment for Shoulders
Front shoulder pain is a disabling complaint commonly seen in the doctor’s office with a lifetime prevalence of 70% (1). It is a treatable condition within the shoulder joint. If left untreated, the recovery can be awfully slow with high recurrence rates. There are many causes of pain in front of the shoulder joint. The key is to identify what causes front shoulder pain and diagnose it promptly.
We will discuss how front shoulder pain occurs, how it can be treated, and when you need to see your doctor.
What Are The Parts Of The Front Shoulder?
The shoulder joint is a ball and socket joint. The rotator cuff muscles stabilize the joint by attaching it to the capsule of the joint. Tendons of other muscles also provide the joint with added stability.
In addition, various ligaments hold the joint in place. This prevents the shoulder joint from getting dislocated.
Nerves that supply each of the muscles of the joint carry pain sensation back to the brain. Therefore, any injury to any muscle or tendon within the shoulder joint can cause front shoulder pain.
Let’s understand the parts of the shoulder in detail.
There are a whole host of muscles in the shoulder joint. This includes the deltoids, teres major and minor, supraspinatus, infraspinatus, subscapularis, trapezius, latissimus dorsi, levator scapulae, rhomboid major and minor, pectoralis major and minor, subclavius, coracobrachialis, biceps brachii, and triceps brachii.
Of these, supraspinatus, infraspinatus, teres minor, and subscapularis form the rotator cuff, which stabilizes the arm bone within the shallow joint. Injuries to any of these rotator cuff muscles can result in front shoulder pain.
Four main ligaments reinforce the shoulder joint. These are the glenohumeral ligaments, coracoacromial ligament, coracoclavicular ligaments, and the transverse humeral ligament.
Each of these ligaments ensures that the clavicle, scapula, and humerus allow movement across different planes while passively stabilizing the joint.
The front shoulder nerve supply is from the subscapular, axillary, and lateral pectoral nerves. Each of these nerves branches from the C5-C6 root of the axillary nerve. These nerves innervate the muscles and ligaments of the shoulder joint.
Injuries to the muscles and ligaments lead to pain across the muscle fibers and result in front shoulder pain. Additionally, if the nerves are impinged or trapped, then a person can experience pain in the front of the shoulder.
Types Of Pain That Occur In The Front Shoulder
Various symptoms can occur because of injury or dysfunction to the front shoulder joint. Pain is a broad symptom that can encompass anything from a dull ache, a burning or stinging sensation. Pain can cause difficulty with lifting heavy loads, decreased strength, and even decreased mobility of the joint. The following are the different types of pain that can occur in the front shoulder, and what may cause it:
A dull ache in the front shoulder can be caused by the rotator cuff muscles getting trapped under the bone or a mild tear in the muscle fibers or ligaments. Inflammation of the rotator cuff tendon, tendonitis, or the beginning stages of osteoarthritis may also present, which can also result in pain. Generally, the worse the tear or injury, the longer the pain can persist.
Sharp, stinging pain in the shoulder joint can be caused by trauma to the joint, a dislocation, fracture, a severe tear in the muscles or ligaments, nerve impingement, joint infection, or tissue death (necrosis). All of these conditions can cause intense, stinging pain that does not subside with rest or over-the-counter medication.
Typically, burning pain or a burning sensation in the shoulder joint is seen in conditions such as bursitis, tendonitis, and arthritis of the joint. This is a classic sign of inflammation and also occurs when the joint is infected.
A lump or swelling in the shoulder joint can indicate a fracture, a dislocation, rheumatoid arthritis, osteoarthritis, or even a severe tear in the rotator cuff muscles. The swelling can be sudden or may develop gradually over a period of time.
Symptoms Of Pain In The Front Of Shoulder Joint
Along with pain in the front shoulder, other signs and symptoms can indicate a severe injury of the shoulder. Here is a detailed list of what else to look for when you have pain in front of the shoulder joint:
· Decreased strength in the arm.
· Inability to carry objects
· Visible deformity of the clavicle, shoulder, or humerus that results from trauma or injury
· Pain that worsens at night or while resting
· Persistent pain that does not go away after two weeks
· Inability to raise the arm either overhead or beyond a certain degree
· Swelling or bruising around the shoulder area.
· Signs of infection or inflammation (e.g., fever, redness, warmth)
· Numbness or paralysis
· Clicking, grinding, or popping sounds when you move the arm
· Other unusual symptoms (e.g., abdominal pain, difficulty of breathing, crepitus in the skin, stiffness, shortness of breath, and more)
Conditions That Cause Pain In The Front Shoulder
Arthritis in Shoulder
The shoulder is a truly remarkable joint. It allows you to reach out into virtually all directions: overhead, forward, and backwards. Unfortunately, like other joints in the body the shoulder is susceptible to irritation and injury.
Osteoarthritis is the most common cause of disability in the United States, affecting up to 32.8% of patients over sixty years of age (1). Shoulder arthritis is a common condition estimated to be as high as 16-20% in the middle aged and elderly population (2). Shoulder arthritis can compromise range of motion, strength and be a source of debilitating pain. This blog will review the shoulder.
There are many causes of front shoulder joint pain. Here is a list of the probable causes:
An accident or trauma to the shoulder joint can dislocate the shallow ball and socket joint. High-speed collisions, accidents, falling on an outstretched arm, or a sudden violent twist can fracture the scapula or humerus. Injuries can also tear the rotator cuff muscles and ligaments, leading to pain in the shoulder joint.
Repetitive occupational movements of the joint can also cause front shoulder pain. For example, sports that require excessive overhead motions can cause front shoulder pain in athletes, such as swimmers, tennis players, basketball players, and weightlifters. People in occupations that require heavy lifting or overhead tasks frequently experience front shoulder pain too.
As a person ages, degenerative changes occur in the joints and the tissues. These changes can also lead to microtears in the muscle fibers. Rotator cuff tendonitis and arthritis can subsequently develop, causing front shoulder pain. In the older demographic, muscle repair can take time so recovery is often much slower.
Common Treatment Options
There are many treatment options for front shoulder pain. There is no reason to live with this pain, no matter what age. Initially, you can try a conservative treatment or over-the-counter medications. If they do not help, you may need to see a doctor to get some prescription medication.
Conservative treatments and non-prescription solutions are the best first step for front shoulder pain. This can involve any one of the following:
Rest from the aggravating activity can be beneficial to people with front shoulder pain. Without the exacerbating activity, whether that is the occupation or sport, the injury can have time to heal and help the pain subside..
In the case of an injury, ice can be immensely helpful, especially within the first 72 hours. Ice to the affected area can help the pain and swelling subside. Conversely, if the shoulder feels very tense or tight, heat can be applied. Heat is helpful more for chronic injuries or long-standing pain. If you’re not sure when to ice or when to heat, speak to your physician or schedule a telemedicine consult with one of our board-certified physicians.
Medical treatment of front shoulder pain can include non-steroidal anti-inflammatory (NSAIDs) medications. This is usually prescribed in conjunction with physical therapy modalities. NSAIDs only relieve or reduce pain. Some common examples of NSAIDs are Motrin®, Advil®, Motrin IB®, Naprosyn®, and Aleve®.
Therapy And Other Modalities
Once you meet with your doctor, they may prescribe other modalities to treat the cause of your front shoulder pain. The doctors will decide which treatment is best for you based on your diagnosis and what is causing your front shoulder pain. Some of these solutions include:
Physical therapy (PT) is the first-line treatment for tendonitis of the rotator cuff. Some patients may benefit from physical therapy exercises alone once diagnosed. Physical therapy of the shoulder joint involves a range of motion exercises as well as stabilizer and strengthening programs.
Steroid injections are another alternative for front shoulder pain, especially for inflamed joints. Cortisone injections are prescribed by a doctor. For example, they are prescribed and delivered by a doctor to the subacromial space for rotator cuff tendonitis. With the injection, people usually experience immediate relief. The injections are helpful in the short-term as they allow people to continue with their physical therapy sessions.
In some cases, these injections are given with local anesthetics. However, it is important to keep in mind that high concentrations of long-acting local anesthetics, such as lidocaine, are chondrotoxic or harmful to the cartilage.
Depending on the cause of the front shoulder pain, surgery may be a suitable treatment. For injuries, fractures, and dislocations, surgical repair and reduction may be necessary. For chronic rotator cuff tendonitis and other rotator cuff injuries, surgical techniques like debridement, subacromial decompression and/or acromioplasty, rotator cuff bursal tear completion, and simultaneous rotator cuff repair are other options.
The surgical repair options depend on what is causing your front shoulder pain and what the doctor recommends. After surgery, you will need physical therapy to condition the shoulder joint.
Doctors usually prescribe a shoulder conditioning program to stabilize the rotator cuff muscles as you recover from injury or surgery. Open and closed chain exercises with manual resistance are added gradually. The exercises progress from static to dynamic as recovery proceeds.
Our Treatment Solutions
At Centeno-Schultz, to avoid medicating patients with NSAIDs and painful surgery, we prefer to use regenerative medicine. This is especially for patients who have front shoulder pain due to excessive wear and aging where the treatment options are limited.
Based on what it needs to heal, this could be platelet-rich plasma, platelet lysate (rich in growth factors), or whatever nutrients your shoulder needs to heal. The treatment is extremely specific to each patient and is customized in our lab. These biologics are then injected under direct visualization with ultrasound and/or fluoroscopy into the joint.
Our team works closely with the department of physical therapy as well so that you have maximum benefit from any platelet-based or bone marrow concentrate-based procedures through a structured program.
When To See A Doctor
If you have shoulder pain, how long is too long? Ideally, you should see the doctor as soon as you have shoulder pain just to make sure it is not something serious. Most people like to wait and treat themselves conservatively with rest, ice, and over-the-counter medications. This is good for minor tears or injuries. However, here are some circumstances when you must consult a doctor for front shoulder pain:
Visual Deformity Of The Joint
If the joint is bent out of shape, then you could be dealing with a fracture or dislocation that needs immediate treatment. Additionally, if you need to support the arm, then the injury should be looked at right away. This type of injury could potentially require a surgical reduction or repair that must be overseen by a trained orthopedic specialist.
If pain in the front of the shoulder keeps worsening despite over-the-counter meds, rest, and ice, it may be time to seek help. If the pain persists even without movement, is accompanied by numbness or paralysis, or changes from an ache to severe pain, then consult your doctor immediately.
Inability To Use The Arm
Front shoulder pain that leads to an inability to use the arm in its full range of motion needs medical attention. If you find that your shoulder has decreased strength, weakness, or suddenly drops while in use, then this might signal severe injury that requires medical attention.
If your shoulder joint is swollen and red, it means it is inflamed and should be seen by a medical doctor. These could also be signs of infection, inflammation, or sepsis within the joint and needs to be treated immediately. Septic arthritis is dangerous – if there are microbes in your joint, they can quickly travel through your bloodstream and make your whole body septic, which can be fatal. Therefore, a swollen joint should not be ignored.
What The Doctor Will Request For Diagnosis
The doctor will meet you and take an extensive history, conduct a physical exam, and use diagnostic tests to identify what is causing the front shoulder pain.
They will want to know details about when your front shoulder pain started, if there was a history of trauma, what is the relationship of the pain to movement, is your dominant or non-dominant arm affected, is the pain bilateral, does it radiate, how long does it last, is it accompanied by exacerbating or relieving factors, what is the functional impact, and does it affect your sleep. They will also take a careful occupational history including the nature of the occupation and how long you’ve been in the role.
After a detailed history, the doctor will also complete a thorough examination, a neurological assessment of both upper limbs, and a full musculoskeletal assessment. The doctor will also check for swelling, redness, scars, and dislocation. They will test active and passive motion through the full range of shoulder movement. Clinical tests, such as the drop arm test for rotator cuff tear, are highly specific for certain pathologies and are done to confirm them.
Injuries to the shoulder joint can be imaged using X-ray, ultrasound, MRI (Magnetic Resonance Imaging), or MRA (Magnetic Resonance Angiography). X-rays are used for fractures and dislocations. Ultrasound and MRI are the best for assessing soft tissue injuries, such as rotator cuff tears and ligaments tears. Arthrography is the only option for joint capsule damage.
You Can Be Free Of Front Shoulder Pain
The shoulder joint is a complex joint. It needs to be stable, yet also flexible and mobile. It functions along many different planes, but that is also what makes it vulnerable to injury.
If you have front shoulder pain, there are solutions to help it get better. When identified early and diagnosed correctly, there are various treatment options for pain in front of the shoulder joint. With the right input, there is every chance of recovery, without the need for a prolonged recovery or risk of recurrence.
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…
My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.
Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.
Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.
Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…
Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…