The shoulder joint is composed of three major bones: the long upper arm bone (humerus), the collar bone (clavicle), and the shoulder blade (scapula). These bones are connected and protected by strong ligaments, tendons, and muscles.
The main muscles that stabilize and support the shoulder are the rotator cuff or the SITS muscles, which consist of the supraspinatus, infraspinatus, teres minor, and subscapularis.
Why Does The Front Of My Shoulder Hurt?
People more often complain about pain in the front of the shoulder than the back. There are several reasons why the front of your shoulder hurts, some of which are as follows:
· Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder begins slowly and gets worse over time. It typically starts with a dull, aching, tender pain in the front of the shoulder above the armpit. As the condition progresses, the shoulder becomes painful, stiff, and difficult to move.
It occurs when the shoulder capsule, which envelops the shoulder joint, becomes thick, inflamed, and rigid. Increasing pain can lead to a lack of use of the shoulder which is often seen with recent injuries or in people with diabetes, Parkinson’s disease, heart disease, or stroke. However, the exact reason why it occurs is not yet fully understood.
· Biceps Tendonitis
When you experience localized and deep throbbing pain in the front of the shoulder along the top part of the upper bone and it worsens when lifting or carrying an object, this can indicate an inflammation of the biceps tendon, which is the tendon that connects the biceps muscles to the bones of the shoulder.
It occurs as a result of overuse or repetitive overhead movements.
· Shoulder Impingement
Shoulder impingement is characterized by sharp and diffuse pain that sometimes radiates in the front of the shoulder and arm. Pain is often felt when moving the arms upwards such as reaching overhead or combing hair.
It occurs when the tendons of the rotator cuff muscles become impinged inside the joint as you raise your arm. This causes the tendons to become inflamed, which can cause further pain.
· Shoulder Fracture
Severe pain, swelling, and bruising in the front of the shoulder can indicate a fracture in the long arm bone or the collar bone.
The most common cause of fracture is falling on an outstretched hand (FOOSH) and a direct force injury to the shoulder. In severe fractures, the bone may protrude and the shoulder joint may look out of place.
· Shoulder Dislocation
Shoulder dislocation rarely happens. This occurs when the muscles, ligaments, and tendons that stabilize the shoulder joint are weak or injured.
It presents with severe pain and swelling, difficulty moving the arm, and a bump that may be felt in the front of the shoulder.
How Do I Relieve Front Shoulder Pain?
Treatment for shoulder pain varies depending on the condition and its severity.
Generally, pain can be relieved through adequate rest, changing your usual routine to avoid movements that cause pain, limiting your exercises and movements to those that do not trigger the pain, physical therapy intervention to improve muscle strength and flexibility, and over-the-counter pain medications.
How Do I Know If I Have Damaged My Rotator Cuff?
The rotator cuff muscles are connected to the bones of the shoulder joint through their tendons. These tendons hold, protect, and stabilize the shoulder along with the other soft tissue structures in the joint. Together, they allow arm rotation and overhead arm movements.
If you experience pain in the front of your shoulder that radiates up to the side of your arm that gets worse when you lift an object or raise your arm to comb your hair or put on a shirt, something may be wrong with your rotator cuff.
When pain is severe and it is difficult to move your arm after performing a strenuous activity such as an intense workout or sports training, seek immediate medical attention as you may have torn your rotator cuff.
When Should I Worry About Shoulder Pain?
You should see a doctor if the pain is too extreme and does not get relieved with rest and pain medications. You should also check if your shoulder is swollen, red, and warm to the touch as it indicates inflammation.
A radiating pain that extends to the forearm, fingers, and neck may indicate nerve impingement. Further, if your injured shoulder looks different from your uninjured shoulder and you notice a bump or some deformation on it, this may be a sign of a dislocation.
Lastly, if there is an open wound and you suspect that one of the bones in the shoulder is fractured, go to the nearest hospital.
Obtaining a comprehensive evaluation and diagnosis from a trained physician is important so you can be given the best treatment intervention and prevent further injury and complications.
A dislocated or fractured shoulder is often associated with ruptured blood vessels. If this is not given adequate attention, it may result in amputation of the arm. Further, if you continue using your arm despite the pain, it can result in a complete rotator cuff tear, which would require surgery and longer healing and recovery time.
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.