Baubles and fairies – a clue to your shoulder pain

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By Mr Harry Brownlow, December 2017

Decorating your Christmas tree might give you a clue as the cause of your shoulder pain. If you pain is worse on very high reaching movements, such as putting the fairy on the top of the tree, and it seems to be coming from the top of the shoulder then it is probably your acromioclavicular joint (AC joint) that is giving you grief. But if most of your pain happens when you hold your arm out at shoulder height while hanging baubles, and is felt in your upper arm, then it is more likely to be impingement. This is pain arising from your rotator cuff tendons.

You will probably need to see a shoulder specialist to work out what is going on and how best to manage your problem.

AC Joint

Arthritis in the AC joint is very common. Second only to arthritis at the base of the thumb.  In most people is not a cause of any symptoms but in some people it can be responsible for pain over the top of the shoulder. When bad it can cause pains running up trapezius and into the neck or down the front of the shoulder towards the biceps muscle. Typically the pain is worse when doing high overhead activities or in the gym when bench pressing or shoulder pressing, or swimming front crawl.

I like to confirm the diagnosis by injecting the AC joint with cortisone under ultrasound control. I tell people that there will be one of three outcomes after the injection. 1. The shoulder symptoms will be cured forever, 2. More commonly, the symptoms will be cured for a while but then return, or 3. There will be no significant benefit. The implications of outcomes 1 and 2 are confirmation that the AC joint is indeed the source of the trouble. The next step, for a permanent cure, is to discuss a relatively minor operation. In the case of outcome number 3 then I was wrong and the AC joint is clearly not the cause of the pain! This too is useful information. By definitively excluding the AC joint as the culprit then further steps need to be taken to find the source.

Rotator Cuff

But if your pain is felt more in the upper arm and typically when doing things at shoulder height then it is more likely the cause of your pain is impingement of the rotator cuff tendons. Typically this occurs in middle aged people and is noticed when doing things like reaching to the back seat of the car, hanging washing, playing tennis, trimming hedges, reaching into overhead lockers etc. It can also cause pain at night. Although the pain is felt in the upper arm the source of the pain is actually from the shoulder. This is a classic example of referred pain.

The best treatment is a staged plan of attack. Initially you should avoid doing the things that cause pain and take anti-inflammatory tablets. If that doesn’t do the trick then the next step is to try physiotherapy. Sometimes it is too painful to engage in physiotherapy and in those circumstances I recommend a cortisone injection to provide several weeks of pain relief. This pain free period is the perfect opportunity to do your physiotherapy and is very likely to settle your symptoms long-term. Sometimes, however, this strategy doesn’t work. This might be due to any number of reasons such as an underlying rotator cuff tear or calcific tendonitis, or maybe the diagnosis is wrong and your problem is a frozen shoulder, arthritis or even a neck condition. You will probably need to see a shoulder specialist to work out what is going on and how best to manage your problem.

So, if decorating the Christmas tree has given you pain and the festive break does not settle your discomfort, set your New Year’s resolution to getting it sorted!