Shoulder

Why Overhead Arm Movements May Cause Pain?

By Last updated on September 3rd, 2020 Last updated on September 3rd, 2020 No Comments

Many cases of pain during the overarm movement can be attributed to either overuse of the shoulder joint, or natural degeneration of soft tissue. There are many ways in which a shoulder can become injured due to its complex nature and the many small components that make up the joint.

Due to this, there are many treatment options and processes that can ease the associated symptoms.

Anatomy of the Shoulder

The shoulder joint is a ball and socket joint, meaning that the head of the arm bone (humerus) fits into a concave portion of the shoulder blade. Between these two down structures is strong, fibrous cartilage that protects their joint. This cartilage also allows the joint glide smoothly, giving the shoulder a wide range of motion.

Ball-and-socket joints need a vast network of soft tissue such as muscles, cartilage, and tendons to support the joint. This is because this shape of the joint is prone to dislocate, and the frequently-used location means that a lot of stress can be placed on the soft tissue.

A rotator cuff is a group of muscles originating on the shoulder blade that allows the joint to have the range of motion that it does. The structure of a ball-and-socket joint is less stable by nature than other joints in the body. This means that muscle groups such as the rotator cuff are extremely important in maintaining the structure and stability of the shoulder.

There are four major muscles in the rotator cuff:

  • Supraspinatus: located at the top of the joint, above the shoulder blade. It is attached to the top of the humerus.
  • Infraspinatus: located on the outside of the shoulder blade, attached to the top of the humerus.
  • Teres Minor: located closer to the bottom of the shoulder blade, slightly under the Infraspinatus. It is attached to the bottom portion of the ball part of the joint.
  • Subscapularis: located under the shoulder blade, providing much of the support needed to support the shoulder from the inside.

Each of these muscles plays an important role in the motion of the shoulder. They are also associated with separate nerves, which send the signals needed to use these muscles. Any of these nerves and muscles can become damaged or injured. There are many potential causes of injury to the soft and hard tissues of the shoulder joint.

Some other (non-rotator cuff) muscles in the shoulder to keep in mind are the Deltoid, located at the top of the arm, and the Trapezius at the base of the neck and down the spine.

What Causes Pain During Overhead Movements?

A shoulder injury can occur to anyone at any time, but some individuals are at a greater risk of injuring their shoulders than others. People who throw overhead frequently are using the joint in such a way that can wear down the rotator cuff muscles. Throwing uses almost all of the muscles in the joint because it’s moving the arm in almost all of the ways it can possibly move therefore activating and engaging many different muscles and tendons.

Some conditions that may contribute to pain during overarm movements are:

  • Muscle Tear
  • Bursitis
  • Arthritis
  • Impingement Syndrome
  • Damaged or torn ligaments
  • Worn down cartilage
  • Bone spurs

And many more. Some conditions that may make somebody more prone to a shoulder injury include diabetes, arthritis, disease of the bone, and abnormal structures which may form due to misuse or occur during birth. Another common injury results from a sudden impact such as a fall or car accident.

Impingement syndrome occurs when a tendon is being pinched between bones, and in the shoulder, this takes place mainly in the space between the scapula and shoulder joint. Bursitis is an injury to the bursa,  a piece of cartilage in the joint shaped like a sac. The bursa is between the ball and socket and acts as a cushion, but can become inflamed and torn.

The injury occurs when the structures of the joint are not functioning properly. This can lead to many symptoms for the individual, including:

  • Pain
  • Weakness
  • Inability to move the joint
  • Inability to lay on the affected side
  • Numbness
  • Tingling
  • “Popping” or “cracking” sensation

Symptoms may occur only during certain activities or be more persistent. The location and duration of pain can vary from one individual to the next – when seeking treatment, it is important to discuss all of the sensations and symptoms that are occurring.

Diagnosing shoulder pain begins with a visit to a medical professional who can examine the joint and how it functions. They will observe the particular motion that causes pain and ask questions to further determine why it hurts. Imaging technology such as MRI or X-Ray can help guide doctors to damaged tissue or structural abnormalities.

Treating Shoulder and Arm Pain

Once the cause of pain is diagnosed, patients and doctors can devise a treatment plan that is individualized to meet each patient’s needs.

Many soft tissue injuries like impingement and tears can heal on their own over time. Treatment for minor injuries consists of managing pain and sometimes physical therapy.

Pain management can be achieved with anti-inflammatory drugs such as Ibuprofen. Using ice and heat as recommended can also help to relieve inflammation, stiffness, and pain. Some patients also use corticosteroid injections for pain relief. These injections are not recommended for everyone, as they can damage soft tissue over time.

Physical therapy can result in significant pain relief in some patients. Trained physiotherapists use certain exercises to restore a range of motion and strengthen muscles that may have grown weak. Some muscles can atrophy if they are not being used – to prevent further atrophy, it is necessary to retrain the muscles. Some exercises may require certain equipment, but there are many at-home practices to learn that can improve quality of life.

Depending on the cause of shoulder pain, the treatment journey may lead to surgery. Doctors will often begin with a more minor surgery when possible. Arthroscopy is performed with a tiny camera and tiny tools that can make small repairs to the joint. More extreme cases could result in partial or even total shoulder replacement surgery.

Replacement surgeries can be a difficult process because there are many positive and negative aspects of it to consider. Preparing for surgery can ease some of this anxiety – though many patients may prefer a non-surgical treatment.

Alternative Ways to Treat Arm and Shoulder Pain

Many causes of arm pain include damage to soft tissue. In many patients, there is more than one injury occurring at the same time – some damage can cause the muscles to overcompensate and tear, bones can rub against one another if the bursa is damaged, and so many more.

Muscles are good at repairing themselves, but some tissues of the shoulder joint are more difficult to treat. Conditions that affect the tendons or ligaments can be more difficult to treat.

The emerging field of regenerative medicine provides treatment for shoulder pain caused by these hard-to-treat injuries.

Stem Cell Therapy uses a patient’s own regenerative cells, injecting them into an injury to speed up the recovery process.

Platelet-Rich Plasma (PRP) Therapy uses platelets in a patient’s blood to increase the number of healing cells in an area.

Both treatments are performed in a short period of time and can offer many benefits:

  • Reduced pain
  • Restore range of motion
  • Regenerative processes can speed up the natural healing

Doctors will look at a patient’s whole profile and experience with injury to determine what treatments are best for them. Persistent arm pain can be relieved by these treatments, but they perform even better if they are accompanied by treatments such as physical therapy.

Conclusion

Repetitive overarm use can create difficulty with overarm movements over time. A shoulder injury can also occur due to an injury or natural wear-and-tear of the muscles keeping the joint together, like the rotator cuff.

Treating shoulder conditions depends on the underlying cause – each has a slightly different healing process. It’s important to discuss all of the available treatment options with a medical professional to ensure you’re getting the right one to meet your personal needs.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Regenerative Orthopedic and Sports Medicine
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan State University Alumni