Shoulder pain: when to do something about it
Shoulder pain is one of the most common and debilitating joint problems, especially as we get older. Doctors are often consulted for musculoskeletal problems, so they're used to managing them. But they're always on alert for the rare occasion that something is seriously wrong, and they need to get a patient the right help with speed.
Doctors can refer you to physiotherapy services to triage your problem and manage it – you may even be able to refer yourself without speaking to your doctor.
In this article, we'll go through some of the more serious symptoms relating to shoulder pain, and when you should be urgently seeking help from your doctor (or Emergency Department in some circumstances) rather than waiting for a routine appointment or physio assessment.
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What are the worrisome symptoms I should be aware of?
There are a few things that can't wait for a routine review with your doctor. If there has been trauma to the shoulder and symptoms of severe pain and weakness, if you are unable to raise the arm, or if the shoulder looks to be an abnormal shape, do seek medical advice immediately.
If there are signs of infection and you have new red skin around the shoulder, if the shoulder is extremely painful to move, and if you have a fever or feel unwell, you should get a same-day evaluation too.
What will my doctor do?
If you have mild to moderate pain, your doctor will want to hear the story of your symptoms and examine you. Depending on the findings, the options for investigations are generally blood tests, if considering a rheumatological or inflammatory condition, such as polymyalgia rheumatica or inflammatory arthritis such as rheumatoid.
If you've had a traumatic injury, or ongoing bothersome symptoms, an X-ray may identify problems with the bones, such as a fracture, or arthritis. If your doctor thinks that your problem is muscular, pain relief and physiotherapy are common first steps. There are other imaging options such as ultrasound or MRI, that can take a closer look at the rotator cuff muscles that surround the shoulder joint.
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When will I need an expert opinion?
There are some problems where doctors need a helping hand from specialists. If your symptoms have been present for a while since initially seeing your doctor, it may be time to go back and discuss a referral. A good rule for musculoskeletal problems is a timeframe of three months to try so-called conservative management – in this case, that's likely to be painkillers, heat packs, and physiotherapy exercises.
If your shoulder pain and ability to use the shoulder is still not improving with the advice and treatment your doctor has given, more investigations may be needed. One exception to this rule is frozen shoulder, which can take many months or even years until recovery.
What onward referral options are there?
Rheumatology doctors, orthopedic doctors, specialist sports doctors, and specialist physiotherapists all see patients referred by their doctor with shoulder problems. The specialist you see will depend on the diagnosis your doctor thinks is most likely.
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