Dr. Wael Al Haddad Orthopaedic Clinic
Dr. Wael Al Haddad is a consultant orthopedic surgeon with Jordanian and Arab Board certification and advanced training at McMaster University in Canada. His wo…
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Treating shoulder pain means building a plan around the cause rather than handing every patient the same painkiller, because the shoulder is the most mobile joint in the body and the most dependent on the surrounding tendons and muscles. The common causes are treated in entirely different ways: rotator cuff tendon problems or impingement beneath the bone, frozen shoulder — a gradual tightening of the joint capsule, calcific deposits in a tendon, an acromioclavicular joint problem, instability or recurrent dislocation, and sometimes pain arising in the neck and felt in the shoulder and arm. In most cases the backbone of treatment is guided physiotherapy: a graded programme that first restores range of motion and then strengthens the rotator cuff and the muscles that stabilise the shoulder blade, together with modification of activities that raise the arm overhead or carry weight far from the body. Correcting sitting and working posture and screen position is added for anyone who spends long hours at a desk. Frozen shoulder deserves a special note: its course is long and typically extends from several months to beyond a year, and it is more common in people with diabetes, so glucose control is part of the treatment. **Forceful stretching or having the shoulder “freed” by untrained hands is not treatment and can cause harm**; the correct approach is progressive, measured exercise increased slowly and performed consistently. The limits must be stated openly: **a shoulder injection does not repair a torn tendon and is no substitute for exercise** — it is essentially a window of pain relief that makes rehabilitation possible. A painkiller does not treat the cause, and complete rest increases stiffness. Candidacy for surgery — for a significant full-thickness tear, recurrent instability, or specific conditions that have not responded — is decided by examination and imaging together, not by the patient’s wish for a quick fix, and rehabilitation afterwards is half the result. One warning must never be omitted: shoulder pain can occasionally reflect a problem in the heart or in the upper abdominal organs, particularly when it comes with breathlessness, chest pain or sweating.
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Procedure steps
- 1
History and defining the pain pattern
The doctor asks which movements hurt, whether pain wakes you at night or stops you lying on that side, whether it began after an injury or overhead work, whether numbness in the arm suggests a neck origin, and whether you have diabetes.
- 2
Examining range of motion and strength
Active and passive range of motion are measured to distinguish capsular stiffness from tendon weakness; rotator cuff strength, tender points, joint stability and shoulder-blade movement are tested, and the neck is examined to exclude a nerve origin.
- 3
Imaging in cases that call for it
Radiographs are requested after trauma and when calcific deposits, arthritis or an acromioclavicular problem is suspected, while ultrasound or MRI is reserved for selected cases to assess the tendons or before a surgical decision.
- 4
The graded physiotherapy programme
A programme is built that starts by restoring range of motion and then strengthens the rotator cuff and scapular stabilisers, alongside activity modification and correction of working posture. Daily adherence is what produces the result, not the number of clinic sessions alone.
- 5
Reassessment, and injection or surgery when required
Response is reviewed after a fair interval. A guided injection may be offered in selected cases to reduce pain enough to allow rehabilitation, and surgery is discussed for a significant tear or recurrent instability, always with a clear post-operative rehabilitation plan.
Before the procedure
Come in clothing that allows both shoulders and the neck to be exposed so the two sides can be compared and the neck examined — a loose shirt or a sports top is better than tight clothing. Before the visit, write down exactly which movements hurt, whether the pain stops you sleeping on that side, raising your arm overhead or dressing yourself, when it started and what preceded it. Tell the doctor if you have diabetes, because it changes both the expectations and the plan in frozen shoulder, and list all your medicines, especially blood thinners. Report any previous dislocation, operation or fracture of the shoulder or collarbone, and bring earlier imaging and reports. Do not undergo forceful stretching or attempts to “free” the shoulder before a diagnosis, and do not immobilise the shoulder completely, because stiffness sets in quickly.
After the procedure
Do your range-of-motion and strengthening exercises daily exactly as prescribed, because the shoulder responds to consistency rather than to one violent effort, and stop any exercise that causes sharp pain or leaves the shoulder more painful for hours afterwards, reporting it to your therapist. Modify activity temporarily: reduce overhead lifting, carrying weight away from the body and forceful pushing, and hold objects close to you. Arrange sleeping position with a pillow supporting the arm, and use a cold pack after activity or gentle warmth before exercise, whichever suits you. If you have diabetes, keep your readings controlled because they affect the course of frozen shoulder. **Seek emergency care immediately if shoulder pain comes with chest pain, breathlessness, sweating or nausea, and seek urgent care if the shoulder looks deformed after an injury or cannot be moved, if sudden weakness or spreading numbness appears in the arm, or if fever develops with a hot, swollen joint.**
Expected duration
The assessment visit usually takes 20 to 40 minutes, and the rehabilitation programme is normally reassessed every 4 to 8 weeks depending on the diagnosis.
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