The shoulder joint is the most mobile joint in the body. It moves the shoulder forward and backward. It also allows the arm to move in a circular motion and to move up and away from the body. The shoulder has a wide and versatile range of motion. When something goes wrong with the shoulder, it hampers its ability to move freely and can cause a great deal of pain and discomfort. Shoulder pain, stiffness or weakness can make it difficult to carry out everyday tasks, like reaching for something on a high shelf, driving a car or brushing your hair [1-2].

There are a number of possible causes of shoulder pain, but the most common causes of shoulder pain are rotator cuff injuries, rotator cuff tears and osteoarthritis. One may injure the shoulder by performing manual labor, playing sports, or even by repetitive movement.  Sometimes shoulder pain is the result of injury to another location in the body, usually the neck or biceps. This is known as referred pain. Referred pain generally doesn’t get worse upon moving the shoulder. Other causes of shoulder pain includes torn cartilage, torn rotator cuff, swollen bursa sacs or tendons, bone spurs (bony projections that develop along the edges of bones),pinched nerve in the neck or shoulder, broken shoulder or arm bone, frozen shoulder, dislocated shoulder, injury due to overuse or repetitive use, spinal cord injury, heart attack etc [3-4].

Most of the time, it is treated at home with rest and analgesic ointments and gels. People also take painkillers to relieve their shoulder pain. Pain due to exertion, posture or mild injury usually disappears with these medical remedies and rest. Surgery is rarely needed to treat shoulder pain [5-6]. A number of studies conducted in different parts of India reveals widespread ignorance and misconceptions about the shoulder pain among people. As this disease largely relies on prevention and the right information at the right time is essential to bring about a behavioral change when the population is most receptive. Hence, this study was undertaken with the objective to assess the knowledge about the risk and preventive factors as well as practices for shoulder pain among ortho OPD patients in civil hospital Rohru.

Objectives of the Study

• To evaluate the knowledge of patients attending Ortho OPD towards risk factors and Prevention of shoulder pain in civil hospital Rohru

• To evaluate the practices of patients attending Ortho OPD in civil hospital Rohru on having shoulder pain 

Research Approach

Descriptive

Research Design

Descriptive survey design

Setting of the Study

Ortho OPD of Zonal Hospital Dharamshala in Himachal Pradesh

Study Duration

Between August - December 2020

Study Population

Ortho OPD patients in Zonal Hospital Dharamshala in Himachal Pradesh.

Sample Size

400 Ortho OPD patients

Sampling Technique

Convenience Sampling Technique

Sampling Criteria

First five patients attending the Ortho OPD of Zonal Hospital Dharamshala everyday were selected till the completion of sample size after explaining the purpose of the study. Informed consent/assent was taken from them and confidentiality of the selected participants was also maintained 

Inclusive Criteria

Patients selected during the day of data collection in study setting and who were willing to participate in the study.

Exclusion Criteria

Patients who were not willing to participate in the study 

Development of Tool-Knowledge related questionnaires

Description of Tool

Section A: Socio-demographic characteristics of the patients (Age, Gender etc.).

Sections B

Questions regarding knowledge of risk and preventive factors for neck pain 

Validity of Tool 

By the experts in this field

Permission

Obtained from the concerned head of the civil hospital

Data Collection 

By myself and patients was given 5 minutes time to complete that questionnaire and collected at the end of the prescribed time

Data Analysis 

With appropriate statistical test in terms of frequencies and percentage.

The present study was Non-experimental descriptive study carried out to evaluate knowledge of risk and preventive factors for shoulder pain and practices of patients in case of shoulder pain in civil hospital Rohru. 

In the present study 35% (140) of the Patients fall were below 40 years of age while 65% (260) were above 40 years. 54% (216) of patients were male and 46% (184) were female.

Among the total study participants, 38 (9.5%%) didn’t know about any risk factor of shoulder pain. 267(66.75%) respondents said that Bad posture while sitting, walking and during sleep is the major risk factor for shoulder pain followed by, Lack of physical activity 206 (51.5%). Overuse the shoulder joint 189(47.25%), Shoulder injury/dislocation179 (44.75%), Inadequate amounts of dietary calcium and vitamin D intake 134(33.5%), Shoulder Muscle weakness 99(24.75%), Obesity 94 (23.5%), Unhealthy diet 79(19.75%) and Bone deformity /Malpositioning of Shoulder joint 35(8.75%) (Table 1).

Table 1: Knowledge About Risk Factors of Shoulder Pain Among Participants

Among the total , maximum 280(70%) respondents told that the Exercise and yoga regularly major preventive factor for shoulder pain followed by, Maintaining good posture while sitting, walking and sleeping 278(69.5%), proper back support while sitting 202(50.5%), Avoid shoulder overuse/ injury/sprain187(46.75%),Take a break and move around at least once an hour 167(41.75%), Calcium and Vitamin D supplements 166(41.5%), Avoid heavy lifting on head 107 (26.75%), Maintain ideal weight 98(24.5%), Eat healthily and  balanced diet 89(22.25%). Still 42(10.5%) didn’t know any preventive factor for shoulder pain (Table 2).   

Table 2: Knowledge of Patients Towards Prevention of Shoulder Pain

Among the total study participants, 312(78%) replied that they take pain killer medications in case of shoulder pain  followed by pain relief gels 306(76.5%), Cold applications/ice application 295(73.75%), Exercise and Yoga Regularly  289(72.25%), Calcium and Vitamin D supplements 287(71.75%), Heat applications 190 (47.5%), Shoulder braces sling or shoulder immobilizer 136(34%), Give rest to the shoulder 108(27%), Massage the shoulder 98(24.5%) and Acupressure and acupuncture  71(17.75%) (Table 3).

Table 3: Practices of Patients in Case of Shoulder Pain

Although the shoulder is the most movable joint in the body, it is also an unstable joint because of its range-of-motion. Because the ball of the upper arm is larger than the socket of the shoulder, it is susceptible to injury. The shoulder joint must also be supported by soft tissues muscles, tendons, and ligaments which are also subject to injury, overuse, and under use. Degenerative conditions and other diseases in the body may also contribute to shoulder problems, or generate pain that travels along nerves to the shoulder [7].

The treatment of shoulder pain depends entirely on the cause and severity of the shoulder pain. In the current study, among the total study participants, 312(78%) replied that they take pain killer medications in case of shoulder pain  followed by pain relief gels 306(76.5%), Cold applications/ice application 295(73.75%), Exercise and Yoga Regularly  289 (72.25%), Calcium and Vitamin D supplements 287(71.75%), Heat applications 190      (47.5%), Shoulder braces sling or shoulder immobilizer 136(34%), Give rest to the shoulder 108(27%), Massage the shoulder 98 (24.5%) and Acupressure and acupuncture  71(17.75%).

Some minor shoulder pain can be treated at home. The first treatment for many common types of shoulder pain are to rest the joint and allow the acute inflammation to subside.It is important, however, to use caution when resting the joint, because prolonged immobilization can lead to stiffness. Resting the shoulder for several days before returning to normal activity and avoiding any movements that might cause pain can be helpful. Limit overhead work or activities [5,6,8].

Ice packs are most often used to reduce the swelling and pain from an acute shoulder injury, but they can also be used to treat shoulder overuse injuries (for example, rotator cuff tendinitis or bursitis). In these cases, the ice is applied right after the overhead activity to minimize the onset of inflammation. Icing the shoulder for 15 to 20 minutes three or four times a day for several days can help reduce pain. Use an ice bag or wrap ice in a towel because putting ice directly on your skin can cause frostbite and burn the skin [3,6,9].

Heat pads are also used to treat chronic shoulder conditions, but generally before the overhead activity is performed. Heat can relax the muscles, ease stiffness, and reduce pain [3,10].

Other home treatments include using over-the-counter nonsteroidal anti-inflammatory medications to help reduce pain and inflammation and compressing the area with an elastic bandage to reduce swelling. Some NSAIDs are available over-the-counter (for example, ibuprofen), and others are only prescribed, like Voltaren (diclofenac). These are commonly used to treat shoulder problems like arthritis, bursitis, and tendonitis. it's important to only use them for a short duration and only under the guidance of doctor [11,12].

Simple shoulder exercises can help stretch and strengthen muscles and rotator cuff tendons. Surgery will be needed only if conservative measures are not working or if shoulder injury is too severe from the start [13].

By Exercise and yoga regularly, maintaining good posture while sitting, walking and sleeping, proper back support while sitting, avoiding shoulder overuse/ injury/sprain, taking a break and move around at least once an hour, Calcium and Vitamin D supplements, Avoiding heavy lifting on head, maintaining ideal weight, eating healthily and balanced diet we can prevent shoulder pain. Pain killer medications, pain relief gels Cold applications/ice application, Exercise and Yoga, Calcium and Vitamin D supplements, Heat applications, Shoulder braces sling or shoulder immobilizer, rest and massaging the shoulder and Acupressure and acupuncture helps in reliving shoulder pain.

1. eMedicine. “Shoulder pain.” Medscape, May 2021, emedicine.medscape.com/article/1899211-overview. Accessed May 2021.

2. Kenhub. “The shoulder joint.” Kenhub, May 2021, www.kenhub.com/en/library/anatomy/the-shoulder-joint. Accessed May 2021.

3. Verywell Health. “Shoulder pain.” Verywell Health, May 2021, www.verywellhealth.com/shoulder-pain-2548793. Accessed May 2021.

4. Healthline. “Shoulder pain: Causes.” Healthline, May 2021, www.healthline.com/health/chronic-pain/shoulder-pain. Accessed May 2021.

5. Penn Medicine. “Shoulder pain.” Penn Medicine, May 2021, www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/shoulder-pain. Accessed May 2021.

6. Healthline. “Shoulder pain remedies.” Healthline, May 2021, www.healthline.com/health/shoulder-pain-remedies. Accessed May 2021.

7. Johns Hopkins Medicine. “Shoulder pain and problems.” Johns Hopkins Medicine, May 2021, www.hopkinsmedicine.org/health/conditions-and-diseases/shoulder-pain-and-problems. Accessed May 2021.

8. Medical News Today. “Shoulder pain.” Medical News Today, May 2021, www.medicalnewstoday.com/articles/325231. Accessed May 2021.

9. Cleveland Clinic. “Shoulder tendinitis.” Cleveland Clinic, May 2021, my.clevelandclinic.org/health/diseases/13203-shoulder-tendinitis. Accessed May 2021.

10. Harvard Health Publishing. “How to release a frozen shoulder.” Harvard Health, May 2021, www.health.harvard.edu/pain/how-to-release-a-frozen-shoulder. Accessed May 2021.

11. Healthline. “Over-the-counter anti-inflammatories.” Healthline, May 2021, www.healthline.com/health/pain-relief/otc-anti-inflammatories. Accessed May 2021.

12. Better Health Channel. “Non-steroidal anti-inflammatory drugs.” Better Health Channel, May 2021, www.betterhealth.vic.gov.au/health/conditionsandtreatments/medications-non-steroidal-anti-inflammatory-drugs. Accessed May 2021.

13. Healthline. “Rotator cuff injury stretches.” Healthline, May 2021, www.healthline.com/health/rotator-cuff-injury-stretches. Accessed May 2021.