The Painful Shoulder

An Information Booklet

Introduction

Shoulder problems are very common, but most cases of shoulder pain only last for a short while and are not caused by arthritis. This booklet explains why people get shoulder pain and looks at the conditions that are most likely to cause problems. The shoulder can be quite easily injured, especially in some sports, but this booklet does not cover problems directly related to an injury such as a dislocation.

Most shoulder problems will settle with simple treatments and you may not even need to see your doctor, but we will also look at the more specialised treatments (including surgery) that are available for severe or persistent shoulder problems. Words which are shown in italics when they first appear are explained in the glossary at the back of the booklet.

How does the shoulder work?

The shoulder is the most mobile joint in the body and is often affected by painful problems which limit its movement. Figure 1 shows the main parts of the shoulder. Movement takes place at the main shoulder joint (glenohumeral joint) as well as the shoulder blade (scapula) which moves over the back of the chest. The shoulder joint is a ball-and-socket type joint which allows a very wide range of movement. The joint is surrounded by a tough, fibrous sleeve called the capsule; the inner layer of this, the synovium, produces fluid to nourish and lubricate the joint. A group of four muscles and their tendons make up the rotator cuff which plays a very important part in the working of the shoulder, helping to move it and hold the joint together. Problems with the rotator cuff can cause several painful conditions.

Where is the pain coming from?

Shoulder problems may be part of a general condition such as rheumatoid arthritis, osteoarthritis or polymyalgia rheumatica or may be a more localised problem. Specific conditions are described in more detail later in this booklet.

Not every pain felt in the shoulder area is caused by a problem in the shoulder joint. Problems in the neck, for example, may cause pain which is actually felt in the shoulder (this is known as ‘referred pain’). When the problem does originate in the shoulder joint the pain is often felt over the front of the shoulder or in the upper part of the arm. The pain can sometimes spread down the arm to the elbow, but if it spreads further down the arm, or if you have tingling or pins and needles, then the pain probably comes from a problem in the neck. If the pain is more towards the side of the neck or over the shoulder blade then, again, the neck may be the source of the pain. Pain at the top of the shoulder may come from the acromioclavicular joint at the end of the collarbone or ‘clavicle’ (see figure 1). Sometimes the pain can come from problems in both the neck and shoulder. Your doctor or physiotherapist will be able to help make the correct diagnosis.

Where the pain does arise from the shoulder joint itself there are several possible causes:

• inflammation of, or damage to, the muscles and tendons around the shoulder especially within the rotator cuff or the joint capsule
• inflammation in the sac of soft tissue (bursa) which normally allows the muscles and tendons to slide smoothly over the shoulder bones
• damage to the bones and cartilage, which can be caused by arthritis. Rheumatoid arthritis quite commonly affects the shoulders. Osteoarthritis is less likely to affect the shoulders but may follow on from previous shoulder injuries.

What can I do?

Unless the pain is extremely bad or you have had a definite injury, you do not need to see your doctor straight away. Many shoulder problems will improve with simple medications and other measures described below. But if your pain is not settling after about 2 weeks then you should make an appointment to see your doctor or a physiotherapist in case you have a more complex problem.

Painkillers

Simple painkillers or anti-inflammatory tablets and creams which you can buy at the chemist’s can be helpful, but you should not use them for more than 2 weeks without seeking medical advice. Check whether you have any medical conditions which might make anti-inflammatory tablets unsuitable for you – ask your chemist about this. (See arc leaflet ‘Non-Steroidal Anti-Inflammatory Drugs’.)

Ice

If your shoulder is inflamed (warmer to touch than the other side) you may find an ice pack helpful. To use an ice pack, place a damp flannel or towel on your shoulder (this prevents a cold burn to the skin), place the ice pack (or alternatively a bag of frozen peas) on top of this, and hold it in place with another towel. Leave on for 10 minutes or so and then remove.

Rest and exercise

You should aim for a balance between rest and activity to prevent the shoulder from stiffening. One good exercise for all shoulder problems is called a pendulum exercise (see Figure 2). Stand with your good hand resting on a table. Let your other arm hang down and try to swing it gently backwards and forwards and in a circular motion. This exercise can be done 2 or 3 times a day and repeated about 5 times on each occasion. Another good exercise is to use your good arm to help lift up your painful arm. You may find these exercises more comfortable to do after you have applied an ice pack as described above.

Try to avoid the movements that are most painful, especially those that hold your arm away from your body and above shoulder height for long periods. When lifting your arm up you can reduce the strain or pull on your shoulder by remembering the following points:

• Keep your elbow bent and in front of your body.
• Keep your palm facing the ceiling when you reach up.
• To lower your arm, bend your elbow, bringing your hand nearer your body.

Posture

Check your posture. It can be tempting to sit leaning forwards with the arm held tightly by your side. This position can make the problem worse, especially if some of the pain is coming from your neck. When sitting, try to keep a pillow or cushion behind your lower back, with your arm supported on a cushion on your lap. Some people find that placing a cushion or rolled towel under the armpit and gently squeezing onto it can ease the pain.

If your shoulder is painful to lie on, try the following positions to reduce the discomfort:

• Lie on your good side with a pillow under your neck. Use a folded pillow to support your painful arm in front of your body. Another pillow behind your back can stop you rolling back onto your painful side.
• If you prefer to sleep on your back, use one or two pillows under your painful arm to support it off the bed.

Reducing the strain

Generally it is best to carry out your normal activities, like going to work or jobs around the house, as best you can – but try not to overdo things. You may need to pace yourself to start with. Try to do a bit more each day. The following tips should help to reduce the strain on your shoulder.

At home...

• When vacuuming, keep your upper body upright. With the cleaner close to your body, use short sweeping movements.
• Only iron essential items. Make sure your ironing board is at waist height (most people have the board too low).
• Use a trolley to move your shopping about. When packing divide the shopping into small manageable bags and carry one in each hand so that your load is balanced. Try not to carry a bag or briefcase in one hand: it is better to use a backpack or knapsack.

At work...

• Try to maintain a good posture by not slumping in your chair or working bent over a desk. Try not to walk around with your shoulders hunched up; instead, try to adopt a relaxed shoulder posture and avoid holding your neck in fixed, bent or twisted postures.
• If you use a computer make sure the keyboard and monitor are directly in front of you, so you don’t have to turn your head or twist your body. Keep the computer mouse within easy reach; you should not have to stretch to reach or use the mouse.
• When you are on the phone never trap the receiver between your head and shoulder.
• Avoid any manual work which hurts while you are doing it. If your job involves repetitive actions and/or awkward postures which might contribute to your shoulder problems it is important to seek advice. Try talking things over with your manager or colleagues initially to see if there might be another way of doing things. Some companies have an occupational health department who might be able to help. Alternatively, contact your local Jobcentre Plus office who can put you in touch with advisers specialising in physical difficulties at work. See the arc leaflet ‘Work and Arthritis’ for more information.

What if the pain continues?

If the problem continues for more than a few weeks, or gets worse, you should see a doctor. Your doctor will ask how the problem started, how it has developed, and how it interferes with your life. Each shoulder problem has its own pattern of symptoms. Most conditions cause pain when you use or move your shoulder. Your doctor will probably ask you which movements give most pain because this will be a good indication of where the problem is. Alternatively, the doctor may examine you to find out which movements are most difficult for you.

If the pain spreads to involve both shoulders and you feel particularly stiff in the morning, or if you also feel unwell, you should ask to see your doctor as soon as possible, as this can be a sign of a condition called polymyalgia rheumatica. This is a condition which often causes widespread muscle pain and which usually requires treatment with steroid tablets. This condition is covered later in this booklet and in the separate arc booklet ‘Polymyalgia Rheumatica (PMR)’.

Do I need tests?

For most shoulder problems blood tests are not helpful. However, your doctor might ask for them to rule out other conditions or as part of an investigation of arthritis.

Do I need an x-ray or scan?

Usually your symptoms and the doctor’s examination of your shoulder will give all the information needed to plan your treatment.

X-rays can be very useful in certain cases, but they need to be interpreted carefully. They can be normal even if you have severe pain. This may mean that the pain is coming from the soft tissues around the joint (muscles, tendons, cartilage and so on) which cannot be seen on an ordinary x-ray. A ‘frozen’ shoulder, for example, usually appears normal in an x-ray. An x-ray may show minor changes, especially in the acromioclavicular joint (see Figure 1), but these changes are quite common and only rarely cause pain. An x-ray may show a deposit of calcium in the tendons which sometimes, though not always, causes inflammation and pain (see ‘Acute calcific tendinitis’).

An ultrasound scan can be very helpful in understanding what is going on in the shoulder. It allows thickening in the soft tissues of the shoulder to be seen, and can also detect fluid and damage to tendons and muscles. It may also show larger tears in the rotator cuff. However, an MRI scan (see below) is more reliable in assessing rotator cuff problems, especially small tears.

Magnetic resonance imaging (MRI) is only needed in certain situations. MRI scans may be carried out when the doctor suspects a complex problem in the shoulder, or when further, more specialised treatment is planned. They have the advantage over x-rays that they allow the soft tissues around the shoulder to be seen (including muscles, tendons and cartilage). One of the most common reasons to have a scan is to see if there is a tear in the rotator cuff tendons. Occasionally it is necessary to inject a ‘contrast medium’ into the shoulder before the scan is carried out. This works a bit like a dye and allows more detail to be seen.

What specific conditions can affect the shoulder?

Because the shoulder joint is such a complex structure it can be affected by a number of different conditions and, confusingly, some of these conditions have more than one name. Some of the more common ones are described below.

Acute calcific tendinitis

Sometimes inflammation in the tendon is caused by a deposit of chalky material (calcium) in the tendon. It is not known why the calcium builds up in some people. Although this tendon calcification may not cause any pain at all, it can sometimes cause intense pain and restriction of movement. Often injection with steroids works well (see ‘Will an injection help?’). Sometimes removing the calcification surgically can be helpful – this is often done using ‘keyhole’ techniques.

Bicipital tendinitis

In this condition, typically there will be pain on bringing the arm forward or flexing the elbow. There will be tenderness over the tendon which lies in front of the shoulder joint. Again, physiotherapy and an injection of steroid can be helpful. However this condition will often settle with rest, home exercises and simple pain relief (see the section on painkillers, above). Very occasionally the biceps tendon may rupture. Although this does not cause any problems with movement, it may cause some bruising, typically just above the elbow, and the biceps muscle bunches – rather like a ‘Popeye’ muscle!

Brachial neuritis

This condition is characterised by severe pain over the shoulder area, a sudden reduction in the range of movement, and wasting of the shoulder muscles. It is diagnosed using nerve conduction studies. Very small needles are placed in the muscles and a reading is taken of the electrical activity in the muscles and nerves. Physiotherapy and pain relief are the main forms of treatment. Surgery does not help.

Frozen shoulder

A ‘frozen’ shoulder is where the capsule of the joint tightens and stops you from moving the shoulder (the medical name for this is ‘adhesive capsulitis’). There is no actual change in temperature. It is not known why this occurs. Often it happens for no apparent reason, though it may follow an injury or sometimes a stroke or heart attack. It usually occurs in middle age, and is much more common in people with diabetes.

Although the condition will usually resolve itself in 2–3 years, physiotherapy or a steroid injection into the shoulder may be tried. Many specialist orthopaedic shoulder surgeons recommend early assessment for keyhole surgery (see section on keyhole surgery below). The main aim of treatment is to reduce the pain and give you back the movement once the pain has improved.

Pain can be particularly bad at night and you may need painkillers and sedatives to deal with this. You can also try a transcutaneous electrical nerve stimulation (TENS) machine: small pads are placed over the painful area and connected to a small battery-driven device; the low-voltage stimulation produces a pleasant tingling sensation and reduces the pain. Your local physiotherapy department may have one of these machines which you can borrow on a temporary basis. Sometimes an injection of steroid may help but generally this has to be given within the first 3 months. Once the pain begins to lessen it is important to regain your shoulder movement, and you will probably need physiotherapy at this point.

If your shoulder movement remains very restricted then keyhole surgery to release the capsule (see ‘Will I need an operation?’) or manipulation under a general anaesthetic may be helpful; these treatments can also be combined if necessary. In any event you will need to follow a programme of physiotherapy afterwards to reduce the risk of your frozen shoulder returning.

Osteoarthritis

Osteoarthritis is a common condition which can affect any joint but occurs most commonly in the hips, knees and hands (see arc booklet ‘Osteoarthritis’). When it affects the shoulder, it may be in the shoulder itself (glenohumeral joint) or quite commonly in the acromioclavicular joint between the collarbone and the shoulder. Shoulder osteoarthritis may result from previous injuries or abnormal stresses on the joint. The structure of the cartilage changes and becomes thinner. Spurs of extra bone (called ‘osteophytes’) form which alter the shape of the joint and affect the way it moves. Typically there is pain and a reduction in the range of movement in the shoulder. If the acromioclavicular joint is involved pain may be most noticeable on stretching across to the other shoulder, or lying on the affected side.

Treatment will depend on the degree of pain and the range of movement. Physiotherapy may be of great help. Painkillers can help with the pain, and if there is a flare-up a course of anti-inflammatories may be used (see section on painkillers and the arc leaflet ‘Non-Steroidal Anti-Inflammatory Drugs’). A local steroid injection may be very helpful especially for the acromioclavicular joint. A shoulder replacement may be required if these treatments are not sufficient to control the pain (see section ‘Will I need an operation?’).

Painful arc

In this condition pain is usually felt as the arm is lifted away from the body. Usually there is a degree of inflammation in both the subacromial bursa and the supraspinatus tendon (one of the tendons of the rotator cuff) so your doctor may refer to ‘subacromial bursitis’ or ‘supraspinatus tendinitis’. Often this occurs because there is not enough space below the acromion for the tendons to pass easily (sometimes referred to as ‘impingement syndrome’). On lifting the arm away from the body the space below the acromion narrows further causing the tendon to be squeezed and leading to inflammation. These conditions can be diagnosed clinically, but an ultrasound scan or MRI may be helpful in confirming the diagnosis.

Treatment for painful arc includes physiotherapy and sometimes an injection of steroid, and usually anaesthetic, into the space below the acromion. If the pain does not settle or recurs within a short time, i.e. 3–4 months, then keyhole surgery will usually be very effective (see figure 3).

Polymyalgia rheumatica (PMR)

This condition characteristically causes stiffness in the muscles of the shoulder and pelvis. The stiffness comes on quite quickly over a week or so and is especially bad in the mornings. If you have pain in both shoulders and you are feverish, or feel generally unwell, you should seek medical advice at an early stage as PMR can have complications – e.g. inflammation of the blood vessels in the head (which could damage the blood vessels if not treated). PMR responds well to treatment with steroid tablets though these may need to be continued for a year or more. Further information is available in the arc booklet ‘Polymyalgia Rheumatica (PMR)’.

Referred neck pain

Often this problem causes pain in the upper outer arm which will ache and feel heavy. Your doctor will be able to help make this diagnosis, but sometimes the diagnosis is confirmed only when physiotherapy treatment to the neck resolves the problem.

Rheumatoid arthritis

This is an inflammatory disease which typically affects the hands and feet, but may affect the shoulder joints. The inflammation in rheumatoid arthritis affects the synovium which lines the joint capsule but it is not known exactly what triggers the inflammation. As the disease progresses it may cause damage to the cartilage which covers the ends of the bones, to the bones themselves, or to any ligaments within the joint. (See the arc booklet ‘Rheumatoid Arthritis’ for further information.) Although there is no cure as yet, there is a range of treatments available including painkillers and anti-inflammatories, disease-modifying drugs (which affect how the disease progresses), and steroid tablets or injections. Joint replacement surgery may also be considered if the arthritis has damaged the joint (see arc booklet ‘Shoulder and Elbow Joint
Replacement’).

Rotator cuff tear

This condition generally occurs in people over the age of 40. Typically people find that they cannot raise the arm properly especially above shoulder height. It is not always painful, but some people do have pain in the shoulder for a few weeks before they notice any difficulty in moving their shoulder. Although the name suggests an injury, most people do not remember hurting themselves beforehand. As the rotator cuff cannot work properly, the muscles between the neck and shoulder and the muscles controlling the shoulder blade come into play to compensate. This results in ‘hunching’ of the shoulder. Although physiotherapy may be very helpful, surgery to repair the torn part of the rotator cuff may be necessary (see the section ‘Will I need an operation?’ below).

Treatments

Can physiotherapy help?

Yes, the vast majority of shoulder problems will benefit from physiotherapy. A physiotherapist will make a detailed assessment of your condition and put together a treatment programme tailored to your needs. This may be aimed at improving your symptoms or it may focus more on restoring function. The approach taken will depend on whether you have a short-term (acute) problem or a more long-standing (chronic) condition. Almost everyone will benefit from some form of home physiotherapy programme which might include some, or all, of the following:

• exercises to ease any stiffness (or to prevent the shoulder from stiffening)
• exercises to strengthen weakened muscles and to get them working together efficiently
• advice on improving shoulder, neck and spine posture
• exercises aimed at increasing the range of joint movement
• ultrasound or other local treatment, such as transcutaneous electrical nerve stimulation (TENS) or heat/cold therapy, to ease pain. The use of TENS is described in the section on frozen shoulder.
• applying adhesive tape to the skin to reduce the strain on the tissues and to help increase your awareness of the position of the shoulder and shoulder blade.

Research has shown that people who work hard to keep their muscles strong, and can maintain movement, tend to make a quicker and more complete recovery. It is important to remain generally active even if you have to limit how much you do of certain activities. There is more information on self-help in the section ‘What can I do?’

Will an injection help?

Injections of steroids (‘cortisone’) help many shoulder problems. They are particularly helpful for acute calcific tendinitis. The injections work by reducing the inflammation and allowing you to move your shoulder more comfortably. Often the steroid is given along with a local anaesthetic, and you may find your shoulder pain is quickly reduced. You can use this time to start gently moving your shoulder (see ‘What can I do?’) but be careful not to use your shoulder for anything too strenuous (for instance sawing) in the first 2 weeks after an injection. Sometimes the pain may be worse for a short time immediately following the injection. This does not mean that it has gone wrong. You only need to seek advice if the pain continues for more than a day or so after the injection. For many people an injection is all that is needed to allow recovery, but for some people the problem can come back and in this case you may need more tests.

There are usually very few side-effects from steroid injections; the most serious is an infection at the site of the injection but this is very rare, and happens in less than 1 in 10,000 injections. A few people may have some thinning of the skin at the site of the injection, but this will gradually return to normal with time. (See arc leaflet ‘Local Steroid Injections’.) The injections can be repeated if necessary. As a rule of thumb, if an injection has given 4 months or so of benefit before symptoms return then it would be reasonable to repeat it. Steroid injections are not normally given more often than every 3–4 months because there is a small risk that the steroid may cause damage to the muscles and tendons. Furthermore if the injection does not give lasting improvement, then an alternative treatment should probably be considered.

Where is the injection given?

This depends on what condition you have. As mentioned above (see ‘Where is the pain coming from?’) shoulder problems may arise either from the glenohumeral joint or the acromioclavicular joint, from muscles or tendons, or from the subacromial bursa. The injection may be given from the front, back, top or side of the shoulder, so that the steroid is delivered as close as possible to the cause of the problem. Sometimes the injection is carried out with the aid of ultrasound images – these allow the inflamed tissues to be seen on a monitor so that the injection can be directed even more precisely.

What other help is available?

If your shoulder problem is interfering with daily activities, such as dressing, washing and driving, you may find it useful to see an occupational therapist (see arc leaflet ‘Occupational Therapy and Arthritis’). Your GP or hospital consultant can refer you to an occupational therapist. If you are having problems at work, talk to your employer or, if there is one, the occupational health team at your place of work. Help is also available from your local Disability Employment Adviser (DEA), who can be contacted via your local Jobcentre Plus office.

Will I need an operation?

Most shoulder problems improve without the need for surgery, at least to a point where they do not cause too much pain or interfere too much with your daily life. But some conditions can be helped by surgery. If an operation is needed it can often be performed using keyhole techniques.

Keyhole techniques (also called arthroscopy) require a smaller incision than conventional surgery. They can be used to find out more about your problem or to carry out a variety of treatments. Examples include:

• removing loose pieces of bone or a calcium deposit if injections have not worked
• releasing the tight capsule of a frozen shoulder
• trimming bone and tissue from the underside of the acromion at the top of the shoulder. This is called ‘subacromial decompression’ (see Figure 3) and can be helpful for severe or recurrent impingement syndrome. The operation gives more space outside the rotator cuff tendons, allowing them to move more freely without causing pain.
• repairing tears in the rotator cuff.

The advantage of keyhole surgery is that the scar is smaller and it is less painful than conventional operations because there is less disturbance of the tissues. As a result recovery may be quicker. However, it is still a big operation.

Conventional surgery may be necessary in some circumstances, for example to repair larger tears in the rotator cuff. This is a major operation and involves a lengthy recovery period. It will only be considered if you have a lot of pain and difficulty in using your arm. Unfortunately, some tears are so big that complete repair may not be possible, but even then there is usually something that can be done to reduce the pain.

Can the shoulder joint be replaced?

Yes. Shoulder joint replacement and shoulder resurfacing are well established and can be very successful for several conditions. These are used mainly for osteoarthritis and rheumatoid arthritis when severe pain restricts movement and use of the shoulder. In shoulder replacement operations a metal head with a long stem replaces the upper part of the upper arm bone, or humerus (see Figure 4). For some conditions a plastic ‘cup’ is fitted into the socket of the shoulder blade but in other cases this is not needed. In shoulder resurfacing a metal cap with a much shorter stem is fitted over the upper arm bone. This means that much less bone has to be removed. (See arc booklet ‘Shoulder and Elbow Joint Replacement’.)

The operations are very good for removing the pain and giving you better use of your arm. Some people regain more movement than others. This usually depends on how severe your shoulder problem was before having surgery. If the rotator cuff has been badly damaged you will probably not get full movement back. However, you should have more movement than before the operation and, because the pain is much less, you will be able to use your shoulder better.

Physiotherapy and exercises after the operation are important to help you regain movement gradually. You will have to wear a sling for about 4 weeks, although you will need to take your arm out of the sling for some exercises. You will not be able to drive for 3 months after surgery. It may take 6 months to feel all the benefits of the operation.

Are there any risks to surgery?

All operations have risks and the potential for complications, because of both the anaesthetic and the operation itself. As the shoulder is such a complicated joint, it can be difficult to predict the outcome of any operation. Generally, the more extensive and the more complex the surgery, the greater the risk. However, the risk will also vary depending on your general health and fitness.

There are usually 3 types of risk associated with an operation:

• Outcome. The outcome of the operation may not be as good as predicted. As the shoulder is a very complicated joint and very dependent on the proper function of the muscles and tendons complete recovery back to a normal shoulder is not always possible.
• Infection. There is a small risk of infection with any operation or procedure but this is very rare. Orthopaedic surgeons take especial care in joint replacement with special air flow theatres to reduce this risk to an absolute minimum.
• Damage to other tissues. It is possible to damage the complex network of nerves around the shoulder but again this is very rare indeed.

As with any operation it is important that you are given a realistic idea of what you can expect to gain as well as any particular risks. If you are in any doubt you should make sure you discuss this with your surgeon before the operation.

Surgery is not often necessary in the treatment of shoulder pain, but in some cases it can be very helpful, and give you back much improved use of your arm.

Summary

The shoulder is a very mobile joint that is prone to several painful conditions; however, severe arthritis of the shoulder is fairly uncommon. Many conditions will settle down with a short period of rest and simple medication from your doctor or chemist. Exercises are important to help prevent stiffness developing. If problems persist there are many things that can be done to help, from physiotherapy to injections and occasionally surgery.

Glossary

Acromioclavicular joint (ACJ) – the joint at the outer end of the collarbone (clavicle). It joins the collarbone to the shoulder blade at the acromion.

Acromion – a part of the shoulder blade (scapula) that can be felt on the top of the shoulder. Some of the muscles that move the shoulder are attached to this.

Arthroscopy – the medical name for keyhole surgery where small (less than 1 cm) incisions are used to allow a special light and camera to look at the inside of a joint. This can be seen by the surgeon on a television screen. More than one incision is often used to allow instruments to be introduced. Stitches are not usually needed in the incisions.

Bursa – a pouch or sac of soft tissue that is present between a bone and the tendons that have to move over it. There is a bursa under the acromion (subacromial bursa) that helps to stop the tendons of the shoulder rubbing on the underside of the acromion.

Glenohumeral joint – the main ball-and-socket joint of the shoulder. To allow such a wide range of movement the socket, or cup, at the shoulder is not as deep as that of the hip joint.

Rotator cuff – the group of four muscles and their tendons close to the shoulder that surrounds the glenohumeral joint. They are responsible for the proper working of the shoulder and help hold the joint together. The tendons of these muscles are prone to inflammation (tendinitis) and damage.

Scapula – the medical name for the shoulder blade. The rotator cuff muscles are attached to this and the socket of the glenohumeral joint is part of it.

Tendon – a strong, fibrous band or cord which anchors muscle to bone.

Useful addresses

The Arthritis Research Campaign (arc)
PO Box 177
Chesterfield
Derbyshire S41 7TQ
Phone: 0870 850 5000
www.arc.org.uk

As well as funding research, we produce a range of free information booklets and leaflets. Please contact the address above for a list of titles or, on this web site, see Publications for People with Arthritis.

Arthritis Care
18 Stephenson Way
London NW1 2HD
Phone: 020 7380 6500
Helpline: 0808 800 4050
www.arthritiscare.org.uk

Offers self-help support, a helpline service (on both numbers above), and a range of leaflets on arthritis.

Employment/benefits
Your Jobcentre or Jobcentre Plus office can put you in touch with your local Disability Employment Adviser. For information on benefits you can contact the Benefit Enquiry Line on 0800 882200.

 

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