The body's most movable joint is the shoulder. The shoulder is moved both forward and backward. Additionally, it enables the arm to rotate and rise and fall away from the body. The range of motion in the shoulder is extensive and flexible. When something goes wrong with the shoulder, it restricts movement, which can be quite painful and uncomfortable. Daily activities like driving a car, combing your hair, or reaching for something on a high shelf might become challenging if you have shoulder pain, stiffness, or weakness [1-2]. 

There are numerous potential reasons of shoulder pain, but the rotator cuff injuries, rotator cuff tears, and osteoarthritis are the most frequent ones. Performing physical labour, participating in sports, or even repetitive movement can all lead to shoulder injuries. Sometimes, an injury to another part of the body, generally the neck or biceps, causes shoulder pain. Referred pain is the term for this. 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].

Rest and analgesic creams and gels are typically used to treat it at home. To treat shoulder discomfort, people also take painkillers. With these medical treatments and rest, pain from effort, posture, or small injury typically goes away. Shoulder pain rarely requires surgery [5-6].

A number of studies conducted in different parts of India reveal 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 at the Regional Hospital in Bilaspur, Himachal Pradesh.

Objectives of the Study

• To evaluate the knowledge of patients attending Ortho OPD towards risk factors for shoulder pain at the Regional Hospital in Bilaspur, Himachal Pradesh

• To evaluate the practices of patients attending Ortho OPD at the Regional Hospital in Bilaspur, Himachal Pradesh on having shoulder pain       

• Research Approach: Descriptive

• Research Design: Cross Sectional Hospital Based Survey

• Setting of the Study: Ortho OPD of Regional Hospital in Bilaspur of Himachal Pradesh

• Study Duration: July 2022 to September 2022

• Study population: Ortho OPD patients in Regional Hospital in Bilaspur of Himachal Pradesh

• Sample Size: 400 assuming 50% adults have adequate knowledge regarding risk factors for Shoulder pain, 5% absolute error, 95% confidence level, and 5% non-response rate.

• Sampling Technique: convenience Sampling Technique

• Sampling criteria: First five patients attending the Ortho OPD of Regional Hospital, Bilaspur 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 factors for shoulder pain and practices of patients in case of shoulder pain 

• Validity of Tool:  by the experts in this field

• Permission: obtained from the concerned head of the Regional Hospital, Bilaspur

• Data Collection: by the researcher themselves and patients were given 5 minutes time to complete that questionnaire and collected at the end of the prescribed time

• Data Analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analysed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc

• Ethical Considerations: Participants confidentiality and anonymity was maintained

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 at Regional Hospital in Bilaspur of Himachal Pradesh

In the present study 32.5% (130) of the Patients fall were below 40 years of age while 67.5% (270) were above 40 years.  52.75% (211) of patients were male and 47.25% (189) were female.

Among the total study participants, 36 (9%%) didn’t know about any risk factor of shoulder pain. 254(63.5%) respondents told that Bad posture while sitting, walking & during sleep is the major risk factor for shoulder pain followed by, Lack of physical activity 196 (49%).   Overuse   the shoulder joint180 (45%), Shoulder injury/dislocation170 (42.5%), Inadequate amounts of dietary calcium & vitamin D intake           127(31.75%), Shoulder Muscle weakness 94(23.5%), Obesity 89 (22.25%), Unhealthy diet 75(18.75%) and Bone deformity /Malpositioning of Shoulder joint 33(8.25%).           

Table 1: Knowledge about Risk Factors of Shoulder Pain among Participants

Table 2: Practices of Patients in Case of Shoulder Pain

Among the total study participants, 296(74%) replied that they take pain killer medications in case of shoulder pain  followed by pain relief gels 291(72.75%), Cold applications/ice application 280(70%), Exercise & Yoga Regularly  275 (68.75%), Calcium and Vitamin D supplements 273(68.25%), Heat applications 181(45.25%), Shoulder braces sling or shoulder immobilizer 129(32.25%), Give rest to the shoulder 103(25.75%), Massage the shoulder 93 (23.25%) and Acupressure and acupuncture  67(16.75%).

The shoulder is the body's most mobile joint, yet because to its wide range of motion, it is also the most unstable. The upper arm is vulnerable to damage because the ball is larger than the shoulder socket. Soft tissues including muscles, tendons, and ligaments that support the shoulder joint are also vulnerable to injury, overuse, and underuse. In addition to contributing to shoulder issues, degenerative disorders and other illnesses in the body can cause discomfort that radiates to the shoulder [7].

The treatment of shoulder pain depends entirely on the cause and severity of the shoulder pain. In the current study, 36 (9%) of the total study participants were unaware of any risk factors for shoulder pain. Bad posture while standing, sitting, and sleeping is cited by 254 respondents (63.5%) as the main risk factor for shoulder pain, followed by inactivity in 196 respondents (49%). Shoulder injury/dislocation 170 (42.5%), and overuse of the shoulder joint 180 (45%). Of the total survey participants, 296 (74%) said they took painkillers for shoulder pain, followed by 291 (72.75%) for pain relief gels, 280 (70%) for cold treatments or ice, 275 (68.75%) for regular exercise, and 273 (68.25%) for calcium and vitamin D supplements.

Treatment for certain mild shoulder pain can be done at home. Resting the joint and allowing the acute inflammation to go down are the first lines of defence for many common types of shoulder pain. However, it's crucial to proceed with caution when resting the joint because continued immobilisation might create stiffness. The shoulder should be rested for a few days before getting back to normal activities, and painful motions should be avoided. Limit extracurricular activities or work [5,6,8].

Ice packs can be used to treat shoulder overuse issues as well as acute shoulder injuries, with the goal of reducing swelling and pain (for example, rotator cuff tendinitis or bursitis). In these situations, ice is used immediately following the overhead exercise to reduce the beginning of inflammation. Pain can be lessened by applying ice to the shoulder three or four times each day for a few days. Because putting ice directly on your skin might result in frostbite and burns, use an ice bag or wrap the ice in a towel [3,6,9].

Heat pads are also used to treat persistent shoulder problems, although usually before overhead exercises. Heat can help muscles loosen up, alleviate pain, and make them less rigid [3,10]

Other at-home remedies include applying an elastic bandage to the area to reduce swelling and taking over-the-counter nonsteroidal anti-inflammatory drugs to help with pain relief and inflammation. Ibuprofen is an example of an NSAID that is available over-the-counter. Other NSAIDs, like Voltaren, must be prescription (diclofenac). These are frequently employed in the treatment of shoulder conditions such tendinitis, bursitis, and arthritis. It's vital to only use them briefly and under a doctor's supervision [11-12].

Simple shoulder exercises can aid in rotator cuff tendon and muscle stretching and strengthening. Only if conservative methods fail or if the shoulder damage is too severe from the beginning will surgery be required [13].

Regular exercise and yoga ensuring sufficient back support while seated, walking, and resting, and maintaining excellent posture Avoiding shoulder overuse, sprains, and injuries by moving around once every hour, vitamin D and calcium supplements, avoiding head-heavy lifting, keeping a healthy weight, We can avoid shoulder pain by eating a healthy, balanced diet. Painkillers and pain relief creams applications that use cold or ice, Yoga and physical activity, calcium and vitamin D pills, applications of heat, shoulder supports sling or shoulder immobiliser, relaxation, shoulder massage, and Using acupuncture and acupressure to relieve shoulder discomfort.

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12. Better health. Available at: https://www.betterhealt h.vic.gov.au/health/conditionsandtreatments/medications-non-steroidal-anti-inflammatory-drugs (accessed on 11 September 2022).

13. Healthline. Available at: https://www.healthline.com /health/rotator-cuff-injury-stretches (accessed on 12 September 2022).