Shoulder pain is very common and can be caused by a variety of issues. Shoulder pain is seen across all demographics of age. In the younger population it is more commonly caused by sporting injuries, while in the older generation it is more commonly caused by general ‘wear and tear’. It is important to note though, that most cases of shoulder pain will improve and resolve well with appropriate treatment. Appropriate treatment is generally in the form of physiotherapy interventions which are aimed at promoting healing and restoring function.
ANATOMY OF THE SHOULDER
Your shoulder is a complex joint made up of highly mobile structures. There are 3 bones which make up the area of your shoulder; upper arm bone (humerus), shoulder blade (scapula) and collar bone (clavicle).
The shoulder complex is constructed by several structures, making up 2 joints.
1. Glunohumeral joint - Traditionally labeled the ‘shoulder joint’. This joint is where your upper arm bone fits into the groove of a rounded socket provided by the shoulder blade.
2. Acromioclavicular joint: Is where your collar bone meets the top of your shoulder blade.
A combination of strong muscles, tendons, ligaments and capsular structures lined with synovial fluid help to support and move this structure. The rotator cuff is one of the more well known structures which supports the shoulder joint and is a group of 4 muscles which cross the shoulder joint.
SYMPTOMS OF SHOULDER PAIN
There are many different causes of shoulder pain, which carry their own set of symptoms. Some common symptoms you may experience are:
Pain within the shoulder joint, at the front, back or down the upper arm.
Pain can be deep, dull aches, sharp, superficial.
Reduced amount of movement which can be limited by stiffness, tightness, pain, weakness.
Weakness and poor activation of surrounding muscles.
Altered sensations such as pins/needles, burning or numbness.
Instability sensation where the joint may feel it is apprehensive and/or ‘slipping in/out’.
OUR SYDNEY PHYSIOS WILL IDENTIFY THE CAUSE OF YOUR SHOULDER PAIN
There are numerous and complex causes of shoulder pain and it is vital that an accurate diagnosis is deduced. This ensures that an appropriate and effective treatment plan can be implemented, having you PAIN free and resolving your shoulder pain quicker!
We recommend consulting with one of our Sydney physiotherapists for the most accurate diagnosis and best treatment for your shoulder pain.
COMMON SHOULDER PAIN CONDITIONS
Rotator Cuff Injuries
The rotator cuff is a group of 4 muscles which surround the shoulder joint and provide an immense amount of stability and support to the joint. They all work together to play a pivotal role in keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. When these muscles are torn/strained the shoulder joint is heavily compromised and as a result symptoms such as weakness, pain, decreased range of motion and reduction in shoulder function are usually experienced.
The extent of injury is usually categorised into a partial tear or a full-thickness tear. They are common throughout most generations and are generally caused by either injury and/or degeneration and overuse. They are one of the most common causes of shoulder pain and are generally well treated via a physiotherapist through conservative treatment techniques such as manual therapy and rehabilitation exercises.
The labrum is a piece of fibrocartilage (rubbery tissue) which attaches to the outside of the shoulder socket. It forms a 'cup-like’ structure for the ball and socket joint, which is vital in ensuring the joint's stability. When this cartilage is damaged there can be severe consequences for the integrity of the shoulder.
Labral tears can be acute, resulting from injury or chronic, resulting with age. Symptoms and treatment vary depending on the type and severity of the tear. A physiotherapy examination may be used to diagnose a labral tear. Due to its complex nature these findings usually form the basis for further medical investigations via x-ray and MRI to support the diagnosis and determine the extent (and type) of labrum injury. Symptoms usually present in the form of catching, locking, grinding of the shoulder, with pain, decreased range of motion and strength.
Treatment generally is determined by the extent and type of injury. It usually includes rest, physiotherapy and even surgery in some severe cases, particularly where the individuals activities are heavily limited.
AC (acromioclavicular) injuries:
The AC joint, formally known as the acromioclavicular joint, is located at the top of the shoulder joint. The joint is made up by a bony prominence of the scapula called the acromion and the end of the clavicle. This joint can be injured by traumatic incidents such as falling on the out-stretched arm or on the tip of the shoulder, or by repetitive overuse such as lifting and throwing. There are 4 ligaments which support this joint and when an AC injury has occurred these ligaments can be overstretched and damaged.
This generally results in symptoms of:
Pain and tenderness at the front of the joint.
A visible bump at the front of the shoulder, pain when the affected arm is moved across the body and/or overhead.
Pain when lying on the affected shoulder.
Less range of motion of the joint.
The type of AC joint injury depends on how much the ligaments supporting the joint have been torn. Typically though, these injuries can be well diagnosed and treated by a physiotherapist and usually do not require surgery.
Impingement of the shoulder usually results in symptoms of pain, limited range of motion and weakness of the shoulder. Shoulder impingement can be classified into four types, depending on the site of the structures entrapped:
- Subacromial impingement
- Subcoracoid impingement
- Posterosuperior inner impingement
- Anterosuperior inner impingement
Subacromial impingement is by far the most common. It is generally caused by a dysfunction of the shoulder, where a decreased space between the rotator cuff muscles and the acromion occurs and the muscles are trapped and pinched within the shoulder joint. This is usually seen when the arm is elevated in front or out to the side and can lead to other complications such as bursitis and tendonitis.
The bursae are small fluid filled sacs that are located throughout joints in the body. They act as a cushioning pad between bony surfaces, muscles and tendons, helping to reduce friction between them. Sometimes excessive use of a joint, in this case the shoulder, can lead to increased friction of the bursa causing them to become inflamed. Within the shoulder one of the common places this occurs is at a space at the front, named the acromion, clinically known as subacromial bursitis.
Bursitis within the shoulder can also be associated with rotator cuff tears, further adding to the complications of inflammation in the shoulder. Many daily activities where the shoulder is moved to bring the arm out in front or out to the side, such as combing one's hair, can become painful in these cases.
Is where the tissue connecting muscle to bone develops some problems. This occurs as a result of the breakdown of collagen in the tendon. It is often associated with an achy type pain and reduction in range of motion. Tendinopathies in the shoulder usually occur in the rotator cuff muscles and are generally a result of over use, such as repeated reaching/throwing/lifting.
It is generally categorised into two sub-categories:
Acute - Exercise and repetitive loads such as throwing.
Chronic - ‘Wear and tear’ of structures over time as well as from degenerative diseases.
They are often diagnosed by an MRI and treated by rest and rehabilitation.
Imaging such as an MRI is often used to diagnose tendon tears in the shoulder. These may be partial or complete (where the tendon is removed from the bone). Again, this can occur from both acute and chronic causes and is most commonly seen in the rotator cuff and bicep tendons.
Shoulder instability occurs when the joint is compromised by either changes to its position or surrounding/supportive structures. This can happen over time or suddenly from an injury.
Shoulder dislocations can be a way in which the shoulder is suddenly injured and its stability compromised. Dislocations can be partial or complete. Partial dislocations, known as subluxations, occur when the ball (head) of the arm bone (humerus) is partially distracted from the socket. Complete dislocations occur when the ball (head) of the arm bone (humerus) completely operates from the socket. During these injuries, surrounding structures which support the shoulder such as muscles, tendons and ligaments can become loose and/or torn. This can place the shoulder at a greater risk for recurrent dislocations, which can further lead to developing arthritis in the joint.
Frozen Shoulder - Adhesive Capsulitis
Is the term used to describe the thickening and tightening of the capsule of one's shoulder joint. When this occurs, there can be less fluid lubricating the joint, further adding to the restriction and limitation of movement. Frozen shoulder is more common in women than in men and in people with certain medical conditions, such as diabetes, high cholesterol, or thyroid disorders. Frozen shoulder can occur after an injury and/or after a period of immobilisation or insidiously. The problem resolves over time but can last an extended period of time (2-3 years in some cases).
Cartilage is smooth tissue which covers the ends of your bones which connect to form joints. Their function is to promote smooth movement, however over time, general ‘wear and tear’ of these structures can result in osteoarthritis, which is the most common type of arthritis. The general ‘wear and tear’ is commonly caused by repetitive use through sport or work. It is known to be degenerative which means it develops slowly then worsens over time. Onset usually occurs during the mid-late stage of life and usually presents as swollen, painful, stiff, inflamed joints. People often tend to avoid movement of the joint to help manage their pain, but this can further exacerbate other symptoms and issues such as increased stiffness and muscle wastage. There are numerous treatments for osteoarthritis, including rest, modifications to activities, anti-inflammatory drugs, corticosteroid injections, and surgery in some cases.
The breaking of the shoulder complex is more commonly seen in the clavicle (collar bone), humerus (arm bone), scapula (shoulder blade), rather than the head of the shoulder bone which makes up the joint and sits in the shoulder socket. Fractures can occur from a variety of forces. In the elderly population fractures are usually seen from a fall. While in the younger population they are often caused by a sporting injury. Fractures are often characterised by immediate severe pain and discomfort, swelling, bruising.
Other issues which can cause shoulder complications
Neck and upper back problems: Problems with the joints and nerves of one's neck and upper back can refer to the shoulder, creating a source of pain.
Poor posture of the mid-back: Having excessive amount of rounding (kyphosis) of the mid-back (thoracic) region, can place excess stress and cause a dysfunction of the shoulder joint.
Axillary nerve injury: This nerve can often be damaged by a shoulder dislocation and can result in weakened shoulder muscles and loss of sensation.
Thoracic outlet syndrome: Is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed.
Muscle imbalances: Dysfunction of the muscles around the shoulder, neck, mid-back can cause shoulder pain.
Health complications: Problems affecting your heart and lungs can present as referred pain into the shoulder region. If symptoms are sudden and do not coincide with any recent mechanisms of injury it is advised to seek immediate medical intervention.
Rest assured, while seemingly complicated most of these conditions can be well treated with the intervention of a physiotherapist. With an accurate diagnosis and optimal treatment plan, patients often respond well to modalities aimed at removing pain and restoring function. Click below on one of the links to connect with expert physiotherapists at one of our Sydney physiotherapy clinics.
HOW AN EXPERT SYDNEY PHYSIO CAN HELP WITH YOUR SHOULDER PAIN
Diagnosing Shoulder Pain
An Infinite Health Sydney physiotherapist will conduct a thorough subjective examination, enquiring about potential causes, aggravating and relieving factors. Followed by an in depth physical examination assessing the joints, muscles and ligaments and movements patterns/restrictions. This will provide them with the vital information needed to establish an accurate diagnosis.
Your physio may also refer you to a doctor for further testing/imaging if they think there may be a more severe cause of your shoulder pain and/or if they want to clarify the extent of a damaged structure. At our Sydney physiotherapy clinics, your practitioner will ensure they have all the valuable information needed in developing a treatment plan that’s right for you.
Treatment usually involves reducing pain, restoring movement and function. Your physiotherapist will devise a rehabilitation program which will consist of exercises which will be designed to promote the healing process, improving strength and flexibility of your shoulder.
Aims of physiotherapy treatment generally consists of:
PAIN RELIEF - Aimed to reduce unwanted sensations and avoiding aggravating factors.
Education - On your condition, its causes, how it is treated and how to prevent it recurring.
Exercises to restore function - rehabilitation exercises plays a key role in resolving shoulder pathologies.
Reducing the risk of the injury/condition recurring - Through activity modification advice as well as with, exercises and movement rehab.
For an accurate diagnosis and effective management of YOUR shoulder pain choose one of the options below and get in touch with one of our Sydney Physiotherapists.
FURTHER INFORMATION ON SHOULDER MANAGEMENT
Where an acute injury has occurred and intense pain experienced it is encouraged to seek immediate medical intervention. Your doctor will complete a thorough investigation to determine the cause of your shoulder pain, conduct any medical imaging needing and/or provide you with treatment options, commonly being that of a physiotherapist.
Medication may be provided by your doctor to help alleviate the pain, and is to be taken only as directed. These medications may be targeted at reducing inflammation and pain. Medication can also assist an individual in better tolerating their exercises.
Surgery may be needed to resolve certain issues within the shoulder. However the majority of people experiencing shoulder pain will respond very well to conservative treatment methods of physiotherapy and will not require surgery.
Your physiotherapist and doctor will be able to discuss any need for surgery in detail with you more thoroughly based on medical imaging findings, your symptoms and response to treatment.
Surgery may be required with conditions such as:
- Recurring and/or frequent dislocations
- Acute/Chronic rotator cuff tears
- Severe joint damage, which can result from a fracture, prolonged arthritis
Imaging that may be used in diagnosing your shoulder pain
X-ray: Will provide information on bony changes such as narrowed space and spurs. They will not be able to detect changes to muscle and ligamentous structures.
Ultrasound: Are generally used to investigate rotator cuff tendinopathy and tears. Ultrasound is useful in clearly identifying symptoms of your shoulder pain but is typically needed to be used in conjunction with an x-ray or other investigation to assist in an accurate diagnosis of your shoulder pain.
MRI: Can provide detailed information regarding muscles, ligaments and bone.
For expert help and treatment visit one of our Sydney physiotherapy clinics or sign up for one of our online services. We'd love to help!