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The shoulder joint is an extremely flexible joint which allows us to move the arm in all directions. This wide range of joint movement however means the shoulder is very susceptible to injury. Many shoulder problems are caused by the breakdown of soft tissue through either repeated use or sudden over load. In most cases, if you are suffering shoulder pain it is because your muscles are simply not strong enough or they are deconditioned.
Causes of Shoulder Pain
The shoulder joint is much prone to injuries in sport. These may be traumatic injuries such as shoulder dislocation or joint sprain or as a result of overuse such as rotator cuff muscle injuries. There are many different causes of shoulder pain.
Overhead activities, such as swimming or throwing a baseball, may cause pinching of the rotator cuff or biceps tendons. Occasionally, poor sitting posture may place increased stress on the shoulder and cause pain. Trauma such as falls or car accidents can also injure the shoulder. Often, shoulder pain occurs with no apparent reason or specific injury.
Major Shoulder Problems
Frozen shoulder, shoulder tendonitis, dislocated shoulder and a broken collar bone are extremely common shoulder injuries. Shoulder injury symptoms typically include shoulder pain, shoulder weakness, a stiff shoulder and shoulder joint instability. Shoulder pain and shoulder injuries frequently occur due to trauma or sporting overuse. Physiotherapy treatment and advice can dramatically improve the treatment and prevention of shoulder pain.
A shoulder dislocation involves the ball of the shoulder joint coming out of the socket of the joint. It is usually a traumatic injury caused by a fall or heavy impact. Shoulder dislocations are characterized by severe shoulder pain and hospital treatment is required to restore normal shoulder anatomy.
The shoulder should be x-rayed to determine if there are any fractures around the shoulder joint, and the shoulder is “reduced” or put back in place. The arm will then be put into a sling to allow healing to occur.
Rehabilitation post shoulder dislocation is extremely important. This is because during dislocation, the ligaments around the shoulder joint are damaged thereby causing instability in the joint and making recurrence of the dislocation a high possibility.
Acromioclavicular (AC) Joint Sprains
The acromioclavicular joint is the joint at the top of the shoulder between the collar bone and the shoulder blade. It is most commonly injured by a fall onto an outstretched hand or by a direct blow to the shoulder. There will be a lot of pain at the time of the injury and arm movement will be limited. The shoulder should be x-rayed to rule out any fracture in the joint.
Treatment and recovery time will depend on severity of the injury. Some injuries may require surgical repair. The arm is usually rested in a sling initially for pain relief. Gentle exercises and manual therapy will help to restore full range of movement to the joint. Strengthening of the rotator cuff and surrounding muscles is important before returning to sport in order to reduce the risk of re-injury.
Rotator Cuff Injuries
The rotator cuff muscles are a group of four muscles which very closely surround the shoulder joint and are extremely important in controlling the movement of the joint. These muscles are often injured over time in sports which involve repetitive movements such as swimming or tennis, and tears can develop within the muscles. This is more common in 35+ age group.
Symptoms of a rotator cuff injury will include pain in the shoulder, particularly with overhead activities, difficulty sleeping on the shoulder at night and often weakness in the arm when lifting objects.
Early diagnosis and treatment of shoulder pain can often prevent complete tear of the muscles. We recommend very specific exercises for strengthening the rotator cuff. Depending on the nature of injury, one can begin with basic exercises and gradually add in intermediate and advanced ones as shoulder strength improves.
Medically known as ‘adhesive capsulitis,’ frozen shoulder is a condition where the capsule of connective tissue surrounding the ball and socket joint significantly tightens, resulting in severe movement restriction at the shoulder. This condition makes the shoulder incredibly stiff and motion is drastically reduced, it gets ‘frozen’ in place.
There remains no known cause to how and why this happens, but research has shown that it more commonly affects middle age woman, diabetes sufferers and more so occurs following an injury that has led to reduced movement at the shoulder.
Physiotherapy and stretching are the key aspects to treating frozen shoulder.
Bicipital Tendonitis and Bursitis
The most common diagnosis in patients with shoulder pain is bursitis of the rotator cuff. The biceps tendon attaches biceps muscle in the upper arm to the front of the shoulder. Many people consider the long head of the biceps tendon to act like a fifth rotator cuff tendon, offering stability to the front of the shoulder. This tendon can get pinched by the bony anatomy of the shoulder blade or by ligaments that attach to the collar bone and shoulder blade, causing tendonitis.
In our shoulder we have a bony tunnel created from the AC joint on top (end of our collarbone) and the shoulder joint below. Through here runs a rotator cuff tendon and a bursa (fluid sac that prevents frictional rubbing between bone and tendon). With acute injury, such as a fall or a sudden jar at an awkward angle, this tunnel can be pinched. With repetitive overuse in awkward angles, such as bench press or overhead painting, the contents of the tunnel can get inflamed and therefore thicken. Both will cause narrowing of the tunnel and compression of the tendon and bursa, causing pain and restriction and what is known as shoulder impingement.
A shoulder fracture occurs after significant trauma. Falling on an outstretched arm is a common cause of a shoulder fracture. The collar bone, the scapula, the humerus or a combination of all three may be injured as a result.
Instability is a problem that causes a loose joint; it may have developed over time, or can be the result of a traumatic injury.
Calcific tendonitis is a build-up of calcium deposits within a tendon; often the rotator cuff tendons. Treatment will depend on the extent of symptoms.
There are several patterns of a torn labrum and the type of treatment depends on the specific injury. This occurs more in the younger population of less than 35 years.
The SLAP lesion is also a type of labral tear. The most common cause is a fall onto an outstretched hand stuck out to try to save yourself, hence the name.
Biceps Tendon Rupture
A proximal biceps tendon rupture occurs when the tendon of the biceps muscle ruptures near the joint.
This is a condition that affects the joints, causing damage to the cartilage and swelling of the tissues around the joints (synovitis). It can also affect the acromioclavicular joint at the top of the shoulder or the glenohumeral joint (main ball-and-socket joint of the shoulder)
This generally occurs due to wear and tear and affects both the bony and muscular structures of the shoulder.
Physiotherapy for Shoulder Pain
Initially, a short period of rest is recommended for shoulder pain. This should last two to three days. During this period, you can apply ice to the shoulder to help control inflammation and provide symptomatic relief. Ice can be applied for 15 to 20 minutes. You can also start gentle pendulum exercises during this time. By keeping the shoulder mobile, you can avoid a frozen shoulder.
Our therapists are trained in treatment of shoulder pain and have extensive experience in getting you back normal as quickly as possible. We provide a thorough physical check-up and the right treatment to get to the root of shoulder pain problem. We work with you to improve flexibility and posture and to give you confidence to move safely again. At Inspire Physio Care we relieve you from pain in the best possible way and in the shortest time possible.
If Shoulder Pain Persists or Worsens
Typically, shoulder pain lasts about four to eight weeks. After a few weeks of treatment, ideally the condition should improve. If you continue to have shoulder pain, you may need to see a specialist. More invasive treatments such as injections or surgery may be required to help treat the pain. The treatment of shoulder pain will depend completely on the root cause; hence an accurate diagnosis helps determine the path to healing.
How Strengthening Exercises Help
It is important to strengthen the muscles around the shoulder without causing pain. Exercises provide the adequate range of motion and the shoulder is be able to function normally without pain. Shoulder rehabilitation focuses on two aspects of shoulder motion: flexibility and strength.
Stretching the Shoulder
Stretches are very important part of treatment for shoulders. Shoulder conditions often involve shoulder stiffness, so stretching exercises can help loosen these muscles that surround the shoulder joint.
Some shoulder problems can be caused by poor posture and straining of the muscles of the upper back and neck; some simple stretches and exercises are good for the cervical spine and upper back muscles. Strengthening exercises are designed to gradual build your shoulder up again, gently, so it’s not prone to reinjury.
At Inspire Physio Care, we have tailor-made short term treatment plan to relieve your current symptoms, and a long term plan to prevent future reoccurrences. Common shoulder treatments include massage, trigger point release, shoulder joint mobilizations, tendon frictioning, postural/muscle balancing education and stretching and strengthening exercises.
Contact us for any shoulder aches or pains and arrange an appointment with one of our expert staff.