My Shoulder is Painful & Sore – Why?
Shoulder Pain is the third common musculoskeletal presentation after back and neck disorders in primary care with the highest incidence and prevalence in women and persons aged 45-64 years.
We don’t think about our shoulders until we injure it or suddenly start to experience pain one fine day.
It makes simple activities such as reaching the backseat of your car, grabbing something from an overhead shelf, sleeping, hand behind back, or getting in and out of your clothes a torturous task!
Because shoulder is the most mobile and least stable joint in the body, it is highly prone to injury.
At Praxis Rehab Physiotherapy, we see a variety of different shoulder injuries. Most of them are related to rotator cuff problems which occurs commonly in people whose work involves repetitive overhead movements and in sports such as swimming and tennis. There is a subgroup of people who have direct trauma to the shoulder following a fall on an outstretched hand in contact sport, or in the elderly population.
Anatomy - A quick overview
The shoulder forms a ball-and-socket joint with the head of the humerus (upper arm bone) and the scapula (shoulder blade), also called the Glenohumeral Joint (GHJ). As the socket is quite shallow, the shoulder relies on the surrounding web of rotator cuff muscles and muscles attached to the scapula, tendons, a cartilage ring called the labrum and ligaments to hold everything in place and deliver large range of movement in different directions.
What may cause a Shoulder Pain?
- Rotator Cuff Strain or Tendinopathy– Acute injuries of the rotator cuff (RC) following a fall include a muscle strain which could simply be a mild stretch or partial tear to a complete rupture of the tendon. Overuse injuries of the RC includes tendinopathy.These are common in athletes such as swimmers and tennis players who do a lot of overhead shoulder movement. Poor technique due to inexperience often seen in novice gym-goers or fatigue in shoulder during heavy activities like rock-climbing or weight training can increase the loading on these muscles over time.
- Shoulder Impingement (Subacromial Pain Syndrome or Rotator cuff disease) –It has been suggested that pain might occur from the tendons of the rotator cuff muscles being caught or getting impinged between the space between the humerus and the acromion (part of the shoulder blade) called the subacromial space. This usually occurs when the shoulders are overused by repetitively moving into the end ranges of its mobility or challenging into awkward positions often leading to cause bursitis e. inflammation of the bursa (a fluid-filled sac that sits in the subacromial space). Symptoms include discomfort (anything from a dull ache to a sharp pain) in the front or side of the shoulder. Pain typically increases when you lie on your side, raise your arm, or reach across your body or behind your back. Poor posture is also a factor. When we slouch, the chest is pushed inwards, causing tightness of the muscles in front of shoulder. The thoracic spine flexes forward, stretching the upper-back muscles, and the shoulders round forward, which decreases the subacromial space. While this won’t necessarily cause the injury, it can make it worse and prolong the recovery process.
- Shoulder Stiffness– Shoulder stiffness may be secondary to fall or trauma including surgery such as rotator cuff repairs, shoulder replacement, open heart surgery, and mastectomy. Sometimes shoulder stiffness occurs spontaneously and is referred to as adhesive capsulitis (or “frozen shoulder”).
- Shoulder Instability –When the shoulder joint is dislocated due to trauma, it stretches and occasionally tears the ligaments and causes instability. Occasionally, the labrum is also torn if there are repeated episodes of dislocation or if the original injury was very severe and traumatic. Shoulder instability can lead to impingement pain due to an imbalance of the surrounding muscles.
- AC joint pathology – The other main joint of the shoulder complex is the Acromio-Clavicular (AC joint). AC joint injuries are very common in AFL football and tend to occur from impact, such as a fall onto the shoulder.
- Referred Pain– Patients often present to the clinic with shoulder pain/tightness referring from the neck and upper back. This commonly is influenced by sitting posture with many of us spending long hours per day seated in front of a computer.
Assessment of the Shoulder
So, as you see the list is long! Hence, a proper history-taking of your problem will help us to identify – the barriers limiting your ability to move at home/work/socially, nature and behaviour of pain, coping strategies, your concerns regarding pain, beliefs and attitudes developed over time to manage the pain, and short & long-term goals.
A detailed assessment will aim to look for any pain, weakness, stiffness or instability in general shoulder movements, functional movements, work-related and sports-specific activities such as overhead movements, push-ups, lifting a dumbbell, throwing a ball, or swinging your racquet/golf club/bat.
Management of Shoulder Pain
Research has shown that exercise therapy is most effective as first-line treatment to improve pain, mobility, strength and function. Hands-on/manual therapy such as soft tissue massage, joint mobilization, dry needling and taping may be integrated as additional therapy to help in the initial treatment phase.
At Praxis Rehab Physiotherapy, we aim to derive considerable comfort and results from research that consistently demonstrates improvements in symptoms with a well-structured and graduated exercise program. We will advise you on the type, duration and dosage of exercise, modify activities if painful, calm the load down before reintroducing controlled loading and gradual progression from simple to complex shoulder movements.
We put great emphasis on education as an essential component of rehabilitation, and attention to lifestyle factors (smoking cessation, nutrition, stress, and sleep management) to enhance outcomes.