Shoulder pain

In the older age group age related changes occur in the shoulder joint and surrounding soft tissue structures (e.g. rotator cuff tendons). In younger people shoulder pain is most likely due to an acute injury/accident or from repeated activity leading to overload. For the middle aged- it is a combination of these factors. It should be remembered that shoulder pain can also be referred for the neck or occasionally  other sources.

Research has shown that physiotherapy is effective in the management of shoulder pain and getting you back to doing the activities you enjoy. 

There are three broad categories of shoulder pain and injury:

1. Injury – such as shoulder dislocation and rotator cuff tears
2. Muscle imbalances leading to impingements, bursitis and rotator cuff tendinopathies and degeneration.
3. Stiff and painful shoulders such as frozen shoulder or arthritis

Some of the most common presentations we see:

Rotator cuff and biceps tendon pain 

Rotator cuff tendons refer collectively to several tendons in the shoulder which attach to the humerus. These tendons attach to muscles critical for normal shoulder function. The long head of biceps tendon works with the rotator cuff. 

These tendons are commonly torn and also degenerate with age. 

Shoulder impingement 

Impingement pain occurs because painful rotator cuff tendons and bursa are compressed against the bone above as the arm is lifted overhead. It is often related to a tendon injury, but can have other causes such as muscle imbalance or nerve injuries. 

This can occur in any age group . 

Overhead arm sports such as swimming, throwing, bowling and racquet sports have a higher risk as do repetitive overhead activities or lifting.

Frozen shoulder – adhesive capsulitis

Frozen shoulder causes pain and stiffness in the shoulder and over time, the shoulder becomes very hard to move. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. 

The shoulder capsule thickens and becomes tight and adhesions develop with reduced synovial fluid. In the early stages  it can be difficult to diagnose.

It develops in three stages and can take between 1-3 years to resolve.

Glenohumeral dislocation 

The most common joint dislocation is shoulder dislocation. This involves the humeral bone moving outside the natural resting position to sit out of its socket. The shoulder can dislocate anteriorly (forwards) or posteriorly (backwards). 

A number of structures may be injured including bony surfaces, glenohumeral ligaments, labrum, rotator cuff tendons or nerves. This usually occurs after trauma. 

Arthritis

Shoulder arthritis is damage to the cartilage inside the shoulder joint and  usually results from gradual wear and tear. The shoulder has two joints. Shoulder arthritis commonly refers to the glenohumeral joint, however the second joint in the shoulder, the acromioclavicular or AC joint, can also develop arthritis. Osteo, rheumatoid, post traumatic and rotator cuff tear arthropathy are the most commonly seen types of arthritis in the shoulder.

Physiotherapy for shoulder pain

Shoulder physiotherapy is able to treat both chronic and acute injuries by reducing discomfort and helping people resume their daily activities, work and sport. In the process, it provides relief from other symptoms such as tingling sensations or loss of strength in the arm muscles.

• Physiotherapy treatments for shoulder pain
• Joint mobilisation & manual therapy
• Activity modification and education
• Stretches
• Strengthening  and restoring muscle balance.
• Pain reducing modalities

Please check our Patient RESOURCES  for more detailed information on shoulder conditions