So you have shoulder pain?
Here in Sydney Physiotherapy Solutions one of the most common areas that we treat is the shoulder. The shoulder is one of the most complex joints in the human body and is made up of a number of different structures including joints, a joint capsule, muscles and ligaments that all work together to help stabilise the joint and prevent injury. If one or more of these structures become injured we then run into problems and this is when you may start to experience pain and/or instability. Below I have discussed some of the most common conditions that we see in the clinic. If any of these conditions sound familiar, book in for a comprehensive assessment by one of our highly skilled Physiotherapists today.
Common shoulder conditions:
Rotator Cuff Injuries
What is the Rotator Cuff?
Your rotator cuff is a group of four muscles that holds the main arm bone (humerus) snuggly into its socket. These muscles provide most of the stability for your shoulder joint, and therefore if they get injured it can be a significant problem.
What is a Rotator Cuff strain or tear?
A rotator cuff strain or tear can either occur acutely, through a sudden movement or force on the shoulder, or alternatively, they can become injured over time due to poor posture or a strength imbalance in your rotator cuff muscles. Find out more about Rotator Cuff tears here.
What does a rotator cuff tear feel like?
If you have injured your rotator cuff you will usually feel pain radiating down the top portion of your arm, but not often below your elbow. It is often sore with reaching movements or lifting your arm upwards, or with movements that need your shoulder to rotate such as putting your jacket or bra on.
How is a rotator cuff tear treated?
The good news is most of these injuries can be fixed with some treatment and a strengthening program that builds up over several weeks. Like all muscle injuries, the strengthening component is the most important as this will be the main factor in preventing re-injury or further damage.
How long will it take to fix a rotator cuff tear or strain?
This will usually take about 4 to 6 weeks however if the injury has been hanging around for a long time, then the recovery time is usually longer as well.
What is Subacromial Bursitis?
The subacromial bursa is a fluid-filled sac that lies below the acromion (shoulder blade) and works to prevent friction in the shoulder space. If the shoulder is injured this sac will fill with more fluid and can cause pain. This is because it then presses on the other muscles and ligaments of the shoulder and causes a condition known as “Impingement.” Bursitis is usually seen in combination with other shoulder injuries and your Physiotherapist can carry out further tests to identify this. If you are suffering with subacromial bursitis symptoms will include a gradual onset of pain on the outside of the shoulder and down the arm and pain with overhead movements.
How is Subacromial Bursitis treated?
This condition can be fixed with a course of Physiotherapy over a period of approximately 6 weeks. The aim with Physiotherapy is to address the cause of the inflammation and prevent it from recurring. Treatment options include strengthening based exercise programmes and postural re-training.
What is Frozen Shoulder?
Another common shoulder condition is Adhesive Capsulitis or Frozen shoulder. The lining of the shoulder joint becomes inflamed and gradually this area thickens making the shoulder stiff and painful to move. Although the exact cause of this condition is unknown it has been found to be common between 40-60 year olds and is more common in women. It limits movement in all directions and the shoulder can feel “stuck.” There are three clear stages with this condition including the painful, frozen and thawing stage.
How do you treat frozen shoulder?
Although this condition will eventually correct itself in a period of up to two years a detailed assessment by a Physiotherapist can correctly diagnose this condition and can set you up with a programme to prevent further stiffness whilst maintaining range of movement and strength. Unfortunately, frozen shoulder is one of those conditions where time is the main factor and there is very little evidence that conservative treatment can speed up this process.
What is Shoulder Instability or Dislocation?
As we discussed previously the shoulder is a ball and socket joint that allows a wide range of movement. The ball of the humerus is meant to stay close to the socket with the help of ligaments, muscles and the joint capsule. If these structures do not work properly the joint may slide partially out of place (subluxation) or it may even come completely out of place which is known as a dislocation.
What are the symptoms of shoulder instability?
Symptoms of these conditions include pain, a persistent sensation of the shoulder feeling loose or unstable, a dead arm feeling in the upper arm or repeated instances of the shoulder giving way.
How is shoulder instability treated?
A thorough treatment plan from a Physiotherapist will work to strengthen and increase the stability of the shoulder joint through specific exercise programmes. The exercises will be targeted at the rotator cuff muscles to strengthen them and increase the stability of the shoulder joint. The Physiotherapist will also introduce specific functional exercises to address the stability at all angles for your chosen sport, for example, overhead work for tennis.
What is a Labral Injury?
Another cause of shoulder pain, especially in overhead athletes, is a labral injury. The labrum is a soft fibrous tissue rim that surrounds the socket helping to stabilise the joint. The labrum helps to deepen the socket by up to 50%. Injuries to the labrum can occur from acute trauma such as a fall onto an outstretched arm or as a result of repetitive overhead shoulder motion. Symptoms are similar to those of a dislocation. They include a sense of instability, pain with overhead movements, decreased range of movement and loss of strength.
Can a labral injury be fixed?
A detailed examination by your Physiotherapist can help to diagnose a labral injury. They will then set you up with a strengthening programme to increase the stability of the shoulder joint through exercise and strengthening plans.
Acromioclavicular joint pain
What is Acromioclavicular joint pain?
The Acromioclavicular joint is another joint at the top of the shoulder between the acromion (shoulder blade) and the clavicle (collarbone). It helps with overhead movements and movements across your body. Injuries to this joint can occur acutely such as falling onto an outstretched arm or it can also occur over time through joint degeneration and the development of arthritis. Symptoms of AC joint dysfunction include pain at the top of the shoulder and pain with overhead or across body movements. Pain is normally very localised to the top of the shoulder.
With Physiotherapy, the aim of treatment is to reduce the inflammation in the joint, increase the strength of the surrounding muscles and restore overhead movements. It usually takes around 6 weeks to recover from an injury to the AC joint. Without Physiotherapy you risk further damage to the joint, so better to get it checked and sorted before the problem gets worse!
Referred pain from the neck and shoulder
Outside of the shoulder joint, there are other structures which can also refer pain to the shoulder and upper arm. A common referral pattern that we see in the clinic is pain around the shoulder joint that is actually referred from the neck or thoracic region. The nerves from the cervical spine supply the rotator cuff muscles and if there is an injury to the neck, symptoms can be felt in the shoulder or upper arm. There are also certain thoracic conditions including thoracic outlet syndrome that can also cause pain in the shoulder and arm. Symptoms from the neck include neck stiffness when turning your head and pain on palpation of the discs in your neck.
A detailed assessment by a Physiotherapist can help to differentiate if the pain is coming from the shoulder or the spine. Luckily treatment can usually resolve this pain in a period of approximately 4-6 weeks. The treatment for this condition focuses more on increasing the neck and back range of movement through the use of both manual and exercise therapy. The physiotherapist will also give you an exercise-based programme to strengthen up the postural muscles that support the spine and the shoulder joint helping to alleviate any symptoms.
These are just a small number of common conditions that affect the shoulder joint. Luckily here at Sydney Physiotherapy Solutions we have been highly trained in assessing and treating all of these. If any of these conditions sound familiar or you would like some further information or shoulder physiotherapy then call us now on 02 9252 5770 or book an appointment online to see one of our skilled Physiotherapists for a detailed assessment.