Shoulder Pain

The shoulder is a very mobile joint allowing a huge range of movement. Shoulder pain can be very frustrating when you get it as we never stop using our arms for even simple day to day tasks.

There are various conditions that can affect the shoulder such as frozen shoulder, rotator cuff tendon problems, impingement and instability. Pain can also be referred from the neck.

• Frozen shoulder is also referred to as adhesive capsulitis. The reason for people to get it is still currently unknown and it normally affects people in their 50’s and 60’s. The main symptoms are that you nor anyone else can lift your arm above your head, or turn your forearm out away from your body (external rotation). It is very painful and then slowly the pain goes and you are left with a ‘frozen’ shoulder. It can take up to 18 months to resolve but symptoms can be eased with treatment.

• Impingement. There are a few different soft tissue structures which sit between the top of the ball and the arch of bone over the top called the acromion. Sometimes these can become painful and this is termed ‘sub-acromial impingement’. Pain typically radiates either down the front or side of the upper arm from the shoulder.

Impingement can typically be resolved by improving the shoulder blade position and movement, as this forms the socket, combined with strengthening of the rotator cuff muscles. 3 research studies have shown little difference between having an operation for this or just completing appropriate rehabilitation.
• Rotator cuff problems - The rotator cuff muscles are 4 muscles which wrap around the head of the humerus (the ball) and ensure it stays centred on the glenoid labrum (the socket). The analogy given for the joint is like a golf ball sitting on a big golf tee. There are a couple of reasons why you may develop pain in these muscle and/or tendons:
• 1. Tears – these can range from a small to medium sized one ( grade I-II), which rehab and your body’s healing process can usually resolve, to a full blown ‘flapping in the wind’ rupture (grade III) which often needs surgery.

• 2. Tendinopathy – please check out our tendinopathy page for more information on tendinitis and all things tendon related.

• Instability. This refers to poor control of keeping the ‘ball’ on the ‘socket’. There are normally two main reasons or a combination of both. • 1) You have dislocated or severely sprained the joint in the past.
• 2) You are ‘hypermobile’ which means that your joints and soft tissues stretch more than the average person.
• Rehab is the key principle for both groups. Surgery sometimes does have a role to play following a dislocation in sporty people, but then it is back to rehab, rehab, rehab!

• Calcific tendinitis – this is where calcium deposits appear in the rotator cuff tendons. It can be extremely painful and may need an injection and/or surgery. The best thing to do is see someone and get an accurate diagnosis so the pain can start to be reduced as soon as possible.

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