Shoulder Pain

Most people will refer to their ‘rotator cuff’ muscles and usually these muscles and other structures in the shoulder do require attention during treatment. However, sometimes an area further away from the shoulder may not be moving as well, or contributing as much as it should, causing the shoulder to work more than is necessary. It is therefore important to assess the shoulder, along with other areas such as the shoulder blade, upper back, neck, and all associated muscles and nerves, that may be contributing to the shoulder injury to help identify the root of the problem. If any of the above mentioned areas are impacting the shoulders’ ability to recover and heal, then exercises and movements will be given to restore proper function.

Causes of Shoulder Pain

There are a number of reasons why you might be experiencing shoulder pain which include:

•  Osteoarthritis - degenerative wear and tear in the shoulder joints.

•  Poor posture- causing the shoulder to be held in a position causing stress to supporting muscles. This often causes a combination of neck and shoulder pain.

•  Inflamed joint (frozen shoulder)- this is a painful condition that reduces normal movement in the joint and can sometimes prevent movement in the shoulder altogether.

•  Rotator cuff damage – the rotator cuff is a group of supporting muscles that control the shoulder joint and maintain its stability.

•  Shoulder instability (hypermobility)  – where the shoulder may become unstable due to an unusually large range of movement.

•  Acromioclavicular joint disorders – damage to the acromioclavicular (AC) joint, where the collar bone and shoulder blade meet.

•  A broken (fractured) bone, such as the collarbone (clavicle) or upper arm bone (humerus).

•  Shoulder blade pain – this often originates from an underlying rib, so accurate diagnosis is vital.

•  Referred pain from elsewhere- sometimes heart, liver and gall bladder problems can refer symptoms to the shoulders, so a detailed case history is important to establish if the cause is mechanical or medical.

Treating shoulder pain When treating shoulder injury, the osteopath will use techniques that will include soft and deep tissue massage, osteopathic mobilisation, joint manipulations, and active mobilisations where the patient challenges their own body through movements to help restore joint coordination and control. Spinal, rib and shoulder manipulation techniques and acupuncture and ultrasound may be used in order to help maintain proper function. Depending on the cause of your shoulder pain, your osteopath may advise or refer you for other treatments such as;

•  injections of corticosteroids

•  avoiding activities that make your symptoms worse such as throwing

•  using a wrapped ice pack for 5-10 minutes each hour

•  painkillers & anti-inflammatories, e.g. over-the-counter paracetamol or ibuprofen or prescribed diclofenac or naproxen

•  exercises to strengthen your shoulder

•  surgery 

You should see your osteopaths or your GP if your pain is the result of a traumatic injury, it's particularly painful, or there is no sign of improvement after a few days.

Some shoulder pain can be a long-term problem: up to half of people still have symptoms after 18 months. A correct diagnosis will ensure you receive the right treatment and speed up this recovery period.

Common Shoulder Pain conditions

Frozen shoulder (adhesive capsulitis) occurs when there is thickening, swelling and tightening of the joint capsule, which surrounds the shoulder joint. This makes movement stiff and painful.

Frozen shoulder pain and symptoms can vary greatly but tend to advance slowly. They are usually felt in three stages, spread over an average of 18 months.

Most cases of frozen shoulder occur in people aged over 40. The condition is more common in women than in men, but as to the reason why- we are still unsure.

Tendonitis is inflammation (swelling) of a tendon.

Bursitis is inflammation of a bursa. A bursa is a small, fluid-filled sac usually found over the joints and between tendons and bones.

Tendonitis and bursitis often occur together. When the tendons or bursa are trapped between the bones it is often known as "impingement syndrome".

If the tendon is repeatedly scraped against the shoulder bones, it can gradually weaken and will sometimes tear tendon tears are most common in people aged over 40. Tears that affect younger people are usually caused by an accident. In older people, tears are often caused by impingement syndrome.

It is estimated that around half of people over the age of 60 may have partial or complete rotator cuff tears. This is because your tendons become weaker as you get older.

Shoulder instability usually occurs in people aged under 35 and can be either:

•  traumatic – the shoulder is forced out of place by a sudden impact

•  atraumatic – the shoulder gradually moves out of place over time.

•   

Acromioclavicular joint disorders include:

•  tearing or stretching the ligaments in your acromioclavicular joint – usually traumatic or from repetitive use

•  partially or completely dislocating your acromioclavicular joint

•  Osteoarthritic change to the joint through wear and tear.

Acromioclavicular joint disorders are more common in men and those between the ages of 20 and 50.