There are many muscles and joints that work in unison to allow the shoulder perform. If this one of the muscles is injured this causes the shoulder to stop performing correctly and can cause pain.
Common conditions seen in the shoulder are Impingement, rotator cuff tendon problems or tears, shoulder instability and frozen shoulder.
Shoulder pain can also be caused by neck, back, or chronic elbow issues
Impingement or bursitis
is the most common cause of shoulder pain. This condition can be caused from an injury such as a fall onto an outstretched hand, injury to a tendon or muscle near the bursa or even sleeping with your shoulder in a bad position. Impingements are characterised by an inability to lift the shoulder forward or sideways due to pain. This pain is from the tendons in the shoulder being pinched. Usually, this pinching occurs when the arm or the shoulder blade are not sitting in the right place due to an imbalance of the muscles.
Is an overuse injury, resulting in microscopic changes in the tendon. This condition often arises from repetitive stressful activities above chest height or with lots of lifting. These conditions often arise a couple of days after strenuous activity. Acute symptoms are a result of a rapid increase in repetitive activities. This results in pain through movement and activity, and can limit your range of motion.
Rotator cuff tears
Rotator cuff tears are increasingly seen with peolple as their age or physical demands increases. It can be degenerative or acute. Degenerative tears can result from chronic tendinopathy or age related changes. Acute tears result from a high energy injury such as sports, falls or catching something heavy. Rotator cuff tears result in a loss of range of motion, with a constant ache with sharp pain under movement. Pain can be localised to the muscle or tendon itself or may refer lower into the bicep or outside of the upper arm.
Physiotherapy can often help in the recovery of rotator cuff tears, however if the tear is very large, surgery is sometimes required. After surgery, physiotherapy is very important to regain range of motion and strength.
Shoulder Dislocations or Instability (labral Tears)
As the shoulder is very mobile and relies on muscular support to maintain the ball and socket joint alignment, the shoulder is prone to dislocations. This often results from a traumatic injury sustained during sports, falls or car accidents. It can also occur when the is a large force applied to the shoulder when you are in a vulnerable position. Dislocations can also result in labral tears (the lining of the socket side of the joint) which can cause instability (lack of control and repeated dislocations). Following a dislocation, the rotator cuff functions ineffectively and as a result you usually have poor range of motion and pain.
Extensive strengthening will be recommended to ensure there is not a recurrence of dislocations or even further worsening of instability.
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder also known as adhesive capsulitis is a condition characterised by a loss of range of motion in all directions. This condition results in inflammation of the ligaments in the shoulders, causing trauma and scarring leading to stiffness. Those aged 40-60 years of age and women are more affected by this condition. Frozen shoulder lasts between 1-2 years on average and has three stages. The initial stage known as the freezing stage, second stage known as the frozen stage, and finally the third stage known as the thawing stage.
Stage 1 is the most painful stage and results in a rapid decline in range of motion and initial range reduction. Physiotherapy during this stage aims to decrease pain, maintain as much range as able and prevent secondary aggravation of surrounding structures.
Stage 2 is often not painful in the shoulder and has a firm restriction to your range of motion. During this phase physiotherapy is less frequent and aims to keep structures surrounding the shoulder moving effectively.
Stage 3 is where the shoulder begins to free and range starts to return. During this stage physiotherapy is important to ensure you regain full range of motion and extensive strengthening is prescribed. Shoulder muscles have struggled to work for a lengthy period and requires correct patterns to be taught