Shoulder Pain is most often caused by a traumatic incident(i.e. heavy lifting, overhead lifting, fall). However it may occur without significant trauma (light weight repetitious lifting, awkward lifting, computer work, slouching, poor sleeping posture, muscle imbalance).The shoulder joint is anatomically unstable and relies on the strength of the muscles of the shoulder and shoulder blade. In most shoulder conditions these muscles are weak, uncoordinated or out of balance. Rotator Cuff Syndrome (RCS) is the most common shoulder injury. RCS usually refers to injuring the supraspinatus tendon but may involve the other muscles.
These tendons are vulnerable to overloading and degeneration due to their small size, high usage and poor vascularity.
Inflammation plays a big role in shoulder conditions and must be well controlled.
Shoulder pain is usually caused from one of the following:
- Joint Trauma (cartilage damage (articular or labral), boney damage)
- Nerve irritation (superior scapulae, brachial plexus, neuritis)
- Joint and Muscle Degeneration (cartilage damage, bone degeneration, arthritis)
- Joint stiffness (postural or pathological)
- Scapulo-thoracic Dysfunction
- Muscle or Ligament Tears / Spasm (AC ligament, SC ligament, Capsular tear)
- Bursitis with or without impingement
- Acromioclavicular or Sternoclavicular Joint dysfunction
- Glenohumeral, Humeral, Scapulae Fracture
If your shoulder hurts, don’t ignore it. Physiotherapists are well trained to give an accurate diagnosis and treatment the problem. We can refer for MRI, CT, X-ray, Ultrasound or blood test as required.
We are able to provide a proven, safe and effective treatment.
Physiotherapy Aims
1) Treat the pain and other symptoms
2) Help identify the causes to prevent recurrence and
3) Provide self-management strategies
Treatment: Strong Evidence in Literature
1) Specific Shoulder strengthening and general exercise programs
(Glenohumeral and Scapulae-shoulder blade stabilisation)
2) Mobilisation, Manipulation and Hands On Therapy
(Manipulation is traumatic and should only be used for certain conditions)
3) Acupuncture / Dry Needling
4) Electrotherapy (TENS)
Treatment: Others
1) Postural Modification
(posture brace, taping, body awareness exercises)
2) Hydrotherapy (great supportive environment)
3) Supportive Taping / Bracing
4) Use of Gels, Creams, Hot & Cold
Shoulder pain is very individual due to the large number of structures and factors that contribute to your condition. What works for others may not work for you and you will have to trial various treatments under the guidance of your Physiotherapist to find what works for your particular condition.
In young athletes with RCS the supraspinatus tendon is normally inflamed due to repetitive overloading of an imbalanced or unstable shoulder.
In the elderly the supraspinatus tendon is normally degenerative and a secondary inflammatory reaction is present in the surrounding tissues.
Both have impingement pain where physiotherapy can provide relief and rehabilitation.
The shoulder blades static and dynamic function influences the stress on the rotator cuff and its predisposition to impingement. A poorly moving shoulder blade means the rotator cuff muscles have to work harder.
Scapula function is affected by:
(1) Spinal dysfunction e.g. postural changes.
Physiotherapists may mobilise, manipulate teh spine and re-educate
posture using exercise programs.
(2) Muscle tightness e.g. pectoralis minor leading to scapula protraction.
Physiotherapists may massage and stretch to treat muscle tightness.
(3) Scapula stabiliser weakness e.g. poor lower trapezius control.
Physiotherapists can help to retrain and strengthen this area by prescribing
specific exercises.
(4) Capsulitis is also a relatively common shoulder complaint. research shows this condition responds well to a combination of anti-Inflammatories and specific local techniques such as massage, mobilisation and capsular stretches.
AHCN 