The shoulder joint is a ‘ball and socket’ joint and requires the muscles and ligaments surrounding it to be strong and flexible to provide stability and motion. The main muscles are called the ‘rotator cuff’ muscles. These muscles have tendons to attach to the arm bone, but these tendons travel between bones of the shoulder joint and therefore commonly get pinched or injured, especially the supraspinatus tendon.
This tendon is one of the most injured joints because of its position between the bones.
- Difficulty in raising the arm or carrying objects
- Shoulder pain lasting for more than a few days
- Swelling or significant bruising around the shoulder or arm
- Injury that causes deformity of the joint
- Shoulder pain that occurs at night or at rest, also disrupting normal sleep patterns
CAUSES OF SHOULDER PAIN
Acute Shoulder Pain
A fall onto an outstretched arm or directly onto the shoulder can cause acute pain. If you notice swelling within 8 hours of injury, bruising, specific points of severe pain, deformity, pins and needles or a sudden inability to move the arm, please seek medical advice before attending physiotherapy. Deposits of calcium may appear in the tendon which may cause swelling and tension in the tendon. This can cause a sharp pain.
Chronic Shoulder Pain
Tendinitis (The Painful Arc Syndrome)
- Repetitive use and wear and tear may cause an inflammation in the rotator cuff (esp. Supraspinatus tendon)
- As the tendon becomes sore and swollen, it can become pinched between the two bones.
- The sac of fluid that cushions the tendon can also be damaged.
- Slight swelling may be enough to affect the movement of the shoulder.
- Sideways lifting of the arm is painful, usually in the mid-range 60 to 120 degrees.
- Pain is worse at night and is severe with movements like putting on a jacket or blouse.
- A common condition characterized by pain with significant loss of its range of motion in all directions progressively worsening over a period of time.
- The pain may be worse at night and often radiates to the middle of the upper arm.
TREATMENT OF SHOULDER PAIN
The treatment of shoulder pain depends entirely on the cause of the problem. Therefore, it is important to understand the cause of your symptoms before starting a treatment program.
Your doctor may prescribe some anti-inflammatories and pain-killers, Sometimes an acute pain injections of steroids are given.
A Physiotherapist will make a detailed assessment of your condition and put together a treatment programme for your specific problems. This may include:
- Radial Shockware Therapy: This involves application of very high energy shockwaves to the area to be treated, commonly for chronic rotator cuff tendinitis or frozen shoulder. It increases the circulation to the area thereby increasing body’s healing response, metabolism and thus reduces inflammation. Usually only 3-5 sessions are required.
- Laser: Used for much localised area of pain to reduce pain and increase micro-circulation.
- Taping: Applying adhesive tape to the skin to reduce the strain on the tissues
- Exercise Therapy: Includes muscle stretches to maintain the shoulder movements and strengthening program for the neck and shoulder, to improve overall stability and control
- Interferential Therapy: Electrical current that stimulates the peripheral sensory and muscle nerve fibres to reduce pain and inflammation
- Ultrasound: The application of ultrasonic waves decreases tissue inflammation and reduces pain and swelling.
- Shortwave Diathermy and Moist Heat: To aid in reducing pain and muscle spasm
- Ergonomics Tips and Advice: Advice on improving neck and spine posture to reduce pressure on the various parts of the shoulder.
- Avoid sleeping on the painful side
- If you have sustained an injury, rest and ice therapy will be immediately important. Seek medical advice if you have experienced immediate loss of power, deformity or severe sharp pain after a fall onto an outstretched arm or directly to the shoulder
- One good exercise for all shoulder problems is the pendulum exercise. Stand with your good hand resting on a table. Let your other arm hang down and try to swing it gently backwards and forwards and in a circular motion
- Another good exercise is to use your good arm to help lift up your painful arm to the limit of slight stretch feeling but not a sharp pain.
Frozen shoulder is also known as painful stiff shoulder or peri-arthritis. It usually presents as pain that progresses with time and leads to increasing loss of movement in the shoulder as one often tries to limit the pain by voluntarily decreasing the movement of the shoulder.
- It affects 2-5% of the population.
- It seems to affect mainly the over-40’s.
- It is more common in women. (60%)
- About 15% of people get it on both sides
Inflammation and tightness of the shoulder joint capsule leads to a frozen shoulder resulting in adhesions between your joint’s surface. Synovial fluid, present in the joint space which helps to keep your joint lubricated and moving smoothly, may decrease. Possibe causes may include
- Minor Injury – Overuse or prolonged rest of shoulder, such as after surgery or an arm fracture
- Pain – from Arthritis, Bursitis, or rotator cuff tear
- Risk Factors – Overactive or underactive thyroid, diabetes, stroke or Parkinson’s disease
- Some form of stress or bed rest following illness
- Pain; usually a dull, aching pain over the outer shoulder area and sometimes on the upper arm
- Pain worsens at night, with difficulty in finding a comfortable position
- Limited movement of the shoulder
- Difficulty with activities such as combing hair, putting on shirts/bras, reaching for your wallet in your back pocket
STAGES OF FROZEN SHOULDER
Frozen shoulder typically develops slowly and in three stages:
- Painful Stage – Pain occurs with any movement of your shoulder and your shoulder’s range of motion starts to become limited. This painful stage typically lasts 6-12 weeks.
- Frozen Stage – Pain may begin to reduce during this stage, However, your shoulder becomes stiffer and your range of motion decreases notably. The frozen stage can last 4-6 months.
- Thawing Stage The thawing stage is gradual, and motion steadily improves over a lengthy period of time. The thawing stage can last more than a year.
With Physiotherapy, medication and self-care efforts, most people with frozen shoulder eventually regain nearly full shoulder movement and strength as signs and symptoms improve.
Pain Relief – with Ultrasound or Short Wave or specialised modalities like Cold Laser or Radial Shock Wave Therapy.
Exercise and stretching to restore movement