INTRODUCTION
Shoulder is a ball-and-socket joint. The round end of the upper arm bone fits into a shallow groove in the shoulder blade. Articular cartilage covers the joint surface. Labrum, a tough fibrous tissue stabilises the joint. The bones of the shoulder are connected by ligaments.
The main supports of the joint are the tendons of the surrounding short muscles known as the rotator cuff muscles. At the upper part of this cuff lies the supraspinatus tendon which travels under the bone on the outside of the shoulder.
This tendon is the one most often injured because of its position between the bones.

Causes of Shoulder Pain
Acute Shoulder Pain
Deposits of calcium may appear in the tendon which may cause swelling and tension in the tendon. This can cause a sharp pain.
Chronic Pain
Tendinitis (the painful arc syndrome)
Repetitive usage and wear and tear may trigger an inflammation in the rotatorcuff (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.
Swelling though slight, 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 usually worse at night and is severe on attempting movements like putting on a jacket or a blouse.
Frozen shoulder
Frozen Shouldeis 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 with difficulty in finding a comfortable position during sleep. It often radiates to the middle of the upper arm.

Shoulder Pain Symptom

Difficulty in raising the arm

Shoulder pain lasting more than a few days

Swelling or significant bruising around the shoulder or arm

Signs of an infection, including fever, redness, warmth

Inability to carry objects or use the arm

Injury that causes deformity of the joint

Shoulder pain that occurs at night or while resting ,sometimes disrupting normal sleep patterns.

TREATMENT
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.
Medical help
Your doctor may prescribe some anti-inflammatories and pain –killers. Sometimes with an acute pain Injections of steroids are given.

Physiotherapy
A physiotherapist will make a detailed assessment of your condition and put together a treatment programme for your specific problems. This may include:
Radial Shockwave 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 3-6 sessions are required.
Laser: used for much localised area of pain to reduce pain and increase micro-circulation.
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 Diathermyand moist heat: To aid in reducing pain and muscle spasm.
Exercise therapy: Includes muscle stretches to maintain the shoulder movements and strengthening program for the neck and shoulder, to improve overall stability and control.
Ergonomics tips and advice: Advice on improving neck and spine posture to reduce pressure on the various parts of the shoulder.
Taping: Applying adhesive tape to the skin to reduce the strain on the tissues

USEFUL ADVICE

Avoid sleeping on the painful side.

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.

Experienced physiotherapists in Singapore, with over 18 years of experience, help you to get relief from pain/weakness quickly and easily. You can book an appointment to see our Senior Physiotherapist. We are located right in the heart of Singapore, at Orchard, and are available Mondays through Saturday.