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Shoulder Pain: In a Nutshell

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Anatomy of the shoulder

The shoulder joint is a ball and socket type joint, that has a very shallow bony socket. This is a great feature because it means that we have a large range of motion available to us which allows us to use our arms in almost every direction whether it be above reaching above head height, forwards, across or behind your body.

However there is one downside to this very mobile joint, and that is due to its lack of stability when compared to other ball and socket type joints like our hips, which are very stable but do not have such a large degree of movement available to them.

Shoulder stability

Most of our shoulder stability comes from four muscles (Supraspinatus, Infraspinatus, Subscapularis and Teres Major) which originate from our scapula or “shoulder blade” and come together to form a group of muscles called the rotator cuff. As these separate muscles join together, they overlay the shoulder joint and along with many ligaments, joint capsules and other muscles (biceps and pecs) help provide stability to the joint as it moves through a wide degree of motion.

Why is my shoulder sore / stiff?

Almost 80% of painful shoulders are usually related to the rotator cuff. If your shoulder is painful or aching, you may notice that pain or soreness and can occur when sleeping or lying on your affected shoulder or when lifting your arm above your head you may notice that your shoulder “catches” or has “stiffness / tightness” and aches or is sore in between a certain point of the movement (usually somewhere around the level of shoulder heigh), then gets better as you continue through the range.

My scan says I have: tendinosis / bursitis / a torn rotator cuff.

These are very common findings we see after imaging has been obtained on the shoulder. If you have ever had a shoulder ultrasound or MRI, you may have been told you have a partial / full thickness rotator cuff tear (this is most commonly seen in the supraspinatus muscle). However you don’t need to be alarmed or worried, in fact most people, especially those over 45 years old will also have these findings in their other shoulder which is not causing them any pain at all!

Will I require surgery to fix the tear in my shoulder?

Remember that there is a high likelihood you may have a tear in your non-painful shoulder, this doesn’t necessarily mean that needs to be fixed by surgery. In the event of an acute injury (such as a dislocation or fall onto your shoulder) then your physiotherapist or GP may refer for the opinion of any orthopaedic shoulder specialist, but for those shoulders that have a chronic history where symptoms have been around for a while but may have only recently worsened due to a particular episode or event, then the most likely course of action is conservative physiotherapy treatment which is outlined below.

How do you treat my shoulder pain?

Even in the presence of a tear in one of these muscles, the rest of the rotator cuff (remember the other muscles which join together) is still able to function. Strength exercises for the rest of the rotator cuff is key to improving your function and tolerance for painful aggravating factors.

This is usually recommended for a minimum period of 3-6 months to allow sufficient time for the shoulder to settle down and regain strength before any other treatment options are considered such as cortisone injections.

In the case of a recent flare up of symptoms, the shoulder may be very aggravated, and In order to help settle an irritated shoulder and calm down symptoms your physiotherapist may use a variety of strategies such as;

  1. soft tissue massage

  2. dry needling / acupuncture

  3. taping

  4. joint mobilisation

  5. shoulder specific exercises

In some circumstances your shoulder pain may be related to a neck or upper back issue, so these areas may also be assessed.

What are the first steps I should take?

  1. Book in an assessment with one of our Physiotherapists

  2. Get started on a treatment and exercise program to help settle your irritated shoulder

  3. Complete 2-3 months of progressive loading exercises to build resilience and strong stable shoulders

  4. In the majority of cases, this will be enough to abolish your symptoms get you back to your goals.

Feel free to leave any questions or comments you may have below, or call us on (03) 9841 5777 to speak to our friendly staff regarding any shoulder problems you may have.

REFERENCES:

  1. EDWARDS ET AL (2016.) EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE.

  2. KUHN ET AL (2013). EFFECTIVENESS OF PHYSICAL THERAPY IN TREATING ATRAUMATIC FULL-THICKNESS ROTATOR CUFF TEARS: A MULTICENTER PROSPECTIVE COHORT STUDY.

  3. TEUNIS ET AL (2014). A SYSTEMATIC REVIEW AND POOLED ANALYSIS OF THE PREVALENCE OF ROTATOR CUFF DISEASE WITH INCREASING AGE.