Struggling with Shoulder Pain? You’re not alone…

Shoulder pain is one of the most common areas of musculoskeletal pain second only to low back pain. It will affect 30% of the population at some point in their life, and of which 50% of these will experience shoulder pain every year. Shoulder pain can also often be referred to areas away from the shoulder such as the elbow, wrist, chest, back, neck and head. Causes from distal sites may also referral to the shoulder and therefore may not actually be the cause of shoulder pain itself.

Musculoskeletal shoulder pain may occur as a result of damage to local tissues such as to bone, joints, ligaments, cartilage, capsule, muscles, tendons, nerves and bursa. Below are just a few of the most commonly seen conditions seen by osteopaths and physiotherapists:

Subacromial Impingement or SAI

Rotator Cuff Tendinopathy

Frozen Shoulder

Arthritis of Shoulder

Myofascial Trigger Points

Subacromial Impingement or SAI

SAI is a condition where structures passing between two bones; the coracoacromial arch and humerus are compressed. The causes of compression may be due to muscular imbalances of the rotator cuff, a group of muscles that work together to stabilise the shoulder throughout its range of motion. Other causes may involve inflammation to bursa which are fluid-filled sacs providing cushioning between bones and tendons or also due to calcium build up in the tendons resulting from chemical irritation and pressure. This is especially common for those aged 40-60 causing weakness using the arm during elevation and rotating the arm inwards and may cause heat, swelling or redness. There may also be pain turning in bed at night when rolling onto the shoulder and pain may also refer to the elbow and neck.

Self-care advice:

• Cold pack or bag of frozen peas wrapped in a tea towel on the area for 10 minutes on followed by 10 minutes off. Repeat two or three times at a time and twice a day or before or after activity that may have aggravated it.

• Keep movement of the arm within a pain-free range until it heals. No over-head shoulder movements or activities.

Rotator Cuff Tendinopathy

This occurs when there is inflammation or irritation to the tendons of the rotator cuff muscles (supraspinatus, infraspinatus, subscapularis and teres minor). Common causes aredegenerationand excessive overload of the rotator cuff muscles such as people who do repetitive overhead movements such as in sports (basketball, tennis, boxing) or certain occupations (painters and plasterers). There is often weakness using the arm due to pain and can refer down to the elbow, neck, back and neck. Patients with this may experience pain, weakness, reduced shoulder movement. Pain that is aggravated at night especially when rolling onto it and with daily functional activities such as dressing, cooking, cleaning, reaching objects high up on a shelf and many more.

Self-care advice:

• Hot and cold pack 10 minutes of each alternating. Repeat as many times as you like or have time for. Avoid direct skin contact so remember to wrap packs/ hot water bottles/ frozen peas etc in a tea towel to prevent skin burns.

• Use the shoulder joint as much as possible within a pain-free to uncomfortable range to maintain as much function of the rotator cuffs and several other muscles that make up the shoulder complex.

• Basic exercise using a theraband if you have one to hand. Tie to a door handle and use the resistance of the band to stretch and strengthen muscles by moving gently into ranges that you find difficult or painful.

Frozen Shoulder or Adhesive Capsulitis

This is a condition that causes pain and stiffness and is theoretically caused by inflammation of the glenohumeral capsule surrounding the shoulder joint. The most characteristic feature of this condition is a significant or complete loss of external rotation (outward arm movement). The cause of this condition is unknown however, there are certain risk factors which have been known to contribute:

• Females aged 40 and over

• Diabetes

• Heart disease

• Stroke

• Thyroid dysfunction (hyperthyroidism and hypothyroidism)

• Trauma (trips, falls, history of fracture, car accidents even where there has been no direct impact onto the shoulder).

There are three main phases of frozen shoulder:

1) Freezing: A reduction in arm movement and pain occur.

Lasts 2-9 months.

2) Frozen: Increasing stiffness with no changes to level of pain and in some cases reduction of pain.

Lasts 4-12 months.

3) Thawing: An increase in shoulder mobility and reduction in pain.

Lasts 4-12 months.

Self-care advice:

• Use the shoulder joint as much as possible within a pain-free to uncomfortable range to maintain as much function of the all the muscles that make up the shoulder complex.

• Seated rotation exercise to maintain function of your spine is very much integral to shoulder mobility. Sitting down twisting from left to right very slowly and holding each full rotation to get a good stretch into the back.

• Shoulder rolls forwards and backwards 10 times each way.

• Ear to shoulder stretch and hold for 30 seconds each side to reduce tension built up in the neck as a result of increased demand of these muscles due to compensatory movements from the shoulder.

Arthritis of the Shoulder

There is damage to the articular surface of the joint (glenohumeral and acromioclavicular joints primarily) due to wear and tear causing cartilage to wear away causing friction and pain between bones during movement. This often occurs in people aged over 50. In most cases this causes the body to lay down extra bone called osteophytes at the site of damage however, they do not lay down appropriately and cause spurring leading to further pinching of structures and stiffness.

Self-care advice:

• Warm pack or microwave wheat/ lavender bags on the shoulder and keep on as long as needed. Ensure it is not too hot but warm and therapeutic to keep on for a long period of time and avoiding skin burns.

• If you have a bathtub a warm bath with a generous handful of sea salt or magnesium salt that can be found in any health food store.

• Holding a lightweight or household item in your hand (milk gallon, can of soup etc) and swing your arm in circular motions to relieve pressure off the shoulder.

Myofascial Trigger Points

There are several muscles that attach to the shoulder, there are 17 that attach to the shoulder blade (aka scapula) alone! Sometimes with overuse, under use or muscular imbalance; there may be parts of muscle that are held in contraction. This can surprising cause a considerable amount of pain and may referr to other local sites such as the upper arm, chest and back. Anyone is prone to this but especially those with prolonged postural issues (e.g. students and desk based workers).

Self-care advice:

• If you have a bathtub a warm bath with a generous handful of sea salt or magnesium salt that can be found in any health food store.

If you have any further questions on any of the information you have read, or think you may have something similar that either is or is not on this article, please do not hesitate to get in contact to speak with one of our practitioners at Woodside Clinic.