Are you experiencing pain in your shoulders?
The shoulder is one of the most complex areas in the body as four joints comprise the shoulder girdle complex: glenohumeral (the ball + socket joint), acromioclavicular (more commonly known as the AC joint), sternoclavicular joint (front), and the scapulo-thoracic joint (shoulder blade on ribs)
In addition, both the neck and upper back are often huge contributing factors in shoulder pain. Therefore, all of these areas must be assessed in order to determine potential areas of dysfunction creating the shoulder pain.
Common Reasons For Shoulder Pain
- Degenerating Rotator Cuff
- Traumatic Rotator Cuff Tear
Degenerating Rotator Cuff, or the “Aging Rotator Cuff.”
As we age (starting approx >40 years), there is a natural, progressive decrease in both muscle fiber size and number – a process called sarcopenia. There is an even greater decrease in muscle force, tensile strength and blood circulation that leads to a diminished ability to repair micro-tears that inevitably occur in an aging tendon. The patient usually describes feeling pain on the upper, outside portion of the arm. This is a common referral location for rotator cuff pain.
“Often asymptomatic (i.e. common and can be present without a mechanism of injury) situations arise when a person is unaware of any dysfunction. As dysfunction progresses though, onset of pain occurs.” – Lisa Sametz, Physiotherapist
Traumatic Rotator Cuff Tear
- A clear mechanism of injury occurs. This entails a sudden, forceful lift/pull; fall onto outstretched arm.
- Different degrees of a tear. Grade 1, 2 and 3 indicate exponentially more tearing. With grade 1 and with most grade 2 partial tears, Physiotherapy is the chosen management tool. With a high grade 2 or grade 3 tear (i.e. rupture), surgery is often needed to repair the tendon. After surgeon clearance, Physiotherapy begins in order to regain mobility, strength and return to pre-injury function.
Impingement in the shoulder is a broad category that can encompass many different involved structures. Some potential structures include supraspinatus, long head biceps and the subacromial bursa (causing a bursitis).
- Quick onset of pain (within 2-3 days), with a limited ability to move the arm out to the side.
- Poor resting posture creating muscle imbalances; poor movement mechanics.
Regular, daily inactivity interrupted by a sudden burst of increased activity can cause impingement signs. For example, a person who has a desk job with a sedentary lifestyle helps a friend move. The move involves repetitive lifting, pushing, pulling and overhead reaching. A deconditioned shoulder is not equipped to take on that amount of activity; therefore acute inflammation surrounds the overused and weak tendons.
Which Category Am I? Is My Shoulder Pain Something Else?
A Orthopaedic Physiotherapist is extensively trained to put together all individual puzzle pieces of information in order to form a well-rounded clinical picture. 3 different clinical diagnoses have been discussed here, but there are endless other conditions your shoulder pain could be in relation to.
Once a thorough assessment has been completed, treatment would likely consist of:
- An individualized home exercise program that is progressed each week in order to address ongoing muscle imbalances.
- Manual therapy that would include mobilization/manipulation of stiff joints in the neck, upper back and shoulder.
- Muscle release techniques such as trigger point release, active soft tissue release and IMS dry needling.
- Education regarding tissue healing timelines, activity modification, self tips and the use of modalities for pain relief.
Several objective tests such as observing movement patterns, special tests, palpation and resisted testing are used to rule in or rule out potential structures at fault. A Physiotherapy assessment will provide a detailed examination in order to decipher the exact source of your shoulder pain.
Written by Lisa Sametz. MScPT, BScPhysiology.