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Common Causes of Shoulder Pain

Updated: Apr 5, 2021

It is estimated that over two thirds of us will experience shoulder pain at some point in our lives. This post explores three of the most common problems that cause pain and limited movement, and the role of physiotherapy in your recovery.

Frozen Shoulder

A frozen shoulder occurs when the capsule which lines the shoulder joint becomes inflamed and painful. This causes the normally flexible capsule to lose it’s normal elasticity, which results in a reduction of shoulder movement and pain. Frozen shoulder is more common in women over the age of 50 and there is some evidence which suggests it is associated with certain conditions including heart disease and diabetes.

Frozen shoulder can sometimes occur after a trauma, but often will develop without an obvious cause. It tends to be characterised by three phases: pain, followed by a period of stiffness, then a ‘thawing’ phase as the movement improves and pain subsides. Treatment of frozen shoulder will depend on the severity and duration of pain and stiffness. Surgery can involve a release of the capsule or a manipulation of the shoulder under anaesthetic to improve movement. Other options include a hydrodilatation procedure which involves injecting a volume of fluid into the shoulder to stretch the capsule and anti-inflammatory injections. Physiotherapy can be helpful maintain mobility and strength.

Shoulder Impingement

Shoulder impingement occurs when structures in the shoulder become rubbed or compressed, causing pain. Impingement pain is characterised with pain with overhead movement and reaching behind the back. The image below shows the structures that are commonly involved in shoulder impingement. This bursa is a fluid filled sac that allows for smooth gliding of the rotator cuff under the acromion with movements of the arm. The rotator cuff tendons (e.g. Supraspinatus) can also become compressed or rubbed in the narrow space under the acromion.

Surgery tends not to be required for pain resulting from shoulder impingement and it should respond well to progressive resistance training which can be provided by your Physiotherapist. It’s helpful to have a thorough assessment to identify the cause of the impingement, which can be associated with altered movement patterns and muscle recruitment at the shoulder. Sometimes injection therapy can be considered if you are unable to complete your rehabilitation exercises because of pain.

Calcific Tendinopathy

This is one of the most painful conditions at the shoulder. It involves a build up of calcium in the rotator cuff tendons of the shoulder. This irritates the tendon and causes pain. It also reduces the amount of space for the tendon and can cause a secondary shoulder impingement. It can present in a similar way to shoulder impingement, but it can be differentiated on an ultrasound scan of the shoulder, and larger calcium deposits can be seen on a plain x-ray. Treatment will normally involve a course of physiotherapy to improve the movement patterns of the shoulder to reduce impingement. If this is unsuccessful then surgery can involve increasing the amount of space between the acromion and the tendons and the removal of calcium deposit.

Physiotherapy for Shoulder Pain

Physiotherapy is a key part of the management of shoulder pain. We have explored just a few of the more common causes of shoulder pain here, but a comprehensive assessment will provide a clearer diagnosis which will guide your treatment. This will normally involve a combination of hands on treatment and exercise therapy. These two strategies are designed to normalise the muscle recruitment at the shoulder to reduce the pressure on the pain -causing structures. Resistance exercise has been shown to be of particular benefit for shoulder pain, but needs to be individually prescribed to ensure it is both appropriate and correctly performed for the best outcomes. Your Physiotherapist may also consider other adjuncts like taping and acupuncture to help improve your pain. Get in touch here to find out more!

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