There are many types of shoulder pain, and like back and neck pain it is something we see a lot of in our clinic.
Sub-acromial impingement can be a very painful condition affecting the shoulder joint. The acromion is a bony shelf forming the roof of the shoulder joint, and the condition's name means that tissues below the acromion can become pinched and then become swollen and sore.
The shoulder is a ball and socket joint and simply put, the ball is held in place by the action of a group of muscles called the rotator cuff. When we lift our arm above our head, the cuff muscles control the position of the humeral head in the socket. If the cuff muscles aren't working properly then the ball can ride up in the socket and cause and impingement.
Sometimes the pain can be mechanical in nature, such as a sharp pain on certain movements. (Patients with this often have a painful arc of movement (which is pain at the range of 90 - 120 degrees of abduction), or if the tissues have been pinched for some time they can become very inflamed, and give lots of pain at rest, especially at night time when lying on that side.
Our physios can make sure that your rotator cuff muscles are working properly, if there is an imbalance in the muscles of the cuff, if one is too tight, or too weak, their synergistic action can be affected and the cuff can become dysfunctional. We also think that upper back flexibility and shoulder blade position can have an effect on the shoulder joint mechanics, so we will check these out too and make sure everything is moving as it should.
If pain is a very big issue we can use acupuncture, if shoulder blade positioning is a problem we use our kinesiotaping techniques, but mainly it's specific exercise therapy that's prescribed for this injury.
If the shoulder is particularly painful we may suggest you have a steroid injection before starting some rehab, and in some (few) cases we may suggest you see a surgeon, as sometimes patients need a sub-acromial decompression (often keyhole)
Frozen shoulder is simply the nickname that has been attached to a condition called Adhesive Capsulitis.
Adhesive Capsulitis refers to a condition in which the shoulder joint capsule (the connective tissue which encases the joint) becomes tight, restricted and inflamed.
As a result the patient is left with a stiff and, often, very painful shoulder.
The cause of this condition is not fully understood. Some patients will develop the problem post trauma or injury, however in many cases it will present without any physical stress or strain. Some research has suggested an increased risk of frozen shoulder in diabetes patients. There is also evidence that suggests it is more prevalent in women and will commonly affect us in our middle age, roughly between the ages of 40-60 years.
The vast majority of patients suffering with frozen shoulder will respond well to Physiotherapy treatment alone. This will often involve an exercise programme and manual treatments focussed on restoring shoulder range of motion.
Occasionally, some patients may also consult their doctor regarding steroid injections to reduce inflammation and ease pain. However, the research suggests that the vast majority of patients will recover within 12-18months of developing the problem, and Physiotherapy remains the most evidenced based way to facilitate a full recovery.
The Rotator cuff is a group of tendons in the shoulder that have a role in stabilising the shoulder and allowing it to move efficiently.
For many years now, we have been using the term tendonitis, meaning pain coming from the tendons caused by inflammation. However, current research has helped to dispel the myth that tendons become inflamed, instead we now know that the tendons become sensitive to being loaded often after some form of physical overloading. (Such has hours of hedge cutting, or painting the ceiling.) It is therefore often referred to as a reactive tendinopathy.
The reason it is important to address this change in the evidence base, is that if our belief is that the rotator cuff is damaged and inflamed, our response is naturally one of rest and avoidance. However, the main purpose of the rotator cuff muscles is to allow us to effectively load through the shoulder. So resting only deconditions the shoulder further and makes it less able and less tolerant of physical stress and strain. A vicious circle.
So, we now know that as Physiotherapists, that we need to help patients to progressively load their shoulder through carefully graded rehabilitative exercise. This is essential, in order to regain strength and function and, of course, to de-sensitise the painful rotator cuff.
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