Shoulder pain is common complaint musculoskeletal physiotherapists often see in their clinics. It can make simple tasks such as reaching into a cupboard, getting dressed or sleeping uncomfortable.
The good news is that shoulder pains can be addressed by a physiotherapist who can pin point the correct diagnosis and provide the most appropriate treatment plan. Understanding the exact cause of your shoulder pain is the first step towards recovery.
Rotator cuff related shoulder pain/Shoulder Impingement
Rotator cuff relates shoulder pain, also known historically as shoulder impingement syndrome is one of the most common causes of shoulder pain. The rotator cuff is a group of 4 muscles which attached to your shoulder where it sits in the socket joint. The muscles work together to stabilise the ball and socket joint as you move your arm up and down.
The common symptoms of shoulder impingement are:
- Pain when reaching overhead
- Pain when lifting objects
- Discomfort and disturbed sleep
- Pain when getting dressed, pulling pants up and fastening bra strap
- Pain when putting hands behind back
Most of these symptoms resolve with physiotherapy.
Frozen Shoulder
Frozen shoulder is a condition that causes pain and progressive shoulder joint stiffness. It commonly effects people between the ages of 40 and 65 years old. It is more common in females and those who have had a trauma or shoulder surgery where there is a period of immobilisation. It can also be quite common in those with diabetes.
The common symptoms of frozen shoulder include:
- Increasing stiffness and loss of shoulder range of movement
- A gradual worsening of shoulder pain with stiffness
- Difficulty with reaching behind your back
- Pain at night
Frozen shoulder progresses through different stages before it improves. Physiotherapy aims to improve shoulder mobility, reduce and manage pain levels and guide you through a safe and evidence based rehabilitation programme. In some cases, injection therapy may be needed to reduce inflammation down and help the physiotherapy treatment process.
Shoulder Bursitis
A shoulder bursitis occurs when the bursa, which is a fluid filled sac between your shoulder and collar bone becomes irritated and inflamed. The function of the bursa is to provide lubrication within your shoulder as it moves. The cause of shoulder bursitis is when there is an increase in over head activities or where there is a weakness within the rotator cuff muscles.
The common symptoms of shoulder bursitis:
- Pain when lifting your arm up
- Pain located on the outside and front of your shoulder
- Constant pain which can be worse at night, disturbing sleep
- Pain when laying on the shoulder at night
Physiotherapy treatment focuses on improving the shoulder mechanics, strengthening the rotator cuff muscles and reducing the irritation.
Rotator cuff tears
A rotator cuff tear occurs when one or more of the 4 rotator cuff muscles become partially or fully torn. Tears occur either from age related changes or from a trauma such as heavy lifting or a fall.
Common symptoms of a rotator cuff tear:
- Pain with weakness when trying to lift your arm
- Unable to reach over head
- Deep pain at night
- Reduced shoulder strength
- Complete loss of function
Many partial tears and some full thickness tears can be managed successfully with physiotherapy by strengthening the deltoid muscles. Having surgery is not always necessary.
Calcific Tendinopathy
Calcific tendinopathy developed when there is calcium deposits that form on the rotator cuff tendons. It presents as severe shoulder pain. It can occur from age related changes or from trauma.
Common symptoms:
- Sudden severe shoulder pain
- Reduced range of movement and difficultly lifting your arm
- Night pain
- Restricted daily activity due to severe shoulder pain
Physiotherapy can help maintain movement and strength as symptoms settle. However, some patients would benefit from ultrasound guided injection therapy either by a physiotherapist or orthopaedic shoulder surgeon.
Shoulder Osteoarthritis
Shoulder osteoarthritis is caused by a gradual wear and tear of the shoulder cartilage and joint. It is less common than knee and shoulder osteoarthritis. It can lead to pain and stiffness effecting daily living and sleep.
Common symptoms:
- Pain during activity
- Morning stiffness after waking
- Reduced shoulder range of movement
- Shoulder joint clicking and grinding sounds and sensations
- Difficulty reaching behind your back
Physiotherapy treatments focus on improving shoulder range of movement, strength and functional independence. Many people achieve significant improvements with physiotherapy input and don’t always need surgery.
When should you see a physiotherapist for your sore shoulder?
You should arrange to see a physiotherapist if:
- Your shoulder pain has lasted more than 2 weeks
- You are struggling with lifting your arm
- Your shoulder pain is keeping you up at night and effecting your sleep
- You are struggling with exercising or doing the things you enjoy.
At Rugby Physio, our experienced physiotherapists provide expert assessment, diagnosis and treatment for all shoulder conditions. Following a detailed clinical examination, we will identify the cause of your symptoms and develop an individual rehabilitation programme to help you return to work, sport and everyday activities as quickly and safely as possible.
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