Shoulder Pain | Is it Shoulder Impingement? | Physiotherapy

Shoulder Pain

What is shoulder pain?

The shoulder has an extensive and versatile range of motion. When something goes mistaken with your shoulder, it hinders your ability to move freely and can cause a lot of pain and discomfort. The shoulder is a ball joint that has three main bones: the humorous (long bone in the arm), the clavicle (clavicle), and the scapula (also known as the shoulder blade).

These bones are protected by a layer of cartilage. There are two main joints. The acromioclavicular joint is located between the highest part of the scapula and the clavicle. The glen humeral joint is made up of the ball-shaped top of the humorous and the outer edge of the scapula. This joint is also recognized as the shoulder joint.

The shoulder joint is the maximum movable joint in the body. Roll your shoulder back and forth. It also allows the arm to move in a circular motion and move up and away from the body. The shoulders get their range of motion from the rotator cuff.

The rotator cuff is made up of four ligaments. Ligaments are the tissues that connect muscles to bones. It may be painful or difficult to raise your arm above your head if the tendons or bones around the rotator cuff are damaged or swollen.

You can injure your shoulder while doing manual labor, playing sports, or even through repetitive movements. Certain diseases can cause pain that spreads to the shoulder. These include diseases of the cervical (neck) spine, as well as diseases of the liver, heart, or gallbladder.

You are more likely to have shoulder problems as you age, especially after age 60. This is because the soft tissues around the shoulder tend to degenerate with age. In many circumstances, you can treat shoulder pain at home. Though, physical therapy, medications, or surgery may also be necessary.

Types of shoulder pain

Rotator cuff injury and impingement

Rotator cuff injuries are the most common cause of shoulder pain in people over the age of 30. The pain that originates in the rotator cuff is usually of two types: inflammation and tears.

Rotator cuff inflammation, also known as rotator cuff tendonitis or rotator cuff tendinopathy, is when the rotator cuff muscles become irritated, swollen, or painful. Sometimes it is due to the rotator cuff getting caught between the humerus and a bony outcrop called the acromion process, which is an impingement of the shoulder.

A rotator cuff tear can be partial, or it can tear completely in two or detach from the bone, and it can be caused by injury or overuse.

Treatment

Tendonitis and impingements can usually be treated non surgically. Treatments include:

  • Resting the injured shoulder
  • Ice
  • Anti-inflammatory drugs
  • Corticosteroid injections
  • Physical therapy

Partial rotator cuff tears can also be treated conservatively, using the modalities listed above. Complete tears may need to be repaired surgically. At Summit Medical Group Orthopedics, rotator cuff repair surgeries are performed arthroscopically at any time possible due to faster medicinal times and less trauma to the shoulder.

Shoulder strain

A strain is an injury to a muscle. In the shoulder, the deltoid or one of the rotator cuff muscles may be tight. Bicep, tricep, and pectoral strains can sometimes be felt in the shoulder area as well.

Treatment

Shoulder strains are usually temporary. They are usually treated with rest, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy.

Shoulder arthritis

Osteoarthritis is the most communal form of shoulder arthritis. Also known as wasting arthritis, it is the breakdown of the cartilage that surrounds the ends of the bones in a joint. This tissue, called articular cartilage, allows the bones in a joint to slide smoothly against each other.

Treatment

Arthritis cannot be cured, only controlled. An active lifestyle and regular physical therapy are two of the best ways to prevent shoulder arthritis from interfering with your life. If you have end-stage osteoarthritis, since there is no cartilage left and the bones are grinding, a shoulder replacement may be an option for you.

Labrum tear

Labrum tears are injuries to the lining of the glenoid cartilage.

Treatment

Conservative treatment, including rest, ice, and physical therapy, is typically enough for most labral tears. Surgery, called debridement, is the last resort treatment. Debridement will likely be performed arthroscopically

Causes of shoulder pain

  • Several factors and situations can add to shoulder pain. The most common cause is rotator cuff tendonitis.
  • This is an illness characterized by swollen ligaments. Another common cause of shoulder pain is impingement syndrome in which the rotator cuff becomes trapped between the acromion (part of the scapula that covers the ball) and the humeral head (the ball portion of the humerus).
  • Sometimes shoulder pain is the result of an injury to another part of the body, usually the neck or biceps. This is known as referred pain. Referred pain is usually not worse when you move your shoulder.

Other causes of shoulder pain include:

  • Arthritis
  • Torn cartilage
  • Torn rotator cuff
  • Swollen bursa sacs or tendons
  • Bone spurs (bony predictions that improve along the edges of the bones)
  • A pinched nerve in the neck or shoulder
  • Shoulder or arm fracture
  • Frozen shoulder
  • Dislocated shoulder
  • Injury due to excessive or repetitive use
  • Spinal cord injury
  • Heart attack

Cause of diagnosed shoulder pain

Your doctor will want to find out the reason for your shoulder pain. They will ask for your medical history and do a physical exam.

They will notice tenderness and swelling and will also assess your range of motion and joint stability. Imaging tests, such as an X-ray or MRI, can produce detailed images of your shoulder to help with the diagnosis.

Symptoms of shoulder pain

There are many reasons for shoulder pain and they all have their own unique set of indications.

Dependent on the cause of your shoulder pain, you may experience:

  • Deep pain in the shoulder joint, in the back or front of the shoulder, and in the upper arm. Sometimes shoulder pain can be described as “grip pain.” The location and type of pain are likely related to the structure causing the pain
  • reduced movement and pain when moving the shoulder.
  • shoulder/arm weakness. Liable on the condition, there may be a sensation of the joint sliding out and into the joint hole, or the shoulder may become dislodged (dislocated) entirely.
  • Tingling (tingling) sensation and burning pain. This is more likely to be associated with the nerves in the neck than with the shoulder joint.
  • lack of movement after a shoulder dislocation. This is usually due to pain. Complete rotator cuff tears and axillary nerve injury cause weakness by pulling the arm away from the body. These problems require a careful clinical examination.

Treatment options for shoulder pain

Handling will depend on the cause and severity of the shoulder pain. Some treatment options include physical or professional therapy, a shoulder sling or immobilizer, or surgery.

If your shoulder pain does not improve with simple home treatments, there are other alternatives that your doctor may recommend that you try:

  • Physiotherapy
  • Occupational therapy
  • Steroid injections
  • Surgery
  • Shoulder pain diagnosis
  • Each shoulder problem has its own pattern of symptoms that can help your doctor or physical therapist make a diagnosis. Most circumstances make it painful to use or move your shoulder, but some make it feel stiff.
  • Blood tests are not usually necessary for most shoulder problems but are sometimes used to rule out other conditions, including some types of arthritis.
  • X-rays are good at looking for shoulder bone problems and minor joint changes. However, small changes are quite common and may not be the cause of your problem.
  • X-rays can only show bones and other hard substances, but will not show soft tissue injuries such as muscles.
  • An ultrasound may show swelling, as well as damage and problems to the tendons, muscles, or other soft tissues in the shoulder. It uses high-frequency sound waves to examine and create images of the inside of the body.
  • You may be referred for an MRI if your doctor suspects a more complex problem with the soft tissue in your shoulder. An MRI uses radio waves to create an image that shows what is happening to the bones and soft tissues, such as muscles and tendons, inside your shoulder.
  • Sometimes a dye is injected into the shoulder before the MRI to get a clearer picture, especially in cases of shoulder dislocation.
  • Nerve conduction studies can show if your problems are due to pinched or irritated nerves in your arm.
  • They measure electrical activity in muscles and nerves. It is common to feel slight pain or discomfort, such as a tap on the skin, but the test does not last long.

Prevention of shoulder pain

Simple shoulder exercises can help stretch and strengthen the muscles and tendons of the rotator cuff. A physical therapist or occupational therapist can show you how to do them correctly.

  • If you’ve had shoulder problems in the past, use ice for 15 minutes after exercising to prevent future injury.
  • After having bursitis or tendonitis, doing simple range-of-motion exercises every day can prevent your shoulder from freezing.

Risk factors for shoulder pain

Shoulder impingement is a condition that causes pain and a pinching sensation in the shoulder. It can also reduce a person’s range of motion. Anyone can get a shoulder impingement, but people with certain risk factors are more likely to develop it.

  • Excessive use
  • Acromion curved or hooked
  • Prominent coracoids.
  • Instability of the shoulder
  • Bone spurs
  • Calcification of the coracoacromial ligament
  • Poor posture
  • Age

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