Shoulder pain can be caused by multiple structures in and around the shoulder joint. Below are a few of the main causes of shoulder pain that we see in clinic.
The rotator cuff refers to 4 muscles that help provide mobility, stability and strength to the shoulder joint. The muscles attach from your scapula to the humerus. These muscles help provide a variety of different movements to the shoulder such as flexion, abduction (reaching out to the side) and rotation such as washing your hair or putting your coat on the back seat of the car.
Injuries to these muscles are common and can happen at any age, although the incidence of injuries does increase as we age. The symptoms can vary but can include pain, limited range of movement and muscle weakness.
Common injuries to the rotator cuff muscles include:
- Imbalance between the muscles – one may be weaker than another or one might be over dominant and cause pain due to the muscle imbalance.
- Tears – this is when there is a tear in one or more of the muscles, which can lead to pain and weakness with certain movements.
- Tendinitis or Tendinopathy – Tendinitis is when there is acute inflammation of one of the rotator cuff tendons and tendinopathy which is when the inflammation has become chronic (3months + duration) or when there is degeneration of the tendon.
- Impingement Syndrome – this is when there is compression of one of the rotator cuff tendons between the acromion (part of the shoulder blade) and a ligament (the coracoacromial ligament). This condition causes pain, which is especially noticeable when the arm is lifted out to the patients side between 60-120 degrees (sometimes referred to as painful arc syndrome).
Osteoarthritis can occur within the shoulder joint, as it can occur anywhere in the body and the symptoms include pain and a reduced range of movement. These symptoms often start gradually as the articular cartilage becomes worn and this can start to affect other structures surrounding the joint- the joint capsule and the muscles. Because these symptoms progress gradually, often people have learnt to adapt to some of the limitations which can start to affect other areas such as the neck, elbow and wrist. Osteopathic treatment can help with these compensations, keep the surrounding muscles stretched and strengthened and help you function as well as possible.
Adhesive Capsulitis (‘Frozen’ Shoulder)
This is an inflammatory condition where the capsule around the gleno-humeral joint becomes fibrosed. This causes pain and gradually a very limited range of movement. The cause of this condition is unclear and often starts for no apparent reason, but both genetics and environmental factors seem to play a role. There are certain conditions such as type 2 diabetes and hypothyroidism that seems to increase the prevalence of this injury.
Patients with frozen shoulders often struggle with day to day activities because the range of movement in the shoulder is so limited. These can include brushing / washing hair, getting dressed and work. Sleep can also become affected which can cause distress to patients.
The symptoms for this condition are consider to be self-limiting (meaning it resolves itself) but the duration of symptoms are usually present for 6 months +. Due to the shoulder having such a limited range of movement, other areas of the body naturally start to help compensate such as the upper back, the neck, the other shoulder etc and osteopathic treatment can help these areas compensate and adapt better.
Referred pain is when we perceive pain in a different location to where the pain is being produced and this can happen in our shoulders. Injuries in our shoulders can produced symptoms down into the arm, wrist and hand and structures in our necks and upper back such as facet joints, disc or inflammation of our rib joints can refer pain around our shoulders. When visiting an osteopath for shoulder pain, they will assess the movement in the neck, upper back, ribcage and through your shoulder blade to see if any of these other areas could be the cause of your symptoms. If the osteopath thinks these areas could be contributing to your symptoms, they will treat the area and help your body adapt and function optimally, helping relieve your symptoms as quickly as possible and to help prevent further injury.
Pain being referred into our shoulders can also be referred from our organs, commonly the gall bladder can cause right shoulder pain and if this is the cause the osteopath will refer you on to your GP.
The aim of osteopathic treatment is to help reduce your shoulder pain and improve the mobility and functionality in your shoulder joint. Our osteopaths use hands on techniques to help alleviate your symptoms, these include articulation and mobilisation of joints and soft tissue techniques to help massage muscles, ligaments and tendons which allows them to work together in a more balanced way. Our practitioners are also trained in Western Acupuncture (dry needling) which is a technique aimed at releasing myofascial trigger points helping muscles relax, be less painful and improve their range of movement. Our osteopaths will advise you on the best exercises to help stretch and strengthen the muscles around your shoulder for both the short and long term management of your symptoms. We will also give you lifestyle advice to help you manage your symptoms on a day to day basis.