Shoulder pain is something we often see as physiotherapists. It is even estimated that up to 70% of people will develop shoulder pain in their lifetime. This type of pain can be very debilitating, affecting many daily activities.
A Brief Anatomy
The shoulder is a complex joint which allows mobility of the upper limb. Three bones make up the shoulder joint – the humerus (upper arm bone), the scapula (shoulder blade) and the clavicle (collarbone).
It comprises of the glenohumeral joint, where the humerus (upper arm bone) connects to the glenoid (socket part of shoulder blade), and the acromioclavicular joint (AC joint), where the collar bone connects with a part of the shoulder blade called the acromion.
The glenohumeral joint is supported by the labrum, which is a rim of cartilage, and other ligaments. The rotator cuff, which comprises of 4 muscles – supraspinatus, infraspinatus, teres minor, and subscapularis also provides stability and support.
Rotator Cuff Related Shoulder Pain
Rotator cuff related shoulder pain (RCRSP) is a very common type of injury in the shoulder. In fact, up to 80% of shoulder pain will involve the rotator cuff, and it is something we see very often. RCRSP is an umbrella term for other conditions such as sub-acromial bursitis, sub-acromial impingement, rotator cuff tendinopathy or rotator cuff tear. These conditions cause similar types of pain and have similar effects on function.
Overloading the shoulder, traumatic injuries, stress, and age can all be contributing factors to developing RCRSP.
People with this type of injury may have pain and weakness with certain shoulder movements such as when lifting their arm up to hang out the washing.
Fortunately, physiotherapy has been shown to be very helpful in treating this type of pain.
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain of the shoulder joint. This injury results in inflammation and eventual fibrosis around the shoulder joint which can result in significant movement reduction and pain.
People at a higher risk tend to be 40-65 years of age, and may also have thyroid disease, diabetes, autoimmune disease, or have had prolonged immobilisation of the limb. Further, this condition seems to affect women slightly more than men.
Symptoms can include intense shoulder pain, particularly at night, and restriction in movement. Later on, stiffness in the joint can set in causing greater movement reduction while the pain often improves slightly.
Frozen shoulder can have a large variation in how long it may affect someone. It may take up to 1-3 years for most symptoms to resolve. Fortunately, large improvements in movement and function can be made relatively early on. Therefore, it’s important to get timely assessment and treatment to maximise the amount of improvement.
Unstable Shoulder (shoulder dislocation or subluxation)
An unstable shoulder can be defined as excessive movement at the shoulder joint. This can manifest as pain or a sense of fear or apprehension of potential excessive displacement.
Injuries involving an unstable shoulder can be traumatic, which may be from sporting injuries, motor vehicle collisions, or a fall. Those at a higher risk for a traumatic unstable shoulder tend to be male, participate in contact sports, or have a previous history of shoulder dislocation on either side.
These injuries can also be non-traumatic and may be from other conditions that involve hypermobility of certain joints, such as Ehler’s Danlos syndrome.
These different types of shoulder conditions, as well as some other conditions, can all have different treatment techniques and healing timeframes. It is important to have a thorough diagnosis so your pain can be correctly managed. If you feel you need assistance with your shoulder pain, head over to our Fix Your Pain page so one of our physios can help get you on the road to recovery!