Common Causes Of Shoulder Problems
At K.M. Woods Physiotherapy, Glasgow, shoulder pain is perhaps the most prevalent condition, alongside lower back pain, that we see in clinic. There are several primary diagnosis which can give rise to shoulder pain and stiffness, and loss of movement.
Rotator cuff pathology
The rotator cuff comprises of a group of muscles around the shoulder which raise and rotate the arm. Often the tendons (which attach the muscles onto the bone) can become irritable under stress. They may also have degenerative changings or tears. It is important to note that tendon tears are often picked up on scans of patients who don’t have shoulder pain, so don’t worry if you’ve been told that you have a tear. Rotator cuff pathologies do not need a specific injury to occur, they can become painful over time for an unknown cause. The distribution and description of pain can vary. A thorough assessment of the shoulder movement and strength will help identify potential contributing factors and design an exercise programme to help you. Strengthening exercises can significantly improve shoulder pain and function even in degenerative and torn tendons, however it is important to start gradually. Your physiotherapist will guide you through the stages of strengthening safely.
Sub-Acromial Pain Syndrome (Shoulder Impingement)
While the term “impingement” is no longer a generally used diagnosis, this condition occurs when the rotator cuff tendon or soft tissues are compressed within the shoulder joint. This is usually felt when raising the arm to shoulder height. Often the pain becomes less severe once the arm is further up towards the ceiling (but not always). This is because the joint space is narrowest when the arm is 90 degrees to the side of your body. Specific tests with help make a diagnosis.
Impingement in the shoulder can occur for many reasons. It may be due to strength imbalance in the rotator cuff muscles, posture or structural changes in bones/soft tissues. Physiotherapy can identify contributing factors and stretching/strengthening exercises can improve symptoms. Strengthening the rotator cuff muscles is a good place to start as long as the exercises are not painful. Sometimes hands-on joint mobilisation techniques are appropriate to gain movement and reduce pain.
A bursa is a fluid filled sac which acts as a cushion in a joint, and they are found throughout all your joints including the ‘sub-acromial space’ which is in the shoulder. Bursitis happens when the bursa becomes inflamed and painful. This could be a cause of impingement (see above) but often the pain will be more constant and irritable to movement when severe.
Symptoms should improve with anti-inflammatory medicaiton and gentle exercises:
Lean forwards letting the affected arm hang down, and gently swing the arm forwards and backwards as pain allows. If tolerated rock the arm side to side and then progress to small circular motions. Sometimes holding a heavy weight will help as it will create some traction on the joint.
Often shoulder pain can be distributed down the outside of the arm as far as the elbow, but when pain goes beyond the elbow into the hand it may be more likely that the pain is coming from a nerve that originates from the neck. Nerve pain is usually described as sharp, shooting or a burning sensation. Often there may be numbness and/or pins and needles in the arm (commonly in the hand).
The nerve could be impinged at the neck or within the shoulder complex. A physiotherapist can help identify the source or nerve irritation and relieve symptoms with a combination of joint mobilisation/soft tissue techniques and exercises.
- Chin tucks: Either sit/stand or lie down if pain is severe – gently move the head backwards while keeping the chin tucked in. If you are lying down push the head back into the pillow. Hold for 10sec and relax. Repeat up to 5-10 times, regularly through the day.
- Shoulder squeeze: Squeeze the shoulders back as if trying to get the shoulder blades to touch and repeat regularly
- Posture: Sitting at a computer or laptop can lead to postures that aggravate nerve pain. Avoid lengthy periods using a laptop, as a raised desktop screen will prevent a head down posture. Sit close to your desk, avoid poking your chin forwards and keep your elbows under your shoulders while you type.
Please call us on 01413530906 today, to book an appointment across any one of our 4 clinical sites (Glasgow West End, Clarkston, Newton Mearns, & Kirkintilloch), or to request a call back from one of our physiotherapy staff members to discuss whether physiotherapy could be of benefit to you.