Unpacking the causes of shoulder pain

The shoulder joint is the most mobile joint in the body and provides the base of all movements for the hand and upper limb. To give the shoulder such mobility, it is formed by a ball and socket joint known as the glenohumeral joint, which is comprised of the upper arm (humerus), shoulder blade (scapula) and collarbone (clavicle). To allow for the mobility, there is less bony support and it relies on a combination of strong ligaments and capsule, as well as dynamic muscle support from a group known as the rotator cuff. Due to the amount of movement and force that it has to put up with, it is no wonder your shoulder can become sore.

Shoulder pain can be classified into two main categories: acute specific incident and gradual onset/overuse.

 

Here are a few of the more common causes we treat at Life Ready Physio:

 

Acute injuries to shoulder are usually a result of trauma or excessive force placed on the joint

 

Shoulder dislocation

Dislocation of the shoulder joint/glenohumeral joint occurs when the arm bone pops out from the shoulder socket. This most commonly occurs during a heavy fall onto the arm or during contact sports such AFL or rugby. In some cases, the tissues and muscles supporting the joint can be torn as well due to the trauma and it is possible for fractures to occur in the socket or arm bone.

It is important not to attempt to relocate the shoulder by yourself, but to rather attend your nearest emergency department. Once relocated, the shoulder will initially be in a sling followed by an extended period of of 3–4 months of intensive exercise rehabilitation.

 

ACJ pathology

The acromioclavicular joint is where the collarbone meets the shoulder blade. Injuries to this area are commonly the result of an impact, such as a direct blow or post a fall. Common injuries include partial dislocations, dislocation and fractures. The resultant symptoms are pain, swelling and restricted mobility. If it’s a mild injury it can be treated with RICE — rest, ice, compression and elevation. Once initial symptoms have settled, a structured rehabilitation program is required (Physio for shoulder pain) to allow for return of full mobility, strength and function.

 

Brachial Plexus Pain

The brachial plexus is a group of intertwined nerves that begin at the neck and extend through the upper chest to the armpit and run all the way down into the hand. An acute injury is caused by an acute stretching or compression, which is often seen in rugby and can be called a ‘stinger’ injury. Symptoms include neck pain, an electric shock or burning sensation, as well as pins and needles and numbness down the arm.

Gradual onset and overuse injuries are usually linked to those tasks we do at home or work that require repetitive movements or positions. Pain can arise if we perform these activities or positions in awkward postures.

 

Shoulder impingement

This ailment occurs when the structures in the space between the collarbone and upper arm get sensitised, causing shoulder pain and disability. The symptoms are related to repetitive overuse of the arm and are usually due to poor technique or poor muscle control and strength of the rotator cuff and shoulder blade muscles. Treatment is focused on first settling symptoms and then followed by improving technique and addressing strength deficits.

 

Shoulder bursitis

Within the shoulder, like many other joints, there is a bursa: a fluid-filled sac that reduces friction between the tissues of the body. Inflammation of the bursa known as shoulder bursitis can occur when overloading of the joint due to poor technique, sudden change in shoulder use or there is insufficient strength and muscle control. Treatment aims to first settle symptoms by avoiding aggravating activities and then focuses on addressing the deficits, as the inflamed bursa is usually just a symptom and not cause of the problem.

 

Shoulder labral tears

The labrum is a bit fibrocartilage attached to the shoulder socket to help increase stability of the joint. Labral tears are common in the shoulder, but can be caused by acute injuries such as dislocation or due to gradual wear. Most of the time you may not be aware you have one of these and can be an incidental finding on scans. In such cases it is important to first let the shoulder settle, then identify and modify the activity that caused the area to become painful, followed by addressing any muscle strength deficits. In some occasions where a feature of the presentation is recurrent instability, further investigations may be required to help formulate a comprehensive management plan.

 

Osteoarthritis

Osteoarthritis is a wear-and-tear condition that often affects us in mid to late age. Due to the mobility and high use of the shoulder it is often a joint where this can occur resulting in stiffness and pain. It is important to assess if there are any strength deficits, lack of muscle control or poor technique that are causing further irritation of joint and then create a management plan addressing these.

 

Adhesive capsulitis

Commonly known as ‘frozen shoulder’, this condition occurs when the shoulder capsule becomes inflamed and stiff, leading to greatly restricted motion in the shoulder, as well as pain. You can learn more about it here.

 

Shoulder pain treatment with Life Ready Physio

With expert treatment such as joint mobilisation, massage and therapeutic exercises for improved functionality, Life Ready Physio will not only alleviate shoulder pain — we’ll provide you with the tools to prevent future injuries too.

For an in-depth assessment by one of our skilled physiotherapists, book a consultation here.

We look forward to joining you on this journey to pain-free living.

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