Shoulder pain is one of the most common presenting conditions in many physiotherapy clinics today. The only searches for "shoulder pain" have increased significantly over the last 5 years.
But what causes shoulder pain?
Firstly, we must understand common painful conditions within the shoulder and what is actually happening within the joint. The 9 most common shoulder injuries are:
- Shoulder Impingement
- Adhesive Capsulitis (Frozen Shoulder)
- Rotator Cuff Injury
- Bursitis
- Biceps Tendonopathy
- Dislocations
- Acromioclavicular Joint Injury
- Scapula Dyskinesis
- Osteoarthritis
Some of the conditions/injuries above can overlap and share symptoms so it is important to understand what is causing your shoulder pain in order to treat it.
There are several methods of pain relief available and suggested online but unless the cause is treated, the pain will never just disappear.
So what does any of the terms above mean?
1. Shoulder Impingement
Shoulder impingement is a common condition that occurs when the tendons or bursae (small fluid-filled sacs) in the shoulder become compressed or pinched. This can cause pain, weakness, and difficulty moving the shoulder. Shoulder impingement is often caused by repetitive overhead reaching or lifting, or by a structural issue such as poor posture or a misalignment of the shoulder blade (scapula).
There are two main types of shoulder impingement: subacromial impingement and subcoracoid impingement. Subacromial impingement occurs when the tendons or bursae in the shoulder become compressed under the acromion, a bony projection on the shoulder blade. Subcoracoid impingement occurs when the tendons or bursae become pinched between the scapula and the upper arm bone (humerus).
Treatment of shoulder impingement typically involves rest, ice, and pain medication to reduce inflammation and pain. Physical therapy may be helpful in improving range of motion and strength, and in some cases, a corticosteroid injection or surgery may be necessary to address the underlying cause of the impingement.
2. Adhesive Capsulitis
Adhesive capsulitis, also known as "frozen shoulder," is a condition that causes the shoulder joint to become stiff and painful. It is characterized by a thickening and tightening of the joint capsule, a structure that surrounds and encloses the shoulder joint. This can lead to a loss of motion and flexibility in the shoulder, as well as pain and discomfort.
The exact cause of adhesive capsulitis is not fully understood, but it is thought to be related to inflammation and scarring within the joint capsule. It is most common in people between the ages of 40 and 60, and it is more common in women than men. Risk factors for adhesive capsulitis include diabetes, thyroid disorders, and a previous shoulder injury or surgery.
Adhesive capsulitis typically develops gradually and progresses through three stages: freezing, frozen, and thawing. During the freezing stage, the shoulder becomes increasingly painful and stiff, and range of motion begins to decrease. The frozen stage is characterized by a significant loss of motion and a decrease in pain. The thawing stage is when the shoulder begins to improve, with an increase in motion and a decrease in pain. The entire process can take anywhere from a few months to several years.
Treatment of adhesive capsulitis typically involves a combination of physiotherapy, medications to reduce pain and inflammation, and in some cases, corticosteroid injections. Physical therapy may include stretching and strengthening exercises, as well as techniques to improve range of motion and flexibility.
3. Rotator Cuff Injury
The rotator cuff is a group of muscles and tendons that surround the shoulder joint and help to stabilize and move the arm. A rotator cuff injury is a common type of shoulder injury that occurs when these muscles and tendons become damaged or strained. Rotator cuff injuries can range from mild strains to complete tears, and they can cause pain, weakness, and difficulty moving the arm.
Rotator cuff injuries are often caused by repetitive strain or overuse, such as from activities that involve overhead reaching or lifting. They can also be caused by an acute injury, such as a fall or direct impact to the shoulder. Risk factors for rotator cuff injuries include age, as they are more common in people over the age of 40, and occupations or sports that involve repetitive overhead movement.
Treatment of a rotator cuff injury depends on the severity of the injury and may include rest, ice, and pain medication to reduce inflammation and pain. Physiotherapy can be helpful in improving range of motion and strength, and in severe cases, surgery may be necessary to repair or reconstruct the damaged muscles and tendons.
4. Bursitis
Shoulder bursitis is a condition that occurs when the bursae (small fluid-filled sacs) in the shoulder become inflamed. The bursae are located between the bones, tendons, and muscles in the shoulder and help to reduce friction and allow smooth movement. When they become inflamed, they can cause pain and difficulty moving the shoulder.
Shoulder bursitis is often caused by repetitive strain or overuse, such as from activities that involve frequent overhead reaching or lifting. It can also be caused by an injury or infection. Symptoms of shoulder bursitis include pain, tenderness, and swelling in the shoulder, and the pain may be worse with movement or pressure on the affected area.
Treatment of shoulder bursitis typically involves resting the shoulder and avoiding activities that worsen the pain, applying ice or cold packs to reduce inflammation, and taking over-the-counter pain medication such as acetaminophen or ibuprofen. Physical therapy may be helpful in improving range of motion and strength, and in some cases, a corticosteroid injection may be necessary to reduce inflammation. It's important to consult with a healthcare provider to determine the best treatment plan for your specific condition.
5. Biceps Tendinopathy
This is something I know very well... After having to undergo shoulder surgery after suffering damage to my bicep tendon.
Biceps tendinopathy is a condition that affects the tendons in the shoulder, specifically the tendons that attach the biceps muscle to the shoulder blade (scapula) and the upper arm bone (humerus). It is a type of overuse injury that occurs when these tendons become damaged or inflamed, often as a result of repetitive strain or overuse. Biceps tendinopathy can cause pain and weakness in the shoulder, and it may be accompanied by a snapping or popping sensation.
There are two main types of biceps tendinopathy: distal tendinopathy and proximal tendinopathy. Distal tendinopathy affects the tendon that attaches the biceps muscle to the elbow, and proximal tendinopathy affects the tendon that attaches the biceps muscle to the shoulder blade. Both types of biceps tendinopathy can cause similar symptoms, but they may require different treatment approaches.
Treatment of biceps tendinopathy typically involves a combination of rest, ice, and physical therapy. Physical therapy may include exercises to strengthen and stretch the muscles and tendons in the shoulder, as well as techniques to improve range of motion and mobility. In some cases, a corticosteroid injection or surgery may be necessary to address the underlying cause of the tendinopathy.
6. Dislocations
Shoulder dislocations are a common type of joint injury that occurs when the top of the arm bone (humerus) becomes separated from the shoulder blade (scapula). This can happen as a result of a fall, direct impact, or sudden twist of the shoulder. Shoulder dislocations are often accompanied by severe pain and may cause the shoulder to appear deformed.
There are three main types of shoulder dislocations: anterior, posterior, and inferior. Anterior dislocations are the most common and occur when the top of the arm bone is displaced forward. Posterior dislocations are less common and occur when the arm bone is displaced backward. Inferior dislocations, also known as subluxations, are the least common and occur when the arm bone is partially displaced.
Treatment of a shoulder dislocation typically involves reducing the dislocation, which involves moving the arm bone back into its proper position. This may be done by a healthcare provider or in severe cases, may require surgery. Once the dislocation has been reduced, the shoulder will be immobilized in a sling to allow it to heal. Physical therapy may be recommended to help restore range of motion and strength to the shoulder.
It's important to seek medical attention as soon as possible if you suspect that you have suffered a shoulder dislocation. Prompt treatment can help prevent further damage and facilitate a faster recovery.
7. Acromioclavicular Joint Injury
An acromioclavicular (AC) joint injury is a common type of shoulder injury that occurs when the ligaments that support the AC joint are stretched or torn. The AC joint is the joint between the acromion (a bony projection on the shoulder blade) and the clavicle (collarbone). AC joint injuries can range from mild sprains to complete tears of the ligaments, and they are often caused by falls or direct impacts to the shoulder. Symptoms of an AC joint injury include pain, swelling, and tenderness in the shoulder, and in severe cases, the shoulder may appear deformed. Treatment options include rest, ice, and pain medication for mild injuries, and more severe injuries may require physiotherapy or surgery to repair the damaged ligaments.
8. Scapula Dyskinesis
Scapula dyskinesis is a term used to describe abnormal movement or positioning of the scapula (shoulder blade). This can result in altered muscle activation and function, leading to shoulder pain and impaired performance in activities such as lifting or throwing. Scapula dyskinesis can be caused by a variety of factors, including muscle imbalances, poor posture, and structural abnormalities. It is often seen in athletes who engage in overhead throwing or pressing movements, but it can also occur in sedentary individuals. Treatment of scapula dyskinesis typically involves correcting muscle imbalances through targeted exercises and improving posture. Physiotherapy can be helpful in addressing these issues and improving scapula function. It's important to consult with a healthcare provider for an accurate diagnosis and appropriate treatment plan specific to your condition's cause.
9. Osteoarthritis
Osteoarthritis of the shoulder is a degenerative joint disease that results in the breakdown of the cartilage that cushions the ends of the bones. This can lead to pain, stiffness, and reduced mobility in the shoulder joint. It is a common condition that usually affects people over the age of 50, but it can also occur as a result of an injury or overuse. The main symptoms of shoulder osteoarthritis are pain and stiffness, which may be worse after periods of inactivity or when the joint is used. Treatment options include medications to reduce inflammation and pain, physical therapy to improve range of motion and strengthen the muscles around the joint, and in severe cases, surgery to repair or replace the damaged joint.
How do you treat shoulder pain?
There are several treatment options for shoulder pain, including:
- Resting the shoulder and avoiding activities that worsen the pain
- Applying ice or cold packs to the affected area to reduce inflammation
- Taking over-the-counter pain medication, such as acetaminophen or ibuprofen
- Doing stretching and strengthening exercises to improve flexibility and strength
- Using a shoulder brace or wrap to support the shoulder and reduce strain
- Seeking physical therapy to learn specific exercises to improve shoulder strength and mobility
- In severe cases, surgery may be necessary to repair damaged tissue or correct structural problems.
It's important to consult with a healthcare provider to determine the best treatment plan for your specific condition. They may recommend one or more of these options, depending on the cause of your shoulder pain.
If you are suffering from shoulder pain, you might find it useful to check out my shoulder-specific blog, where you can read in more detail about a number of shoulder injuries and download a range of free resource.
I'm also launching an app soon which will be full of helpful information and specific programmes to treat shoulder pain. It's not quite ready yet, but if you register your interest, I'll let you know when it launches and you'll be able to claim an extensive free trial as a thanks.
