The shoulder is a very mobile structure that is made up of a “ball and socket” joint created by the arm bone (humerus) and shoulder blade (scapula). This ball and socket joint is surrounded by four muscles collectively called the rotator cuff, which act to hold the joint together. There are many ligaments that further help to provide stability to the shoulder joint. The shoulder joint also has a bursa, which is a fluid filled sac that acts to reduce friction between the moving parts. The whole shoulder joint is surrounded by strong muscles like the deltoid, pectoralis and trapezius. All of these parts have to work properly together to create arm movement and generate strength.
Causes of Shoulder Pain
The most common shoulder conditions or injuries are:
• Rotator Cuff Tendonitis
• Rotator Cuff Bursitis
• Rotator Cuff Tears
• Frozen Shoulder
• Dislocations or Separations
The Rotator Cuff
Pain in the rotator cuff is often felt at the joint, or down the upper arm. Overhead activities such as throwing, swimming, or lifting can lead to pain in this area. If the space between the rotator cuff and the bone above is narrowed, either due to injury or the aging process, the rotator cuff tendons and bursa can get squeezed. This is called “impingement” and can eventually lead to tendonitis (inflammation of the tendons), bursitis (inflammation of the shoulder bursa), or tears. A calcium deposit may also form in the rotator cuff and cause irritation of the tendon and bursa.
As we get older, the rotator cuff tendons naturally weaken and can wear out; especially if there have been injuries in the past, or a history of a lot of wear and tear. A rotator cuff tear can occur due to the aging process alone, impingement as described above, or when the weakened tendons are stressed during activities or accidents, like a fall on an outstretched arm.
Frozen shoulder, also known as adhesive capsulitis, occurs when you have extreme stiffness and pain in your shoulder. Many times, the cause of frozen shoulder is unknown, but it can also occur following an accident, injury or surgery to the shoulder.
Frozen shoulder is thought to be caused by a general inflammatory process that affects the entire ball and socket joint, ligaments and tendons. Most people with frozen shoulder go through stages of recovery, with the shoulder initially being very painful with movements, then becoming very stiff, and finally loosening up again. This process can take many months, but most people with frozen shoulder regain all or almost all of their range of motion and strength back again.
Studies have shown that early and frequent stretching and strengthening exercises prescribed by a Physiotherapist can significantly help to speed up the recovery process of frozen shoulder
Dislocated or Separated Shoulder
A dislocated shoulder occurs when a traumatic force causes the shoulder ball to slip out of the socket. This can happen from a sports injury or a fall. When the ball and socket completely separate, it is called a true dislocation. Dislocations usually have to be reduced by a doctor in the emergency room. When the joint only partially separates then goes back into place again, it is called a subluxation. With either a dislocation or a subluxation, there is damage to the ligaments and tendons that surround the shoulder joint. This is characterized by weakness, instability and decreased range of motion for 6-12 weeks following the injury. The shoulder may need to be immobilized in a sling for a few weeks to allow all the structures to heal properly.
A separated shoulder is slightly different from a dislocation. A shoulder separation is a common injury among athletes (e.g. when a hockey player gets checked into the boards), but it can happen to anyone who falls and lands on the tip of their shoulder. The result can be a partial or full tear of the ligaments that hold your collarbone (clavicle) to your shoulder. After such an injury your arm may feel limp and painful to lift. Usually the pain is located over the top or outside tip of the shoulder. Most people need to wear a sling or brace for 2-4 weeks following a shoulder separation.
If you have had a bad shoulder injury, you may require immediate medical attention. For such injuries you may need surgery (such as the repair of a torn rotator cuff), and you will be sent to Physiotherapy for rehabilitation afterwards. If you are having shoulder pain that is bothering you more and more over time, or from a minor injury, you should see a Physiotherapist for diagnosis and treatment as soon as possible.
Whatever the nature of your shoulder pain, Dorval Physiotherapy will perform a number of tests to try to determine the exact cause of your symptoms in order to begin the correct course of treatment. Your rehabilitation may include one or more of the following:
• Pain relief through the use of electrical currents, heat, ice and Acupuncture
• Ultrasound and/or laser to reduce inflammation and scar tissue
• Manual, hands-on stretches mobilization to improve the movement of your shoulder joint
• Strengthening and stretching exercises for your shoulder, rotator cuff, and shoulder blade muscles
• Taping or bracing of the shoulder joint
• Advice on posture, activity, sports and work to avoid further irritation to your shoulder
• A long-term plan to make you independent and help you to avoid shoulder injuries in the future