The shoulder joint is one of the most complex joints in the human body. Due to the large range of motion available at the shoulder it is an inherently unstable joint. This reduction of stability is one of the reasons you can be predisposed to shoulder injury. In order to maintain stability, your shoulder has a complex system of ligaments, tendons and muscles.
The rotator cuff muscles are a group of four muscles that act to hold the head of the humerus (arm bone) into the shoulder socket. Overload of these muscles and their tendon insertions are common in the ageing population & in cases of overuse: such as with manual workers and athletes.
Often, several years of poor posture leads to gradual overload of shoulder structures such as the rotator cuff muscles. When a state of long-term overload exists at the shoulder then you can injure it more readily than would be the case in an otherwise healthy shoulder.
For this reason, a lot of individuals will report a relatively benign onset of shoulder pain. For example, they may develop a sudden pain after reaching overhead or doing light manual work.
The goal, in such cases, is to alleviate symptoms while addressing the underlying muscular imbalances that have brought on the pain.
The earlier such problems are addressed the better the long-term outcome.
Ross discussing Shoulder Injuries on KFM Radio:
Due to the complexity of the shoulder joint and the many structures that may give rise to pain, rehabilitating your shoulder requires a more comprehensive approach than other joint conditions.
Causes of Shoulder Pain:
- Fracture or dislocations
- Tendonitis or capsulitis
- Arthritis (Osteoarthritis or rheumatoid arthritis)
- Cervical disc herniation (disc bulge in the neck)
- Thoracic outlet syndrome (compression of nerves supplying the shoulder)
- Vascular (blood flow) disorders
- Referral from organs such as the heart, liver, gallbladder, & lungs.
Modern Western living, with its emphasis on prolonged sitting & slouched postures, can give rise to poor alignment of the shoulder joint.
This can impact negatively on movement patterns and muscular control around the shoulder.
Over time this can lead to overload your shoulder cuff tendons and muscles over several months, or even years. Eventually, a sudden onset of pain can result.
Are Shoulder Problems more common with ageing?
In the elderly population, the accumulation of years of degeneration can often create rotator cuff tendon degenerative changes & give rise to pain with end range shoulder activities.
This can require a number of months to address & requires that you adhere closely to a rehabilitation programme.
Another frequently encountered condition in the elderly is a frozen shoulder, where a progressively increasing pain & limitation of shoulder movement develops.
When should I have a Shoulder Scan?
The value of MRI scans in the diagnosis and management of shoulder pain is increasingly brought into questions in recent years. Oftentimes, MRI scans show structural changes which may be reflective of the natural ageing process as opposed to being the source of your pain
The table below gives an example of the incidence of cuff muscle tears in the shoulder. It demonstrates the high numbers of tears in individuals who do not suffer from shoulder pain.
Shoulder Impingement – Should I have Decompression Surgery?
Recent evidence suggests that outcomes for pain and function are similar for both surgical and non-surgical treatments. The British Journal of Sports Medicine in 2020 published a review of the current evidence and strongly discouraged the use of subacromial decompression surgery. They reported that it provided no benefit over placebo but carried a small but serious risk.
Weakness of the shoulder muscles incorporating the rotator cuff is normally seen alongside impingement; therefore, physiotherapy rehabilitation is the first-line approach to treating shoulder pain.
Physiotherapy Management of Shoulder Pain
If there has been a history of severe trauma and clinical findings warrant further investigation then x-rays or MRI scans may be ordered to identify the source of shoulder pain.
Suspected fractures & acromioclavicular joint separations are best diagnosed with x-ray while rotator cuff tears are best diagnosed using MRI scans or contrast arthrography (injection of dye prior to scanning).
Given the complexity of the shoulder joint complex there can often be multiple drivers of shoulder injury. Management of shoulder pain will be guided by the severity of symptoms. A progressive rehabilitation program is vital to restore normal strength and shoulder function.
Best Treatments for shoulder pain includes:
- Myofascial release techniques
- Dry needling
- Joint mobilisation
- Strength training to restore normal muscle activation patterns
- Proprioceptive training (improving shoulder joint position sense)
Activity modification (for example athletes who have undergone shoulder dislocation are at greatest risk of further dislocation for two months after injury).
Is Manual Therapy Effective for Shoulder Pain?
Schmerz et al. (2016) analysed the impact of manual trigger point compression therapy in patients with chronic shoulder pain. The authors found that manual trigger point therapy was significantly more effective when compared with sham therapy.
Is Laser Therapy Effective for treating Shoulder Injuries?
A review of the existing research by Haik et al. (2016) reported strong evidence for the lack of beneficial effects of low-level laser, ultrasound and pulsed electromagnetic field (PEMF) on pain, function or range of motion in the treatment of shoulder pain.
Are PrP injections effective for Shoulder Pain?
Plasma rich protein (PRP) is thought to promote healing and stimulate growth by the release of growth factors from a high concentration of activated platelets [23, 24•, 26, 27]. Yet despite this exciting promise, human subject research with PRP has not produced consistent results in favor of its use in either operative or non-operative conditions of the shoulder…..
Additionally, cost-benefit analyses of PRP in rotator cuff repairs indicate that the benefits of its use do not compensate for current costs.
There is moderate evidence that taping offers no benefits.
Schmerz et al. (2016). Manual trigger point therapy of shoulder pain : Randomized controlled study of effectiveness.
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