It’s not often I write a blog like this but I’ve been treating a lot of shoulder injuries since January and the patients with shoulder injuries are still waltzing through the door like the cast of Strictly.
Common Causes of Shoulder Pain:
Osteoarthritis
Most people think of arthritis as being something that occurs in the fingers, knees and spine but it can affect any joint. Osteoarthritis is a fancy word for “wear and tear” of the cartilage that covers the ends of bone. Symptoms can include joint pain, stiffness and swelling; all of which starts slowly and worsens over time. For many active people they fear this diagnosis means the end of all exercise but this just isn’t true. The damage to the joints cannot be reversed but the symptoms can usually be well managed by staying active, taking over the counter pain-relief, maintaining a healthy weight and manual therapy such as osteopathy.
Bursitis
Bursa are small fluid-filled sacs that aid the movement of soft tissues (muscles, tendons, ligaments) over bones and other soft tissues to reduce friction. Excessive use of the shoulder, particularly in repetitive movements, can squish the bursa and cause inflammation. It usually occurs in association with rotator cuff injuries. Symptoms can include achiness in the shoulder, hurt more when you press on it or lift you arm above your head, or look red and swollen. Relief from bursitis can be achieved with manual therapy, exercises to strengthen the shoulder and medication such as ibuprofen, volterol or antibiotics if it’s caused by an infection. In extreme cases corticosteroids or surgery may be advised but this is rare.
Rotator Cuff Injury
The rotator cuff is a group of 4 muscles that hold the ball and socket joint of the shoulder (glenohumeral joint) together. These injuries are common and the risk of occurence increases with age or with activities that require repeated overhead movements. Rotator cuff injuries that occur as a result of one direct event should seek medical help immediately in case there is a more urgent need for surgery. Other causes of rotator cuff injury can often find relief from hands-on manual therapy coupled with a progressive load rehab programe to regain strength and flexibility.
Tendinitis
This is inflammation of a tendon (the fibrous tissue connecting muscles to bones) and can occur in any tendon, with higher likelihood in the shoulders, elbows, wrists, knees and heels. Usually symptoms occur gradually with repetitive movements, presenting as tenderness to touch and a dull ache, especially when moving the affected limb, although this discomfort can be more severe in extreme or chronic cases. Tendinitis can usually be resolved with rest, manual therapy and medications to reduce pain. If tendinitis is severe and leads to the rupture of a tendon, you may need surgery which makes it even more important to seek treatment quickly and follow your rehab plan to avoid this.
Instability
The cause of instability could be from a shoulder dislocation, hypermobility spectrum disorder (HSD), muscle loss/weakness, overuse, or Elhers-Danlos Syndrome (EDS). Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations can lead to pain and unsteadiness when you raise your arm or move it away from your body and increases the risk of developing arthritis in the joint. Ruling out conditions such as EDS and HSD is important *waves in osteopath* to ensure you can follow a progressive load rehab plan designed to increase the strength without sacrificing flexibility or function.
Less Common Causes of Shoulder Pain
Thoracic Outlet Syndrome
Abbreviated to ‘TOS’, this is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed. There are 3 types:
- Neurogenic – Most common and caused by compression of the brachial plexus; a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand.
- Venous – When one or more of the veins under the collarbone are compressed, resulting in blood clots.
- Arterial – Least common and occurs when one of the arteries under the collarbone is compressed, resulting in bulging of the artery, also known as an aneurysm.
It’s possible to have a mix of the three types when multiple parts of the thoracic outlet are being compressed and symptoms can vary depending on the type.
Neurogenic symptoms:
- Numbness or tingling in your arm or fingers
- Pain or aches in your neck, shoulder, arm or hand
- Weakening grip
Venous symptoms:
- Discoloration of your hand (bluish color)
- Arm pain and swelling
- Blood clot in veins in the upper area of your body
- Arm fatigue with activity
- Paleness or abnormal color in one or more fingers or your hand
- Throbbing lump near your collarbone
Arterial symptoms:
- Cold fingers, hands or arms
- Hand and arm pain
- Lack of color (pallor) or bluish discoloration (cyanosis) in one or more of your fingers or your entire hand
- Weak or no pulse in the affected arm
The type of TOS will dictate your treatment plan, which could involve manual therapy for range of movement, stretching and exercise-based therapy; anti-inflammatory, muscle relaxant or clot-dissolving medications. Surgical decompression is reserved for when conservative treatments are unsuccessful.
Frozen Shoulder
Known medically as adhesive capulitis, it involves stiffness and pain in the shoulder joint. The shoulder joint is enclosed in a capsule of connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint. Signs and symptoms typically begin slowly, then get worse over time before they slowly start toget better, usually within 1 to 3 years. There are three stages:
- Freezing stage (2 – 9 months) – Movement of the shoulder causes pain, and the shoulder’s range of movement becomes limited.
- Frozen stage (4 – 12 months) – Shoulder becomes stiffer but pain can decrease. Using the shoulder becomes more difficult.
- Thawing stage (5 – 24 months) – Improvement in the shoulder’s ability to move begins.
Most occurences are due to not moving the shoulder for long periods of time, like after surgery or breaking an arm so speak to your healthcare provider about exercises suitable for you to move your shoulder. Treatment includes controlling pain and preserving as much range of motion in the shoulder as possible through actie and passive manual therapy. Steroid injections and surgery are options if no other interventions are helping.
Polymyalgia Rheumatica
Abbreviated to ‘PMR’, this is an inflammatory disorder causing muscle pain and stiffness, especially in the shoulders and hips. It rarely affects people under 50, with most patient over the age of 65. Symptoms usually begin quickly and are worse in the morning. PMR can be related to another condition called giant cell arteritis (GCA). This can cause headaches, vision difficulties, jaw pain and scalp tenderness; and it’s possible to have both conditions together.
The signs and symptoms of PMR usually occur on both sides of the body and might include aching or pain in your shoulders, neck, upper arms, buttocks, hips or thighs and stiffness or reduced range of motion in the affected areas, particularly in the morning or after being inactive for a time. There may also be pain or stiffness in your wrists, elbows or knees.
PMR might also cause more general signs and symptoms, including mild fever, fatigue, loss of appetite, unintended weight loss, low mood or an overall feeling of unwellness. These are all symptoms that should prompt you to visit your doctor, if your osteopath suspects PMR they will refer you to your GP and support your journey to diagnosis. Treatment will then primarily be through medication, calcium and vitamin D supplements, and lifestyle changes with support from your osteopath or physical therapist.
In summary…
There are a lot of structures in the shoulder and identifying the cause of pain can be tricky; it requires precision testing and a great knowledge of anatomy. We use our shoulders all the time so it is very important to have any shoulder pain investigated sooner rather than later to give the best chance of a full and speedy recovery!
Wisbey Osteopathy 