Common Shoulder Conditions
Frozen Shoulder (Adhesive Capsulitis)
The ball of the top of the humerus and socket of the shoulder blade are enclosed within a loose fibrous capsule that allows synovial fluid to nourish the cartilage rich joint surfaces whilst providing protection. Frozen shoulder occurs when the capsule becomes thickened and scarred restricting its flexibility, resulting in reduced painful movement. Pain and restriction is commonly noted when pulling up underwear and trousers, getting on coats and jackets and reaching for the biscuit cupboard. More common in patients with Diabetes, the condition will usually resolve itself within two to three years. Physiotherapy can be helpful alongside pain medication and steroid injections. In prolonged cases arthroscopic surgery may be required.
Shoulder Impingement
Shoulder impingement is thought to be a mechanical problem where the top of the humerus bone and underside of acromioclavicular (AC) joint squeeze soft tissue as the arm moves, causing pain. Inflammation within the squeezed tissue occurs leading to a further reduction in pain free shoulder movement. More recently research has suggested that the problem is less of a compression problem and more to do with age related changes and wearing of tendons within the rotator cuff. The condition may lead to other shoulder problems such as bursitis and tendinopathy. Physiotherapy can be helpful in identifying the cause of the impingement and how best to resolve.
Rotator Cuff Tear (muscle tear)
The Rotator cuff muscles are a group of four muscles that provide stability and initiate movement at the shoulder joint. When working well the Rotator cuff controls the movement of the joint ensuring the ball remains firmly placed on the socket of the shoulder blade, allowing the larger muscles of deltoid, pec major and latissimus dorsi to exert their force in tasks, from brushing your hair to carrying shopping bags. Rotator cuff tears are common especially in the over 40’s, considered as fair wear and tear not requiring any attention. However, when a tear is significant patients will have difficulty raising their arm +/- pain. Patients may notice the whole shoulder rising up as you try an initiate movement which is caused by the larger more powerful muscles doing their thing to help. Neck ache or pain is also a factor due to the altered movement patterns. Physiotherapy is helpful in identifying the underlying cause and rehabilitating as required. Failure to resolve may require arthroscopic surgery which we will advise on following a detailed assessment.
Subacromial Bursitis
Imagine a small sheet of cling film folded in two with a drizzle of olive oil in between; this would be a bursae. The purpose of bursae are to sit between muscle tendons and bone to reduce friction and encourage gliding movement. The bursae can become inflamed and swollen causing pain. Movement of the shoulder can also cause pain as the bursae are aggravated by passing Rotator cuff muscle tendons. The subacromial bursae is a common site for the problem which is usually caused through overuse (commonly decorating and racket sports) or injury (suffering a fall) and is also linked to Shoulder impingement. Physiotherapy is helpful in identifying the underlying cause and rehabilitating. Steroid injections and analgesia are helpful if pain is the main complaint.
Tendinopathy
The Biceps and supraspinatus tendons are prone to tendinopathies that occur through overuse or lack of use injuries. The tendon becomes sore due to repetitive loading which causes a change in the tendon structure and infiltration of free nerve endings. Without correct Physiotherapy guidance, the tendon will remain painful with movement and function being severely restricted. Relative rest can be helpful alongside a progressive loading programme +/- Shockwave Therapy. https://www.faypedlerclinic.co.uk/shockwave-therapy
Osteoarthritis (OA)
Less common in shoulders unless you have suffered a fracture in the past, OA occurs where the smooth cartilage that covers the end of the bones wears away exposing the bone ends. Further bone grows to try and compensate which changes the shape of the joint over time (months and years). Crunching and grinding noises may be heard coming from the shoulder when moving which may also be painful. A reduction in movement is also noticed with difficulty reaching over head height and reaching across the body e.g. putting a seat belt on. Sleeping may also be disturbed if side lying is a favoured position.
Whilst OA cannot be cured Physiotherapy can be helpful in improving the range of movement and manging the pain that comes with it. Steroid injections are sometimes helpful and replacement shoulder surgery may be appropriate should pain be awful with a severe negative impact on quality of life.
Fracture – Broken Bones (ouch!)
Fractured Humerus (upper arm bone), clavicle (collarbone), scapula (shoulder blade) will result in immediate pain and restricted movement. Severe fractures may require surgery whereas less severe may be allowed to heal naturally. Physiotherapy helps to manage initial pain, promote good healing and progressively restore movement and function.
Dislocation
The shoulder (ball and socket joint) can partially dislocate (subluxation) or fully dislocate (dislocation) which results in immediate pain and severe loss of function. Most dislocations occur through trauma for example a fall on an outstretched arm or as a result of contact sports which requires skilled medical help to relocate. Dislocations can also occur with a fracture. The dislocated shoulder can be prone to ‘popping out’ therefore requires committed rehabilitation of the surrounding muscular structures to promote joint stability. Recurrent dislocators who have not succeeded with rehabilitation may be offered surgery to prevent ongoing problems.
Calcific Tendonitis
We use calcium to build bone and maintain strong teeth. Occasionally calcium crystals form inside rotator cuff tendons which can lead to pain and restricted movement. In normal state the tendon is flexible and able to tolerate mild distortion as it functions however when hard calcium forms inside the tendon, it loses this flexibility. Furthermore, the presence of calcium within the tendon increases its relative size which when combined creates a stiff rigid tendon that is unable to glide through the small bone channel beneath the acromioclavicular joint leading to pain and a loss of movement. Physiotherapy is helpful in assessing and treating this problem. On occasion Shockwave therapy https://www.faypedlerclinic.co.uk/shockwave-therapy can be utilised to disperse the calcium deposits.
Referred Neck Pain
Some shoulder pain symptoms can be due to a problem within the neck where the nerves are being irritated. Patients report burning, aching and pins and needles which may travel down the arm to the hand. Clinically called a cervical radiculopathy you may also consider it as sciatica of the upper limb. More details can be found here on our cervical spine page https://www.faypedlerclinic.co.uk/neck-pain
Rheumatoid Arthritis (RA)
An inflammatory arthritis that affects the joint capsule, cartilage, bone and ligaments of the shoulder. Physiotherapy alongside good medical management is helpful in maintaining shoulder range and function.