Painful shoulder conditions that limit movement are common, and are caused by problems with the shoulder joint and its surrounding structures. The shoulder is more prone to injuries than other joints because of its wide range of movement. There are several conditions that cause pain and limit movement of the shoulder joint, including Rotator Cuff Disorders, Frozen shoulder, Bursitis, Shoulder impingement syndrome, SLAP (superior labrum anterior to posterior) tear, and Arthritis.
Many years of sitting at a desk as well as a sedentary lifestyle means that our arms are held by our side or in front of us over a desk. This creates a shortening or a lack of elasticity of the soft connective tissues of the shoulder, in particular, the rotator cuff tendons and the muscles. The shoulder blades starts to migrate forward and around the rib cage which then changes the way the shoulder moves and can compromise the biomechanics of the shoulder and the head of the arm can migrate upwards causing impingement of the bursa.
Bursitis is typically identified by localized pain or swelling, tenderness, and pain with motion of the tissues in the affected area. Shoulder bursitis is often accompanied by tendinitis (inflamed tendon) of tendons adjacent to the affected bursa in the shoulder. Shoulder bursitis causes focal tenderness of the inflamed tissues.
Shoulder impingement is common in sports that involve repetitive overhead motions or throwing, such as swimming, surfing, baseball, softball, water polo, and volleyball. During normal shoulder motion, the rotator cuff and subacromial bursa travel smoothly beneath the acromion in the subacromial space (the space between the acromion and humeral head). Additionally, the subacromial bursa, a small fluid-filled sac, helps the rotator cuff travel smoothly beneath the acromion and AC joint. In shoulder impingement, however, the rotator cuff and bursa get pinched or impinged underneath the acromion during overhead activities, resulting in pain.
Several factors can contribute to shoulder impingement. Structural or anatomic abnormalities might result in a narrower subacromial space. For example, some people are born with a curved or hook-shaped acromion that narrows the subacromial space. With aging, development of AC joint arthritis and bony spurs underneath the acromion can also narrow the subacromial space. The less room there is for the rotator cuff and bursa to travel, the more likely it is that these structures get pinched during shoulder motion.
A second factor is inflammation. Overuse or repetitive irritation of the rotator cuff underneath the acromion can lead to inflammation and swelling of the rotator cuff tendons and overlying bursa (tendinitis and bursitis). Not only are the inflamed tendons and bursa painful, but pain is aggravated when these inflamed and swollen structures get pinched or impinged underneath the acromion during overhead motions.
A third factor is shoulder instability, especially in young athletes. If the structures of the shoulder are ineffective in stabilizing the humeral head within the socket (glenoid fossa) during overhead motions, the humeral head might migrate upward out of the socket, causing impingement. Underlying shoulder instability is likely a primary cause of impingement symptoms in young athletes.
Frozen shoulder, also known as adhesive capsulitis, is characterised by progressive pain and stiffness in the shoulder. The pain is felt deep in the shoulder joint and may be worse at night. The pain can be felt with movement in any direction.
The exact cause of this condition is not known, but it sometimes develops following other shoulder injuries. It is thought that resting a painful, injured shoulder for too long can cause the shoulder muscles and connective structures to stiffen up. Most people with frozen shoulder tend to improve within 2 years, with or without treatment, but not all will regain full range of movement, however, those who have treatment get better quicker and regain more range.
SLAP (superior labrum anterior to posterior) Tear –
The socket part of the shoulder joint has a ring of tissue around it that deepens the socket, making the joint more stable. This tissue is called the labrum. When the top part of the labrum is injured or torn, it is known as a SLAP tear. SLAP tears are usually the result of an injury such as a fall onto your shoulder or outstretched arm, although they may also arise from repeated lifting or other overhead activities.
Symptoms of a SLAP tear can include pain on throwing or lifting your arm overhead, popping or clicking in the shoulder, a feeling of weakness or instability and a general shoulder ache.
Arthritis causes progressive joint pain, tenderness, swelling and stiffness. Both rheumatoid arthritis and osteoarthritis can affect the shoulder joint.
Sometimes shoulder pain is actually due to problems in your neck or a mixture of several different problems which contributes to the symptoms.
In addition to relieving pain, treatment is aimed at restoring mobility in your shoulder joint. The choice of treatment depends on the shoulder problem. Treatment is aimed at restoring the limited movements so that the surrounding soft tissues and joint can move freely and cope with normal activity without getting distressed. Strength and elasticity is restored so that they can acquire the length with the ability to cope with the load in every position that the shoulder is required to do.
We massage and use active releases to restore the elasticity of the muscles and tendons and we mobilise the joint to gently break-up the adhesions within the soft connective tissues of the joint (capsule and ligaments). Whilst this is happening, we commence a strengthening program initially using a theraband along with a stretching program. The patient may then progress to a more elaborate exercise program to minimise the chance of recurrence.
We strongly recommend the shoulder problem isn’t rested for too long. While you should avoid strenuous activities and lifting heavy objects, you should still move your shoulder to help make sure that you regain full use of the joint. By returning to your normal activities as soon as possible (within the limits pain), you can help prevent the shoulder joint from stiffening up and thus requiring far less treatment to restore it.