There are many different problems within the shoulder that can cause pain. These are the most common:
This is the most common cause of shoulder pain and often originates from chronic inflammation to the rotator cuff tendons and/or surrounding bursa. Quite often, the pain is not actually felt within the shoulder, but more the upper arm where you would expect to find a military badge on a uniform.
Symptoms are experienced as the arm is moved away from the body (abduction) and often worse at 80 to 100 degrees of movement (an ‘arc’ of pain). It can also be very painful to put the hand behind the back, making actions such as tucking your shirt in or fastening a bra very painful.
Pain can come on slowly over time or quite quickly if the shoulder has been used for an activity that is much more demanding than it used to doing each day.
Evidence shows that the best way to manage tendon inflammation is to optimally load the tendons, through a graded strengthening programme to restore the strength and function of the joint. The joint can also become stiff due to the pain affecting its use, therefore treatment can also be aimed at mobilising stiff joints and re-educating faulty movement.
Shoulders become stiff for many reasons and it is important to exclude the neck or thorax as a source of the problem. ‘Frozen shoulder’ is caused by tightening of the sac surrounding the shoulder (or capsule) and this condition is hard to manage and people can have symptoms for years. Fortunately, most stiff shoulder problems (including many diagnosed incorrectly as ‘frozen shoulder’) are easily treated by mobilising the shoulder and home stretching and mobility exercises. Incorrect shoulder movement during a specific activity, e.g. lifting at work or playing a specific racquet sport can cause structures in the shoulder to tighten and produce symptoms. Pain is usually encountered at the end of the available range, for example reaching to a high shelf or using a hairdryer.
The shoulder has a wide range of movement and requires the joint to have sufficient movement to allow normal shoulder function. The downside to this flexible joint is that following trauma or after repeated shoulder movements (e.g. prolonged swimming, throwing a javelin or just poor posture for many years), it is possible to lose the control of shoulder movement and a catching pain on certain activities may be elicited. Causes of chronic shoulder instability can also be genetic. The shoulder still has its normal range of movement, but the patient complains of a ‘catching’ pain and /or ‘clicking’ in the shoulder. This abnormal movement of the shoulder can produce structural damage to the joint and if conservative treatment fails, surgery may be indicated.
Treatment is aimed at restoring the correct shoulder control around the joint (and surrounding joints) and addressing weakness of specific muscles within the shoulder that provides dynamic stability to the joint. Re-educating correct upper limb function is also important to prevent future problems and help the person manage their problem more effectively. Success is judged by returning you to your normal functional state, be that climbing to international standard or just being able to reach for objects on a top shelf.
