Shoulder pain physiotherapy treatment

The shoulder is a wonderful mobile structure due to its specific anatomy but as a result, it can often become a source of unwanted pain in 10-30% of the population! For stability and strength, the shoulder requires a number of specific muscles to be engaging throughout its normal ranges. It's often this loss of strength and normal movement that leads to acute or chronic pain.

 

 

Painful shoulders generally tend to get favored or adapt different movement patterns to get by with normal daily task. It is this change in movement or more often lack of movement that leads to both a sensitivity of various structures in the shoulder and a weakness in the surrounding muscles causing ongoing dysfunction and pain.  Pain is normally felt in the shoulder itself or in the upper arm and can occur through all directional activities but most commonly with lifting the arm up or to the side.

 

 

Do I need a scan to diagnose and treat my shoulder pain?

 

 

The good news is most shoulder pain although at times extremely painful is not serious in nature and scans such as x-rays, ultrasound and MRI's are generally not required when rehabilitating a painful shoulder.  We know through significant amounts of scans in pain-free subjects that 'pathology' of certain structures (eg rotator cuff tears full and partial, bursitis, labral tears) are common findings in shoulders and therefore not always the definite reason for pain and symptoms.  Traumatic cases such as heavy falls or significant forceful injuries may require further investigations though to rule out bony pathology such as fractures. Findings in our physiotherapy assessment may also lead us to request imaging to rule out rare sinister cases.

 

 

After a thorough physiotherapy assessment, most rehabilitation is targeted at resuming normal movement through certain exercises and progressive load on the rotator cuff and surrounding global shoulder muscles. As movement and strength increase pain normally decreases and normal shoulder function can resume.

 

 

The neck can also often refer pain or symptoms into the shoulder joint and arm so we also rule this in or out as a cause of the pain when assessing your shoulder pain. 

 

 

 

 

 

 

 

Shoulder surgery vs conservative

 

If you have been told you need to have surgery or are thinking its something you may require make sure you try some rehabilitation treatment first (see what the science says)

Common shoulder diagnoses treated with physiotherapy

 

  • rotator cuff tendon injuries -full thickness and partial thickness tears

  • sub acromial bursitis (shoulder bursitis)

  • shoulder impingement

  • frozen shoulder

  • glenoid labrum injuries

  • sports shoulder injuries (swimmers and throwers shoulders, strains and sprains)

  • osteoarthritis of the gleno-humeral and acromio-clavicular (AC) joints

  • AC joint injuries

  • shoulder subluxation

  • shoulder dislocation

  • acute calcific tendinopathy

  • tendon pathologies (tendonosis and tendinopathy)

  • Nerve entrapments

Ref: Jeremy Lewis (London Shoulder Clinic)