SHOULDER PAIN

Shoulder Pain

Shoulder Pain Relief Is Available In Burlington

Our Physiotherapy Service in Burlington Is Here To Help!

After low back pain and knee pain, shoulder pain is regarded as the third most common musculoskeletal presentation in doctor's offices. Shoulder pain affects 18-26% of adults at any point in time. The prognosis for people with musculoskeletal shoulder pain varies widely with, on average, 50% of people with shoulder pain still reporting symptoms 6 months later.

In addition to pain, persistent shoulder pain can interfere with work, hobbies, social, and sporting activities. Some patients may also experience psychological distress and reduced quality of life.

The shoulder has evolved to withstand heavy physical demands over an unusually wide range of motion. To achieve this, it is not a simple ‘ball and socket’ joint but rather a complex composed of four articulations and a supporting arrangement of bones, muscles and ligaments within and outside of the joint capsule. Unfortunately, the complexity and the nature of the demands on it make it susceptible to a range of problems inside and around the shoulder joint.

WHAT IS CAUSING PAIN IN MY SHOULDER?

Shoulder pain has a lot of causes. In addition to problems in an injured shoulder, shoulder pain may be referred from the neck causing symptoms that may be difficult to distinguish clinically from those localized to the shoulder. Furthermore, pain may be experienced in the shoulder referred from abdominal pathologies affecting the diaphragm, liver or other viscera.

Rotator Cuff Tendinopathy

Rotator Cuff Tears

Biceps Tendinopathy

Adhesive Capsulitis

Shoulder Osteoarthritis

Acromioclavicular Joint Injuries (Shoulder Separation)

Shoulder Instability And Labral Tears

Rotator cuff (RC) tendinopathy is an umbrella term that includes different shoulder conditions affecting subacromial structures, such as rotator cuff tendinitis/ tendinosis, subacromial bursitis and shoulder impingement syndrome. Age above 50 years, diabetes, overhead activities and certain occupations that use vibration tools such as hair dressers and construction workers are associated with increased risk of RC tendinopathy. A combination of extrinsic mechanical compression (narrowing of the subacromial space) and tendon overuse/overload (repetitive overhead activities) have been shown to be the major mechanism of RC tendinopathy

The signs and symptoms associated with rotator cuff tendinopathy have been reported to include symptom duration greater than 3 months, minimal resting pain, largely preserved range of shoulder motion and pain exacerbated through resisted testing. Typically, the pain is made worse by sleeping on the affected shoulder and moving the shoulder in certain directions and there can be pressure on the tendons by the overlying bone when lifting the arm up.

The occurrence of rotator cuff tears in the general population is ~20% and increases with age. Chronic rotator cuff tears are most common and result from intrinsic degeneration of the rotator cuff tendons from long-standing overuse, with or without impingement. The typical pattern of progression is tendinopathy, followed by partial-thickness tears and eventual full-thickness tears if left untreated. Acute tears of the rotator cuff are less frequent, with a reported new cases of up to 8%. They often result from a high-energy trauma and tend to be large full-thickness tears.

Biceps tendinopathy, describes inflammation of the tendon that attaches the biceps muscle to the bone and can impair a person's' ability to perform many routine activities. Biceps tendonitis describes a clinical condition of inflammatory tenosynovitis, most commonly affecting the tendinous portion of the long head of the biceps (LHB) as it travels within the bicipital groove in the proximal humerus of the shoulder. The development of the condition ranges from acute inflammatory tendinitis to degenerative tendinopathy.

Isolated cases of LHB are typically observed in young athletes participating in baseball, softball, volleyball, gymnastics, and/or swimming. During an overhead throw, such as pitching in baseball, the thrower’s shoulder is brought into a position of maximum shoulder abduction and external rotation during the late cocking phase. LHB injuries occur in this position secondary to the peel-back phenomenon. Subsequently, the biceps muscle eccentrically contracts to slow down straightening of the elbow during the follow-through phase of throwing.

The vast majority of cases are seen in association with other shoulder conditions including RC tendinopathy, RC tears or subacromial impingement. For example, in RC tears, 90% of cases demonstrated related LHB tendinopathy, and 45% of cases had additional LHB instability.

Adhesive capsulitis also known as “frozen shoulder,” is a common condition of the shoulder defined as a pathologic process in which contracture of the glenohumeral capsule is a distinct feature. Clinically, it presents as shoulder pain, stiffness in three key directions (lifting the arm, reaching sideways and rotating the arm outwards) and dysfunction of the affected shoulder that is often self-limited. Pain is described as a poorly localized, dull ache, and may radiate into the biceps. Reaching overhead or behind the back may stimulate the sensation of pain and stiffness. However, it can persist for years and some patients never regain full function of their shoulder. The occurrence is estimated at 2% to 5% of the general population. Most patients diagnosed with adhesive capsulitis are women between the age of 40 and 60 years.

Glenohumeral (shoulder) osteoarthritis (GOA) is one of the most common causes of shoulder pain in clinical practice. About 16% to 20% of adults older than age 65 years have radiographic evidence of GOA. Affected persons under 50 years account for 5% to 10% of GOA. Factors such as inflammation or trauma have been known to lead to decline in performance and loss of articular cartilage. Therefore, GOA has been divided into primary (unspecific) and secondary (specific) forms depending on whether or not there is a known underlying cause. Specific GOA is by far more common among the younger patients. The occurrence of unspecific GOA ranges from 2 to 10% in the 40–55 years age group, however, significantly increasing during the last decade.

In shoulder OA, shoulder range of motion (ROM) is frequently limited in various directions instead of specific directions. The loss of shoulder motion can be caused by pain, decreased flexibility of soft tissues, and deformity of bones in the shoulder due to arthritis. Weakness especially in the supraspinatus occurs from lack of use of the shoulder because of pain.

The acromioclavicular (AC) joint is formed by the cap of the shoulder (acromion) and the collar bone (clavicle). It is held together by strong ligaments. The outer end of the clavicle is held in alignment with the acromion by the acromioclavicular ligaments and the coracoclavicular (CC) ligaments. The AC joint is strong, but its location makes it vulnerable to injury from trauma. Injury to the ligaments (also called shoulder separation) can occur as a result of a fall, direct blow, or other trauma. AC injuries may be associated with a fractured clavicle, impingement syndromes, and neurovascular damage to the shoulder.

AC joint injuries account for more than 40%of all shoulder injuries. Mild injuries are not associated with any significant condition, but severe injuries can lead to significant loss of strength and function in the affected shoulder. Patients typically present with pain at the top and front of the shoulder and will describe an injury of blunt trauma to the abducted shoulder or landing on an outstretched arm. They may also describe pain radiating to the neck or shoulder, often worse with movement or when they try to sleep on the affected shoulder.

Shoulder instability occurs when the humeral head is unable to maintain its normal alignment with the glenoid (scapula) during shoulder movement, causing forward, backward, or downward offsets. The shoulder can become unstable in three major ways:

Shoulder Dislocation - Severe injury, or trauma, is often the cause of an initial shoulder dislocation. When the head of the humerus dislocates, the socket bone (glenoid) and the ligaments in the front of the shoulder are often injured. The labrum (cartilage rim around the edge of the glenoid) may also tear. This is commonly called a Bankart lesion. A first dislocation can lead to continued dislocations, giving out, or a feeling of instability.
Hyperlaxity - It is possible to experience shoulder instability without first having a dislocation. Most of these patients have looser ligaments in their shoulders. This increased looseness is their normal anatomy and called hyperlaxity.

In a very few patients, the shoulder can become unstable without a history of injury or repetitive strain. In such patients, the shoulder may feel loose or dislocate in multiple directions, meaning the ball may dislocate out the front, out the back, or out the bottom of the shoulder. This is called multidirectional instability. These patients have naturally loose ligaments throughout the body and may be double-jointed.

How Can Physiotherapy Help With Shoulder Pain?

There is growing evidence that surgical intervention does not result in superior patient outcomes compared to physiotherapy alone for shoulder pain. Physiotherapy has been shown to result in a positive short and long term clinical outcomes as subacromial decompression/acromioplasty and acromioplasty plus rotator cuff repair in patients with subacromial pain.

Furthermore, evidence is growing that treating shoulder pain with physiotherapy greatly reduces the number of patients undergoing surgery for subacromial pain syndrome and rotator cuff tea.

The main Physiotherapy intervention for treating shoulder pain and dysfunction is active exercise therapy. At cogent Physical Rehabilitation Centre, our physiotherapists are have proven results treating various shoulder problems and in some cases, significant relief in a few sessions!

REQUEST AN APPOINTMENT WITH OUR PHYSIOTHERAPY CLINIC IN BURLINGTON FOR SHOULDER PAIN RELIEF TODAY

If you are struggling with shoulder pain, we can give you the help to get back to doing the things you enjoy or return to work without pain in your shoulder.

Request an appointment with a physiotherapist in Burlington to begin your journey towards full shoulder pain relief!

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Physical exercises vary widely from general land-based or aquatic exercise to neck-specific endurance, strength, stretching or McKenzie exercises. When exercise was compared with no treatment or placebo, or evaluated as an additional treatment for neck pain, strength, endurance, motor control and stabilizing exercises were beneficial in chronic neck pain, cervicogenic headaches and cervical radiculopathy.