Shoulder Pain

Our shoulders are one of our most mobile joints. Muscle stability and control is vital to shoulder health.

Rotator cuff issues are the most common condition we come across when it comes to shoulder problems. Your rotator cuff is a group of muscles which keeps the top end of your arm bone centered in its socket. Problems arise when we try to use these muscles to hold static postures such as when you are at your desk. The larger rotator cuff muscles becomes stiff and instead of stabilizing the shoulder they start to jam the arm bone into the socket and limit both the accuracy and range of movement. You tend to feel this either as tightness or pain with lifting the arm up to around 90 degrees away from the side of your body.

These kinds of rotator cuff dysfunctions can lead to tearing of smaller, weaker rotator cuff muscles - most commonly the small supraspinatus, as the larger muscles lead to its fraying. This can be confirmed on ultrasound imaging if we suspect it - but we can also diagnose it fairly well with a few tests in the clinic. If the tears are serious they may require surgery in which case we would need to refer you to a specialist. A frequently inflamed rotator cuff can also develop calcifications within itself. Think of it as a small bit of bone growing within the muscle. This little bit of bone can then squish a piece of muscle up against other bones in the vicinity causing minor bruising and inflammation of the muscle. This can usually be settled with structural osteopathy, but in severe cases we may need to refer you for an ultrasound or a cortisone injection. Then after that, treatment can remedy the remaining symptoms and help you greatly decrease the chances of the same condition happening again. Another structure called a bursa can become squashed and inflamed. See the appropriate section on this page for more information.

The shoulder joint itself can be a problem of course. Arthritis of the shoulder joint is comparatively rare, but not impossible, especially after a major injury or fracture. In such cases with osteopathy we address the surrounding problems in muscles of the shoulder and other areas which may be influenced. We also tend to get you involved with doing certain strengthening and stretching exercises in order to both create a more lasting treatment result and to create a routine for you to increase your mobility. In general, with more severe cases it is never possible to recover 100% of movement but we can get fairly close to that.

Frozen shoulder (adhesive capsulitis) is the most common shoulder joint affliction which we tend to see. This is a condition where the capsule of your shoulder joint becomes inflamed and segments of it stick to each other. Frozen shoulder usually has a rough 6 month period called the freezing stage where pain levels are quite intense and there is a gradual loss of movement. The next 6 month stage is called the frozen stage where the shoulder movement is quite limited but there is very little pain. The final 6 months consist of a gradual recovery of movement but never quite to full range. This is why if we catch frozen shoulder early there are many options which can halt it before it fully progresses and leaves you with a lasting lack of movement. Another area in the shoulder which can cause problems is the acromioclavicular joint. It’s the little bony lump on the top side of your shoulder. It’s where your collar bone joins onto a bony projection from the shoulder blade. This little joint can become arthritic usually as a result of a major injury or dislocation, or simply due to a long time of poor posture. In general muscle balance recovery is very important in order to take as much load off the acromioclavicular joint.

Where ever a tendon or a muscle is likely to rub over another structure the body there is a fluid sac (like a water balloon) called a bursa which prevents fraying from taking place. When a sudden impact or a repetitive movement which irritates it takes place, bursitis can develop. In the case of the shoulder where space is already tight, this leads to a pinching sensation when reaching out or lifting your arm away from the side of your body.

Bursitis can be slow to improve because the circulation in the area is very poor. Also it is quite common to keep compressing the bursitis with simple everyday movements if the bursa is quite swollen. Osteopathic treatment is aimed at keeping the pressure off the bursa. We also tend to show you some exercises and stretches which you can do on your own at home to speed up the process. This is still a slow recovery process usually. If the bursa is completely resistant to conventional treatment, we can also refer you for an ultrasound guided cortisone injection to get rid of bursitis if you would like to take that approach.

The shoulder is very dependant on muscular balance, so all of its muscles can potentially be a problem. The rotator cuff is the most commonly affected muscle group in the shoulder, closely followed by the biceps and then pectoral and deltoid strains. All of these generally happen either with an activity that is too heavy for your shoulders or is unusual in comparison to your usual activities. For example a career office worker who has never picked up anything heavier than a pencil decides to go and try weightlifting. He could potentially perform this task just fine but not all at once.

We also need to consider that the shoulder is built for mobility, however, with our sedentary jobs we often put our shoulders into very compromising static postures. The most common example we see is a computer worker who is right handed with the mouse and ends up leaning over to their left side onto the elbow. This drives force up into the left shoulder and both stiffens and compresses it. Pectoral problems tend to arise more so from exercise injuries because they are large muscles which give the shoulder power rather than stability. It is also possible to get referral of pain into the pectoral area can from the neck. Biceps problems tend to arise from either exercise or heavy work. Whilst any muscle can suffer from any problem, some are more prone to certain issues. The biceps consists of two heads, the long and short heads. The long head has a very long tendon which runs along the front of the shoulder and can be easily tested in clinic for soreness or instability within the small bony groove it runs through. This tendon is also prone to swelling or developing minor tears. If there are any concerns about moderate damage, we always recommend imaging - usually in the form of ultrasound.

The shoulder can hurt as a result of other structures sending pain to it. The neck is the most common structure to send pain to the shoulder as a result of a disc problem. In this case you will generally not feel much pain in the neck, just in the shoulder. The shoulder pain will be eased if you put the hand of the affected side onto your head. Tilting your head back will also make it worse after several seconds, or laying on a thin pillow with your head dipping back. In these cases we need to double check with a series of neurological tests in clinic. If they are positive we may need to order some imaging or we may need to refer you to a specialist.

Organs from the upper abdomen can also irritate your biggest breathing muscle called the diaphragm which will then refer to the shoulder on the same side. The left shoulder is also affected by heart problems although heart pain is quite particular in nature. Your shoulder and arm pain would be worse when you exert yourself such as climbing the stairs. In some of these cases we can do a few clinical tests to try and track down where the pain is coming from, but in many cases where we suspect an organ problem we need to send you to get further investigations done. Whilst this technically isn’t a shoulder problem, it is very closely related to the shoulder as the neck and shoulder affect each other quite profoundly. The front of your neck consists of many strand-like muscles between which all the nerves, arteries and veins pass which then travel further on to the shoulder and arm. These muscles can compress the blood vessels and cause swelling in your hands - usually worse first thing in the morning. They can also compress the nerves which would lead to tingling, numbness or pain in the shoulder or arm region. Thus if we take this into account, we can’t really treat the neck without the shoulder and vice versa.

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