Feeling like you have more than a little weight on your shoulders? You are not alone. Here at Fairfield Physiotherapy, we meet many people suffering from pain caused by a shoulder injury. The majority of shoulder injuries are brought about by excessive or repetitive motions during sport, manual labour or even everyday activities such as hanging curtains. Let’s explore the most common types of shoulder injuries and how physiotherapy can help.
WHAT IS A SHOULDER INJURY?
If you find yourself suffering from a great deal of shoulder or neck pain after a workout or a series of long days at the office, you may have a shoulder injury.
Such injuries can vary greatly from one person to the next, but the most common types of shoulder injuries include:
Rotator Cuff Injuries
Rotator cuff injuries refer to a spectrum of disorders occurring in the complex structure of muscles and tendons responsible for the stability and movement of the shoulder joint. These injuries often stem from acute trauma, degeneration over time, or repetitive strain from overhead activities like throwing or swimming. They can also manifest with other issues, such as inflammation, bursitis, or tears in the cuff itself.
The American Academy of Orthopaedic Surgeons has stated that rotator cuff tears are among the most common conditions affecting adults, noting how they can lead to significant disability and deteriorate one’s quality of life.
Frozen shoulder, clinically known as adhesive capsulitis, can be a truly painful and debilitating condition with a progressive loss of both active and passive shoulder motion. Unfortunately, the cause is largely unknown, but likely linked to inflammation and fibrotic changes that lead to capsular contraction.
The shoulder itself is a relatively unstable joint to assist with a greater range of motion, leaving it exposed to injury. When the head of the upper arm bone (the humerus) is forced out of the shoulder socket, either partially or completely, it will dislocate in a forward, backward or downward direction. Usually due to strong force or extreme rotation, dislocation can cause pain, swelling, numbness, and sometimes visible deformity. Treatment for a dislocated shoulder needs to occur as soon as possible, beginning with everything being returned to their appropriate place.
An acromioclavicular joint injury – more commonly referred to as a shoulder ‘separation’ – refers to specific trauma to the joint where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). Those engaging in high-impact sports are most at risk, with a contact or a fall onto the shoulder or outstretched hand causing the displacement. Depending on the severity, treatment can range from conservative management to surgical intervention to reduce pain and regain maximum shoulder function.
Given the correct postural needs for the shoulder joint to function properly, breaks in this area can prove difficult and require individualised treatment plans. Shoulder fractures themselves can occur anywhere around the collarbone, proximal humerus, and shoulder blade. These are typically the result of high-impact trauma, such as a hard fall or motor vehicle collision. The approach to rehabilitation will depend on the location and extent of the fracture, as well as the patient’s age and overall health.
Shoulder impingement syndrome occurs when the rotator cuff tendons or bursa become ‘impinged’ or compressed during your regular shoulder movements, creating intense pain and restricted movement. Causes vary, stemming from anatomical factors like bone spurs, to wear and tear from overuse and repetitive activity. Careful rehabilitative exercise programs and lifestyle alterations can help to resolve the issue, but surgical intervention may be necessary for more serious, chronic conditions.
Arthritis of the Shoulder
As with the other areas of the body, arthritis of the shoulder will stem from a group of conditions causing inflammation in the shoulder joint, as well as a gradual wearing down of cartilage. The most common types are:
- osteoarthritis (‘wear and tear’)
- rheumatoid arthritis (an autoimmune disease)
- posttraumatic arthritis (following injury)
Treatment methods normally require a combination of physical therapy, medications, and, in some cases, surgery.
Bursitis is inflammation and swelling of the bursa, a fluid-filled sac that reduces friction between the joint’s bones, tendons, and muscles. It’s often caused by repetitive, minor impact or sudden, more serious injury. Shoulder bursitis can lead to pain and impact the range of motion.
A tear in the cartilage ring (labrum) around the shoulder socket can cause pain and instability in the shoulder. This can occur from acute trauma or repetitive shoulder motion. Athletes in sports that require overhead motions, such as baseball, swimming and weightlifting, are at greater risk.
Bone spurs, or osteophytes, are bony projections that form along joint margins. They typically occur in response to damage from osteoarthritis as the body attempts to repair itself. In the shoulder, they can limit joint movement and cause pain.
WHAT ARE THE SYMPTOMS OF A SHOULDER INJURY?
The shoulder is made up of the humerus (arm bone), scapula (shoulder blade) and clavicle (collar bone) and is surrounded by many ligaments and muscles that support the shoulder and help it move. Our shoulder joints allow for a high degree of mobility, but this also means it is less stable and more prone to injuries than other joints of the body.
Symptoms of a shoulder injury to look out for include pain, swelling, numbness, tingling, changes in temperature or colour of the skin, and changes in the range of motion you have in this part of the body.
HOW CAN A PHYSIOTHERAPIST HELP WITH A SHOULDER INJURY?
The key to overcoming any shoulder injury is quickly identifying the type of injury and applying an appropriate pain management and rehabilitation plan. That is where physiotherapy can help! By diagnosing and effectively treating your injury, we can help you overcome pain and discomfort, improve your shoulder mobility, as well as help prevent further injury from occurring.
Diagnosis: First and most importantly, a physiotherapist will need to diagnose the cause of your shoulder pain. This is incredibly important because understanding where your pain is coming from will determine the type of treatment you receive.
Our physiotherapists conduct a range of motion and muscle strength tests to help identify where the pain is felt, both at rest and during movement of the shoulder.
Treatment: After diagnosing your shoulder pain, we ascertain the best way to relieve any pain and inflammation. In many cases, intermittently applying an ice pack to the affected area can be incredibly effective and if more help is needed with immediate pain relief, doctors can also prescribe non-steroidal anti-inflammatory drugs (NSAIDs).
As pain and inflammation subsides and your shoulder begins to heal, your physiotherapist will then focus on restoring your range of movement and building muscle in the area – to help prevent further injury.
Your physiotherapist can assist you with a suitable range of motion exercises and strengthening and rehabilitation exercises during your recovery.
If you’re looking for a physio for a shoulder injury or wish to discuss your symptoms, make an appointment with Fairfield Physiotherapy on (03) 9489 7744. We’ll arrange your comprehensive consultation and begin a course of corrective care today!
May T, Garmel GM. Rotator Cuff Injury. 2022 Jun 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613444.
American Academy of Orthopaedic Surgeons, Rotator cuff tears, 2020, https://orthoinfo.aaos.org/en/diseases–conditions/rotator-cuff-tears/
St Angelo JM, Fabiano SE. Adhesive Capsulitis. [Updated 2022 Dec 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532955/
Ramirez J. Adhesive Capsulitis: Diagnosis and Management. Am Fam Physician. 2019 Mar 1;99(5):297-300. PMID: 30811157.
Abrams R, Akbarnia H. Shoulder Dislocations Overview. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459125/
Frank RM, Cotter EJ, Leroux TS, Romeo AA. Acromioclavicular Joint Injuries: Evidence-based Treatment. J Am Acad Orthop Surg. 2019 Sep 1;27(17):e775-e788. doi: 10.5435/JAAOS-D-17-00105. PMID: 31008872.
Warth RJ, Martetschläger F, Gaskill TR, Millett PJ. Acromioclavicular joint separations. Curr Rev Musculoskelet Med. 2013 Mar;6(1):71-8. doi: 10.1007/s12178-012-9144-9. PMID: 23242975; PMCID: PMC3702768.
Burkhart KJ, Dietz SO, Bastian L, Thelen U, Hoffmann R, Müller LP. The treatment of proximal humeral fracture in adults. Dtsch Arztebl Int. 2013 Sep;110(35-36):591-7. doi: 10.3238/arztebl.2013.0591. Epub 2013 Sep 2. PMID: 24078839; PMCID: PMC3785018.
Creech JA, Silver S. Shoulder Impingement Syndrome. 2023 Apr 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32119405.
Creech JA, Silver S. Shoulder Impingement Syndrome. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554518/
Millett PJ, Gobezie R, Boykin RE. Shoulder osteoarthritis: diagnosis and management. Am Fam Physician. 2008 Sep 1;78(5):605-11. PMID: 18788237.
Williams CH, Jamal Z, Sternard BT. Bursitis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513340/