Shoulder Pain
Shoulder pain is a common complaint in people of all ages and there can be many different causes of shoulder pain. Shoulder pain can occur due to injury, inflammation, or chronic degeneration/tearing of the joints, muscles, tendons, or other soft tissue structures in the shoulder.
Common Conditions of the shoulder treated by PTs at AVORA:
Your PT will perform a skilled evaluation in order to determine what structures are affected, what pathology is most likely contributing to your pain, and will facilitate a treatment plan to reduce your pain and help you get back to your regular activities.
The glenohumeral joint is a ball and socket joint allowing for multidirectional movement including flexion, extension, lateral movements (abduction/adduction), and rotational movements. It is one of only 2 ball and socket joints in the body. The shoulder complex consists of the glenohumeral joint, as well as the scapulothoracic joint which is your shoulder blade. This joint movement allows for retraction and protraction, upward rotation, and elevation and depression. These joints together allow for complete movement of your arm and shoulder for daily activities including reaching and lifting.
Joint Pathology
Shoulder osteoarthritis (OA) occurs in 1 in 3 people over 60 years of age. This occurs when the joint space degrades and the ball of the humerus cannot move as fluidly within the glenohumeral joint socket during movement.
Signs and Symptoms of Shoulder OA:
Although physical therapy cannot stop osteoarthritis it can help to restore and maximize shoulder motion and strength and help to manage and reduce the pain associated with osteoarthritis.
The rotator cuff is a group of the four muscles which allow for the primary movements of your shoulder:
Due to traumatic injuries in sports, during falls, or with other sudden impacts the tendons which attach these muscles to the bone can be torn. In addition, just due to daily activities you can have microtrauma to these tendons leading to irritation and inflammation (tendinopathy) or to partial tearing.
Shoulder impingement is one condition that occurs specific to the supraspinatus in the rotator cuff and with the biceps tendon. Due to shoulder stiffness, poor posture, and muscular imbalances these two tendons run under a bony point called the acromion. They can get pinched as they run under this and attach to the bone and this can lead to irritation contributing to tendinopathy and sometimes even to tearing. Physical therapy can help even if there is a rotator cuff partial tear and often can lead to reduction of pain and return to function without surgery. A common healing timeline for non-surgical rotator cuff pathology is 8-12 weeks. A common healing timeline for surgical repair for rotator cuff is 16-20 weeks.
Signs and symptoms of Rotator Cuff injury or impingement:
Labral Pathology
The labrum is a fibrocartilaginous complex that attaches to the shoulder and its main job is to improve shoulder stability and to allow for controlled movement to occur.
The labrum can be injured traumatically such as in sports or falls in which the shoulder is dislocated or subluxed (partial dislocation) but it can also be injured due to repetitive overhead activities or movements. If you are overly flexible or hypermobile the labrum can be injured due to too much movement of the shoulder during daily activities.
Signs and symptoms of Labral injury:
Adhesive Capsulitis (Frozen Shoulder)
Adhesive capsulitis, or frozen shoulder, is an inflammatory condition in which the shoulder mobility is significantly restricted and the shoulder can be very painful. The motion loss occurs in a specific pattern which is referred to as a capsular pattern. This is different from the motion restriction occurring with osteoarthritis and is often described as “a hard stop”. Adhesive capsulitis generally has a good prognosis for near full recovery of mobility and full resolution of pain.
Frozen Shoulder is generally talked about in phases:
Although the true cause of frozen shoulder remains unknown there are risk factors which increase your likelihood of this condition.
Risk Factors for Adhesive Capsulitis:
How will PT help with my shoulder pain?
Common Conditions of the shoulder treated by PTs at AVORA:
- Shoulder Osteoarthritis
- Rotator Cuff Tendinopathy
- Shoulder Impingement
- Rotator Cuff Tears (non-surgical, prehab, and postsurgical rehabilitation)
- Labral Injuries (non-surgical, prehab, and postsurgical rehabilitation)
- Adhesive Capsulitis
Your PT will perform a skilled evaluation in order to determine what structures are affected, what pathology is most likely contributing to your pain, and will facilitate a treatment plan to reduce your pain and help you get back to your regular activities.
The glenohumeral joint is a ball and socket joint allowing for multidirectional movement including flexion, extension, lateral movements (abduction/adduction), and rotational movements. It is one of only 2 ball and socket joints in the body. The shoulder complex consists of the glenohumeral joint, as well as the scapulothoracic joint which is your shoulder blade. This joint movement allows for retraction and protraction, upward rotation, and elevation and depression. These joints together allow for complete movement of your arm and shoulder for daily activities including reaching and lifting.
Joint Pathology
Shoulder osteoarthritis (OA) occurs in 1 in 3 people over 60 years of age. This occurs when the joint space degrades and the ball of the humerus cannot move as fluidly within the glenohumeral joint socket during movement.
Signs and Symptoms of Shoulder OA:
- Aching pain at rest, especially first thing in the morning
- Pain diffused in the shoulder and upper arm
- Restricted movement and or creaking/catching during arm movement. This creaking is referred to as crepitus
Although physical therapy cannot stop osteoarthritis it can help to restore and maximize shoulder motion and strength and help to manage and reduce the pain associated with osteoarthritis.
The rotator cuff is a group of the four muscles which allow for the primary movements of your shoulder:
- Supraspinatus - This muscle is a small muscle that runs from the upper portion of your shoulder blade, around to the greater tubercle on the humerus. It runs under the acromion as it attaches to the greater tubercle. This muscle is responsible (along with the medial deltoid) for shoulder abduction or lifting your arm out to the side. This is the most common tendon to injure, irritate, or tear nontraumatical.
- Infraspinatus - This muscle starts from the lower portion of your scapular and attaches to the greater tubercle of the humerus. This muscle is responsible for external rotation of the shoulder. Examples of this motion include reaching behind you for an object or for the seat belt.
- Teres Minor - This is a small muscle which runs from the lateral scapula to the greater tubercle of the humerus. This muscle assists with external rotation and abduction of the shoulder.
- Subscapularis - This muscle sits between the bottom of the scapula and your ribcage. It runs from the scapula to the lesser tubercle of the humerus (located in the front of the shoulder). This muscle is responsible for internal rotation such as reaching behind your back to put on a belt or bra.
Due to traumatic injuries in sports, during falls, or with other sudden impacts the tendons which attach these muscles to the bone can be torn. In addition, just due to daily activities you can have microtrauma to these tendons leading to irritation and inflammation (tendinopathy) or to partial tearing.
Shoulder impingement is one condition that occurs specific to the supraspinatus in the rotator cuff and with the biceps tendon. Due to shoulder stiffness, poor posture, and muscular imbalances these two tendons run under a bony point called the acromion. They can get pinched as they run under this and attach to the bone and this can lead to irritation contributing to tendinopathy and sometimes even to tearing. Physical therapy can help even if there is a rotator cuff partial tear and often can lead to reduction of pain and return to function without surgery. A common healing timeline for non-surgical rotator cuff pathology is 8-12 weeks. A common healing timeline for surgical repair for rotator cuff is 16-20 weeks.
Signs and symptoms of Rotator Cuff injury or impingement:
- Aching pain in the shoulder at rest or with sleeping
- Sharp or radiating pain with reaching, lifting, or movement of the arm and shoulder
- Shoulder or arm weakness
- Pinching and/or catching in the shoulder
Labral Pathology
The labrum is a fibrocartilaginous complex that attaches to the shoulder and its main job is to improve shoulder stability and to allow for controlled movement to occur.
The labrum can be injured traumatically such as in sports or falls in which the shoulder is dislocated or subluxed (partial dislocation) but it can also be injured due to repetitive overhead activities or movements. If you are overly flexible or hypermobile the labrum can be injured due to too much movement of the shoulder during daily activities.
Signs and symptoms of Labral injury:
- Pain in the shoulder that is deep. It can be sharp or achy
- Catching or clicking in the shoulder
- Feelings of instability in the shoulder, especially with overhead motions
Adhesive Capsulitis (Frozen Shoulder)
Adhesive capsulitis, or frozen shoulder, is an inflammatory condition in which the shoulder mobility is significantly restricted and the shoulder can be very painful. The motion loss occurs in a specific pattern which is referred to as a capsular pattern. This is different from the motion restriction occurring with osteoarthritis and is often described as “a hard stop”. Adhesive capsulitis generally has a good prognosis for near full recovery of mobility and full resolution of pain.
Frozen Shoulder is generally talked about in phases:
- The Freezing Phase - Pain begins and worsens. Pain is often the worst at night. Motion starts to become more restricted. This can last anywhere from 6 weeks to months. It is important during this phase to manage pain and maintain mobility of the shoulder.
- The Frozen Phase - Pain lessens in intensity but motion remains restricted. Often when you notice the feeling of “it just won’t go”. This stage can last for 8 weeks- months.
- The Thawing Phase - Motion starts to progress towards normal. Increased pain is variable. It is important to have a personalized program during this phase to guide you in return of full motion and return of strength.
Although the true cause of frozen shoulder remains unknown there are risk factors which increase your likelihood of this condition.
Risk Factors for Adhesive Capsulitis:
- Women >50 years of age
- Diabetes
- Women in menopause
- Thyroid conditions
- Cardiovascular disease
- Having had a recent shoulder injury or surgery
How will PT help with my shoulder pain?
- Manual interventions to improve shoulder and scapular joint mobility
- Stretches, soft tissue mobilization, trigger point release, or muscle energy techniques to improve muscle flexibility or soft tissue mobility
- Guided functional strengthening program to focus on the rotator cuff and allow for return to regular activity
- Plyometrics and sport-specific training for return to sport
- Posture retraining and strengthening to reduce impingement and allow for improved shoulder complex mobility
- Proper instruction in the use of modalities if needed for returning pain or inflammation and for improving mobility
- Post-operative PT if needed for rotator cuff repair, labrum debridement or repair, joint reconstruction or other surgeries from days after surgery until full function is restored