Shoulder pain can be really debilitating. It impacts on your ability to do normal tasks during the day, not to mention the pain at night when you roll over (insert sad and tired face). So, what could be the cause of your shoulder issue and what should you do? Tom Hamilton has some great info for you on a few of the more common shoulder injuries.
Let’s look at the shoulder
The shoulder is a complex joint. Here is a diagram and a glossary of terms to help you better understand how it works.
The shoulder viewed from the front (on the right), the back (on the left) and the side with the arm removed
- rotator cuff – a group of four muscles and tendons, subscapularis, supraspinatus, infraspinatus and teres minor.
- humerus – the large bone between the shoulder and the elbow. The part that joins to make the shoulder is rounded, a bit like a ball.
- tendons – endons are the tough fibres that connect muscle to bone.
- glenoid – the shoulder socket.
- labrum – a piece of rubbery tissue attached to the rim of the shoulder socket that helps to keep the ball of the joint (humerus) in place.
- scapular – shoulder blade
- clavicle – collar bone
What is the Rotator Cuff?
The rotator cuff keeps the head of your upper arm bone firmly within the shallow socket of the shoulder. The rotator cuff is prone to tears and damage to the tendons (tendinopathies).
Splitting and tearing of tendons may result from an acute injury such as falling directly onto the shoulder or lifting heavy objects in awkard positions.
Degenerative changes in the tendons due to advancing age, long-term overuse and wear and tear can also impact the rotator cuff. These tears may be partial or the tendon may competely split into two pieces. In most cases where there is a complete tear, the tendon is pulled away from its attachment to the bone. Not all rotator cuff tears are painful, studies have shown that 20% of adults have partial thickness tears and 15% have full thickness tears with no symptoms at all.
Can tendons be injured?
Tendons can become irritated, inflamed and have micro tears. In many ways tendinopathies (injured tendons) precede tendon tears, particularly degenerative and overuse tears and are a sign that the tendons are being loaded incorrectly.
Instability
Instability is an increase in movement of the humeral head in the glenoid. This can happen as a result of a sudden injury or from overuse. The increase in movement can often cause damage to other structures in the shoulder such as the rotator cuff, joint capsule, labrum and the bony elements.
Treatment of instability depends on the severity of instability and the condition of the other associated structures. Your physiotherapist will do a detailed assessment to assess the direction/s of instability. Shoulder instability can often be treated with physiotherapy, but in severe cases surgery may be warranted.
What is Impingement/ Bursitis?
Shoulder impingement is a broad term which most commonly describes the narrowing of the space between the shoulder blade (acromion) and top of the arm bone (humerus). This decrease in space puts pressure on the underlying soft tissue (rotator cuff and bursa) which sits in this space. Rubbing and pressure on these tissues often leads to inflammation of the bursa (bursitis) and rotator cuff (tendinitis), if left untreated, this can lead to rotator cuff tear and thickening of the bursa.
Arthritis in Shoulders
Shoulder pain can also be caused by arthritis. There are many types of arthritis and the most common type of arthritis in the shoulder is osteoarthritis, also known as “wear and tear” arthritis. Osteoarthritis, may be related to sports or work injuries and chronic wear and tear. Other types of arthritis can be related to rotator cuff tears, infection, or an inflammation of the joint lining.
Often people will avoid shoulder movements in an attempt to lessen arthritis pain. These adaptations sometimes lead to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion. Severe arthritis can be treated with a shoulder replacement.
Fractures
Shoulder fractures or breaks commonly involve the clavicle, humerus or scapular. In the elderly these breaks are usually from falls, in the younger population these types of injuries are from high impact/energy incidents (car crashes, sports). Fractures require immediate medical attention and often involve significant pain, swelling and bruising.
Tom Hamilton is a physiotherapist in our Penrith practice. Apart from being an excellent physio, he’s a pretty decent soccer player. Other articles by Tom:
