Are you struggling to be active in your sport because of shoulder pain?
Perhaps you’re struggling to sleep at night or lie on your affected side?
Maybe it’s getting to the stage where it’s actually difficult to put clothes on?
Shoulder pain can be really unpleasant and disabling, especially if it’s impacting your ability to get a good night’s sleep. Don’t struggle on – there’s lots we can do to help.
What is causing my shoulder pain?
What is causing my shoulder pain? The shoulder is a wonderfully versatile, but complex joint and consists of a ball and socket joint for the socket being housed in the shoulder blade. The shoulder unit is attached to the body by the collarbone- a bit like the boom of a crane.
There’s an elegant arrangement of muscles and tendons, which pull the ball onto the socket, rotate the shoulder blade, and enable us to put our hand in many different positions.
The shoulder moves with the rest of our bodies and is intimately related with our neck and thoracic spine and sometimes pain in the shoulder is actually referred from these areas.
There are common kinds of shoulder injuries that you may have learned about including rotator cuff pain, which we sometimes call subacromial pain. Pain is can also be generated by wear or irritation of a joint on top of the shoulder called the ACJ (acromioclavicular joint). In sport, it’s possible to injure the shoulder during a fall, or even dislocate it.
Most of the shoulder pain I see in clinic, however, occurs as a result of overuse and postural issues.
Dr Cath was wonderful. She was kind, thorough, and after an examination and an ultrasound she worked out that I had problem with shoulder tendons and my ‘ACJ’. After an injection and physio exercises, I was back on the court within a month. Fantastic!
How do we diagnose the cause of the shoulder pain?
In clinic, I begin with a thorough assessment of the symptoms you were experiencing when you experience it, what positions would affect your pain the most, and what has happened in the past. And then examine you to see how you’re moving.
Is your range of movement limited in all directions, which might be a sign of a frozen shoulder (capsulitis)?
Perhaps you have pain elevating your arm above your head that may indicate pain arising from the rotator cuff tendons and the bursae that in an area we call the subacromial space.
Sometimes there may be symptoms, which point to the possibility of an injury to the labrum in the shoulder, which is a ring of gristle at the entrance to the shallow shoulder socket which assists with shoulder stability.
What investigations might be needed?
Sometimes you might want to further assess the shoulder using a musculoskeletal ultrasound scan, or if you believe that there may be an issue deep in the shoulder, such as a problem with the labrum or capsule, we might want to carry out a high-resolution MRI scan.
What are the treatments for shoulder pain?
The conditions we commonly see are related to the rotator cuff (aka subacromial pain or shoulder impingement). Sometimes poor movement or abnormal loads can lead to tendinopathy of one or more of the rotator cuff tendons (e.g. the supraspinatus tendon). This may secondarily lead to irritation within the bursa that sits next to it, and the space we call the subacromial space.
Really good physiotherapy and osteopathy techniques to realign the shoulder and restore normal movement patterns are very, very important. Sometimes we’ll need to set you up with an ultrasound-guided injection of cortisone to settle this area down so that you can carry out the rehab more comfortably.
In the case of a frozen shoulder, we might need to consider an injection called a hydro dilation or a high-volume injection to help gently stretch the capsule to improve pain and stiffness around the shoulder.
Is surgery required to treat my shoulder pain?
Thankfully, whilst it may have been more common-place in the past, thankfully these days, it’s not common that we need to refer people for shoulder surgery. We now know from research that rehab is usually the way to go, most people recover well with exercise, and that surgery doesn’t add any benefit in the long-run. If you’re experiencing shoulder pain that’s not settling. Please don’t hesitate to book a consultation.