Sore and painful shoulders are one of the most common complaints at Wellington Physiotherapy. The challenge is that the shoulder is a very complex joint and as a result there can be a variety of underlying sources for a person’s painful shoulder. This blog highlights a few of the more common shoulder conditions in very simplified terms. It is important to keep in mind that everyone’s condition is different and should be assessed and treated individually.
The shoulder joint, anatomically known as the glenohumeral joint, is considered a ball and socket joint involving the round ball of the humerus and the shallow socket of the glenoid which is part of the scapula or shoulder blade. Another joint associated with the shoulder is the acromioclavicular joint which involves the collar bone and shoulder blade.
The glenohumeral joint, is often described as a golf ball sitting on a tee because the ball does not sit deeply in the socket. This makes the shoulder a relatively unstable, but highly mobile joint. The joint relies on a capsule, ligaments, tendons and muscles to provide stability and movement. There are over 15 muscles that attach to and influence the bones of the shoulder.
Movement of the shoulder, that we often take for granted, is the result of very complex mechanics between the bones, capsule, ligaments, tendons and muscles.
Some of the common sources of shoulder pain include:
Tendonitis: Tendonitis is usually a sudden onset of pain due to inflammation of the tendons. Tendons are the ends of the muscles that attach to the bone. This inflammation often follows an increase or change in activity involving the shoulder. Treatment of tendonitis involves rest, activity modification, ice, and modalities to help manage the inflammation, followed by a strengthening routine.
Tendonosis: Tendonosis is part of the changes that occur in tendons as they age. As the tendon ages it can show signs of ‘wear and tear’ which are often noted when a person is sent for ultrasound imaging. It is important to understand that many people can have tendonosis and not experience any pain in the shoulder. Depending on the degree of tendonosis the tendon may be susceptible to irritation with overuse and take longer to heal when injured. Treatment for tendonosis involves managing the pain and aggravating activities as well as prescription of exercises to maximize the health of the tendon.
Impingement Syndrome: Impingement Syndrome occurs when the rotator cuff tendons get pinched between bony structures of the joint. There can be many factors that lead to impingement including work/leisure activity at shoulder height, posture and muscle imbalances. Initially, pain is often intermittent, occurring when the shoulder is in a position that causes mechanical compression of the tendon, as the condition progresses the pain becomes more constant as the tendon becomes more sensitized. Treatment requires a thorough assessment to determine the underlying source of the impingement and correction of the shoulder mechanics using manual therapy and exercises.
Rotator Cuff Tears: Rotator cuff tears can result from acute or chronic tearing of the tendon. Tears are often identified through ultrasound or MRI diagnostic imaging. Tears are categorized as partial or full thickness tears. Rotator cuff tears may require assessment by an orthopedic surgeon, but not all tears require surgical repair. Treatment of rotator cuff tears, whether surgical or not, will involve pain management and a specific rehab protocol of strengthening exercises to restore strength to the tendon.
These are a small sample of the numerous sources of shoulder pain, others conditions include: frozen shoulder, calcific tendonitis, AC joint separations, shoulder dislocations and referred shoulder pain.
It is important to have a thorough assessment performed to identify the actual source of the shoulder pain so that the appropriate treatment plan can be developed.
If you are experiencing shoulder pain feel free to contact Wellington Physiotherapy Associate to book an appointment. Our therapists have over 50 years of combined experience treating shoulders.