6 reasons that may be causing your shoulder pain and how to treat it

Do you suffer from chronic pain in your shoulder as well as a lack of mobility? Shoulder pain and injuries is a common complaint for many adults. 

Shoulder pain and injuries include a range of conditions, each with its underlying causes and symptoms. As one of the most mobile joints in the body, the shoulder is susceptible to different forms of discomfort, which may lead to injuries and pain. 

Various reasons may cause the discomfort, including overuse, trauma, age-related wear and tear, or any underlying medical condition. Whatever the cause, it’s crucial to treat shoulder pain as soon as possible because prolonged damage to the joint can lead to problems later on, such as arthritis or a frozen shoulder

If you are constantly experiencing shoulder pain, or it returns easily, there may be more reason behind it besides a temporary strain or injury. 

shoulder pain
Shoulder pain is a common complaint as it is one of the most mobile joints in the body.

Here are some 6 common types of shoulder injuries and conditions that may be causing your pain:

1. Rotator cuff injuries

The rotator cuff consists of four muscles that keep the head of your upper arm bone firmly in place inside the shoulder socket. Rotator cuff injuries [1] are a common cause of shoulder pain due to overuse and wear and tear of the joint. It feels like a dull ache and often worsens with age. It is also common for rotator cuff pain to be especially bad at night. 

Rotator cuff injuries can be treated in several ways, depending on the severity of your pain. Surgery may be required for serious injuries. For mild cases, physiotherapy and medication can help alleviate the pain and improve symptoms. 

Symptoms of rotator cuff injuries include:

Rotator cuff injuries consist of: 

rotator cuff injuries
Rotator cuff pain can be caused by a tear, tendinitis, or tendinopathy.

In general, rotator cuff injuries are commonly caused by:

rotator cuff injury
A rotator cuff injury can cause pain and limited range of motion in the shoulder. 

2. Bursitis

Also known as inflammation of the bursa – a small fluid-filled sac that cushions the joints; bursitis [5] refers to a condition in which the bursa becomes inflamed and causes pain. Bursitis can be prevented by caring for your joints, such as warming up before workouts, gradually increasing exercise, using protection for your joints such as padding, resting sufficiently, and not overusing your arm when feeling pain. However, if it still happens, it may be time to visit a specialist to seek treatment such as medication, surgery, or physiotherapy

The most common causes of bursitis are injury or overuse, which can also be caused by infection. Pain, swelling, and tenderness near a joint are the most common signs of bursitis. Bursitis can be treated with rest and medicines to help with the inflammation. Antibiotics are used if infection is found.

Symptoms of bursitis include:

Common causes of bursitis include:

bursitis
Bursitis occurs when the bursa becomes inflamed, causing symptoms such as pain and tenderness.

3. Shoulder impingement syndrome

Shoulder impingement syndrome happens when the rotator cuff rubs or pinches between your humerus and the top outer edge of your shoulder. When the tendons of the rotator cuff and the subacromial bursa are compressed or pinched during shoulder movements, it can result in this painful condition. This impingement leads to pain, inflammation, and limited range of motion. It is a common cause of shoulder pain, with shoulder impingement syndrome being the cause of 44% to 65% of all shoulder pain complaints [6].

Symptoms of shoulder impingement symptoms include: 

Common causes of shoulder impingement syndrome include: 

poor posture
Poor posture, caused by prolonged sitting, can cause shoulder pain and muscle imbalances. 

4. Frozen shoulder

As mentioned previously, lingering shoulder pain can also lead to a condition known as frozen shoulder. Frozen shoulder [7] is the gradual onset of stiffness and pain. The condition is marked by the thickening and tightening of the capsule surrounding the shoulder joint, which may impact the joint's range of motion.

Signs and symptoms of a frozen shoulder typically begin gradually and then worsen. However, it usually gets better within one to three years with treatment. It is believed to be caused by keeping a shoulder still for an extended period, such as after breaking an arm or having a surgical procedure.

Frozen shoulder is usually treated with physiotherapy, such as range-of-motion exercises. Medication such as corticosteroids, painkillers, and numbing medications through injections may also be prescribed. Surgery may be recommended in rare and severe cases to allow the frozen shoulder joint to move more freely.

frozen shoulder
Frozen shoulder usually occurs due to long periods of immobility of the shoulder.

Symptoms of frozen shoulder (adhesive capsulitis):

Certain factors and causes may indirectly lead to frozen shoulder. These include:

swelling
Swelling and inflammation in the shoulder are common signs of shoulder injury. 

5. Shoulder fractures and dislocation

Shoulder injuries such as fractures and dislocation can cause severe pain and limited movement in the joint. When the shoulder joint is forced out of its normal position, often due to trauma or shoulder instability, it can result in shoulder dislocation. A dislocated shoulder happens when the upper arm bone pops out of the cup-shaped socket in the shoulder blade. This causes pain and discomfort in the shoulder. When there are fractures in the shoulder bones, such as the clavicle [8] or humerus [9], they can also cause pain.

Fractures and dislocation in the shoulders are usually caused by traumatic injuries such as car accidents, falls, or sports injuries. Fractures and dislocated shoulders require prompt treatment. A sling or brace may be necessary for a few weeks until the shoulder heals. In some cases, surgery may be needed to repair the fracture. Recovering from these types of shoulder injuries can take a few months. 

Symptoms of shoulder dislocation:

Symptoms of shoulder fractures:

sharp and sudden shoulder pain
Fractures or acute rotator cuff tears may cause sharp or sudden pain and impact daily activities.

6. Arthritis

Arthritis [10] is a condition due to damage to the cartilage of the joints. It can be caused by overuse and lack of treatment for shoulder pain because it happens when the cartilage starts to wear down on the socket of the shoulder joint. This leads to chronic pain, stiffness, and reduced mobility in the arm and shoulder. Our shoulder joints may experience degenerative changes as we age, resulting in osteoarthritis. The wear and tear on the joint can cause pain and reduced functionality.

Although it is a condition that can severely impact one’s quality of life, several treatments for arthritis lead to effective results, these include certain stretches and exercises, lifestyle changes, ice or heat application, and medication. 

Shoulder pain due to arthritis can be caused by:

Symptoms of arthritis:

shoulder pain
The risk of shoulder injuries and pain increases with age. 

How is shoulder pain treated?

Now that you know the reasons behind shoulder pain, you should know that several forms of treatment are available. Once a diagnosis is confirmed, an appropriate treatment plan can be developed based on the underlying condition and individual needs. 

It's crucial to consult with a qualified healthcare provider, such as a physiotherapist, for a thorough evaluation and proper diagnosis. 

Once that’s done, there are several treatment options that your specialist will discuss with you. The treatment plan typically depends on your pain, the underlying cause (such as if a traumatic injury or overuse causes it), and the severity of the condition. 

Here at Physioactive, our shoulder injuries expert, Dr Denis Mecklenburg, with 17 years of experience and over 1000 treated shoulders, will give you the most effective treatment for your shoulder injury. Some commonly used treatment options for shoulder pain and injuries include:

Seeking timely medical advice is crucial for accurate diagnosis and appropriate management of shoulder injuries and pain. If you suffer from shoulder pain or injuries, schedule an appointment with Physioactive for proper diagnosis and individualised treatment. 

exercise therapy
Exercise therapy may help strengthen the shoulder muscles, improve range of motion, and correct muscle imbalances. 

References

  1. Mayo Clinic Staff. 2023. Rotator Cuff Injury: Symptoms & Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/syc-20350225#:~:text=The%20rotator%20cuff%20is%20a,common%20and%20increase%20with%20age.
  2. Author Unknown. 2021. Rotator Cuff. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/21504-rotator-cuff
  3. Tooth, C., Gofflot, A., Schwartz, C., Croisier, J. L., Beaudart, C., Bruyère, O., & Forthomme, B. (2020). Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review. Sports health, 12(5), 478–487. https://doi.org/10.1177/1941738120931764.
  4. Dabija, D. I., Gao, C., Edwards, T. L., Kuhn, J. E., & Jain, N. B. (2017). Genetic and familial predisposition to rotator cuff disease: a systematic review. Journal of shoulder and elbow surgery, 26(6), 1103–1112. https://doi.org/10.1016/j.jse.2016.11.038
  5. Johns Hopkins Medicine. (n.d.). Bursitis. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/bursitis#:~:text=Bursitis%20is%20inflammation%20of%20a,elbows%2C%20hips%2C%20and%20knees.
  6. Author Unknown. 2021. Shoulder Impingement Syndrome. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/7079-shoulder-impingement-syndrome
  7. Mayo Clinic. (n.d.). Frozen Shoulder (Adhesive Capsulitis): Symptoms & Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684#:~:text=Frozen%20shoulder%2C%20also%20called%20adhesive,risk%20of%20developing%20frozen%20shoulder.
  8. Oliver Jones. 2020. The Clavicle. Teach Me Anatomy. https://teachmeanatomy.info/upper-limb/bones/clavicle/
  9. Oliver Jones. 2020. The Humerus. Teach Me Anatomy. https://teachmeanatomy.info/upper-limb/bones/humerus/
  10. Author Unknown. (n.d.). Shoulder Arthritis. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/shoulder-arthritis
  11. WebMD Editorial Contributors. 2022. Shoulder Osteoarthritis (Degenerative Arthritis of the Shoulder). WebMD. https://www.webmd.com/osteoarthritis/shoulder-osteoarthritis-degenerative-arthritis-shoulder
  12. Centers for Disease Control and Prevention. (n.d.). Rheumatoid Arthritis. CDC. https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html#:~:text=Rheumatoid%20arthritis%2C%20or%20RA%2C%20is,usually%20many%20joints%20at%20once.
  13. Geidl, W., Deprins, J., Streber, R., Rohrbach, N., Sudeck, G., & Pfeifer, K. (2018). Exercise therapy in medical rehabilitation: Study protocol of a national survey at facility and practitioner level with a mixed method design. Contemporary clinical trials communications, 11, 37–45. https://doi.org/10.1016/j.conctc.2018.05.004 

Training in the Sporting Shoulder

Denis Mecklenburg recently completed a high-level sporting shoulder course conducted by shoulder physiotherapy clinician, researcher and course presenter – Lyn Watson.

The shoulder is the most mobile joint in the body, which also makes it prone to injury. If you’re an athlete, taxing your shoulder over time with repetitive, overhead movements or participating in contact sports may put your shoulder at risk for injury.

With a mix of both theory and practical components, Dr Lyn Watson covered various topics including:

At PhysioActive, we place great emphasis on continuing professional development because it ensures that our physiotherapists continue to be competent in their profession. This is also an ongoing process to ensure our quality of care to our patients!

Frozen Shoulder Treatment with the Niel-Asher Technique™

Last month, Denis Mecklenburg had an opportunity to learn about the treatment of Frozen Shoulder using the renowned Niel-Asher Technique™.

He was tutored by Stuart Hinds, a leading Australian soft tissue physical therapist with over 28 years’ experience in professional practice.

What are common causes of frozen shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a condition where the shoulder joint has a limited range of motion and pain is felt when exploring the range of motion of the shoulder.

The frozen shoulder cause may vary from individual to individual. Typically, the causes of frozen shoulder are mainly physiological in nature. Injuries that prevent you from moving your shoulder or make you incapable of moving your arm (such as a stroke) increase your risk of developing frozen shoulder.

Some risk factors of developing frozen shoulder include:

If your shoulder is immobile due to physical reasons and you begin to feel pain, consider visiting a doctor for a physical exam. Your doctor may recommend imaging tests or he/she may instruct you to perform frozen shoulder exercises. Performing exercise for frozen shoulder will keep the shoulder active, reduce pain and inflammation as well as prevent the frozen shoulder from worsening.

What is the Niel-Asher Technique™?

The Niel-Asher Technique™ is a ‘natural’ method of frozen shoulder treatment that does not involve any drug or surgery. Instead, the technique uses a specific and unique sequence of manipulations and pressure points to the joints and soft-tissues of the frozen shoulder. It is a form of frozen shoulder exercise and physical therapy that seeks to reduce swelling and pain of the shoulder and regain range of motion.

In summary, it works with the body and listens to the body’s wisdom – not by forcing the arm into the restricted ranges, but by applying gentle stimulation to muscles whilst they are resting. The technique manipulates the shoulder joint and the shoulder muscles - loosening up the shoulder capsule and joint capsule in the process. No pain is felt during this technique.

This technique has been in use since the 1990s and has been adopted and approved by medical professionals in the UK, Europe, and the United States for the treatment of frozen shoulder.

How does the Niel-Asher Technique™ differs from other treatments?

Traditional approaches to the frozen shoulder either address the inflammation (steroid tablets, steroid injections and hydrodilatation) or the stiffness (physical therapy, exercise therapy and surgical manipulation). Some might also attempt to improve the range of motion by forcing the shoulder through the blockage. Depending on the context, sometimes forcing might lead to a worsening of symptoms, leading to damage on the shoulder joint or the rotator cuff.

On the other hand, the Niel-Asher Technique™ addresses the inflammation in the rotator interval and emphasizes on improving the range of motion. Results can be seen in just 1 session! However, this would depend on how long you have had the problem and which phase you are in.

At PhysioActive, we place great emphasis on continuing professional development because it ensures that our physiotherapists continue to be competent in their profession. This is also an ongoing process to ensure our quality of care to our patients!

Lyn Watson Shoulder Course

The PhysioActive team cordially invited Dr Lyn Watson from the Melbourne Shoulder Group to conduct her specialty Shoulder Course right here in Singapore.

Dr Lyn Watson is an Australian Manipulative & Sports Physiotherapist with over 30 years experience in clinical practice and research into the shoulder. She holds an Adjunct Professorial position in research at Western University in Ontario Canada and has been teaching physiotherapists throughout Australia and around the world for the last 25 years.

The two-day course for registered physiotherapists in Singapore included the latest evidence-based best practices: research, clinical information and treatment techniques as well as examples of real patient presentation.

It provided the therapists with relevant information and techniques that will have immediate clinical application in the way shoulder patients are assessed, informed, managed and treated.

At PhysioActive, we are grateful for these opportunities to improve our own learning, and find every chance to pass on the knowledge we gain as benefits to our patients!

 

Planning an international course/conference?

From local sporting events to international tours and conferences, our expertise makes us the team of choice to manage your specific event requirements!

Contact or drop us an email today at info@physioactive.sg to find out more.

Congratulations Denis Mecklenburg!

Denis Mecklenburg successfully completed a high-level shoulder orthopaedic course in Australia last month - the Lyn Watson Level 2 Shoulder Course.

Over the past 10 years, approximately 4,000 Physiotherapists in 8 countries have completed this course conducted by shoulder physiotherapy clinician, researcher and course presenter – Lyn Watson.

“Learning from Lyn, a renowned shoulder physiotherapy clinician, researcher and course presenter, was definitely an enriching experience. I had the opportunity to observe her at work, where she assessed, developed primary diagnoses and treatment strategies for new patients with a variety of conditions. There was also an open discussion about her assessment techniques, differential diagnoses, treatment and rehabilitation strategies and progression of rehabilitation. This course is simply world-class!”

- Denis Mecklenburg

Denis brought back invaluable clinical reasoning skills to develop an assessment and treatment strategy for any shoulder patient that presents to our clinic. He is also eager to share what he has learnt with the team so that we can continue to provide the highest standards of physiotherapy and rehabilitation services in Singapore.

At PhysioActive, we are grateful for these opportunities to improve our own learning, and find every chance to pass on the knowledge we gain as benefits to our patients.

Don’t shrug off shoulder pain! Pain in this joint can curb your independence. Catch problems early, build strength, and avoid injury!