Treatment and Cause for Shoulder Pain
Treatment and Cause for Shoulder Pain
The shoulder joint is one of the most mobile joint in human body, what most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm — from scratching your back to throwing the ball in cricket.
Mobility has its price, however. It may lead to increasing problems with instability or impingement of the soft tissue or bony structures in your shoulder, resulting in pain. You may feel pain only when you move your shoulder, or all of the time. The pain may be temporary or it may continue and require medical diagnosis and treatment.
If your shoulders are healthy, you must be doing the right things to strengthen them. If not, you are either performing compromising movements or are negligent on your strengthening protocols.
Who are more prone to suffer from shoulder pain/ frozen shoulder?
• Professionals working on desktop computer for long hours.
• Active adults in sports involving lot of shoulder movements (Tennis/Badminton/Cricket etc.)
• Individuals involve in heavy weight resistance training.
• Diabetic population with low physical activity.
• Middle or Old age population with sedentary lifestyle.
• Commuters in bus and trains holding overhead handles for long hours.
• Individuals with history of direct or indirect trauma to upper arm and shoulder.
• Occasionally people who drive cars daily for long hours.
• Teachers and Professors who write on board with overstretched shoulders for long duration.
The typical shoulder pain is collection of symptoms of neck as well as the shoulder occurs due to the overuse of the neck and shoulder muscles.
How do you get a painful shoulder?
Most shoulder problems fall into four major categories:
1. Tendon inflammation (bursitis or tendinitis) or tendon tear
Other much less common causes of shoulder pain are tumours, infection, and nerve-related problems.
Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They work as cushions between bones and the overlying soft tissues, and help reduce friction between the muscles and the bone.
Sometimes, overuse of the shoulder leads to inflammation and swelling of these bursae between the rotator cuff and part of the shoulder blade (acromion), this may cause subacromial bursitis. Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as brushing teeth, combing hair or getting dressed, may become difficult.
A tendon is a cord like structure that connects muscle to bone. Most tendinitis is a result of a wearing down of the tendon that occurs slowly over time from overuse. Tendinitis is one of two types:
Acute: Excessive throwing or other overhead activities during work or sport can lead to acute tendinitis.
Chronic: Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.
Rotator cuff along with one of the biceps tendons is most commonly affected tendons in the shoulder. The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability.
Acute injury or degenerative changes in the tendons due to advancing age, long-term overuse and wear and tear, may result in splitting and tearing of tendons. These tears can be partial or complete split of the tendon into two pieces. In most cases of complete tears, the tendon is pulled away from its attachment to the bone. Rotator cuff and biceps tendon injuries are among the most common of these injuries.
It occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is raised away from the body, the acromion rubs, or “impinges” on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement. Over time, severe impingement can even lead to a rotator cuff tear.
Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket as a result of a sudden injury or from overuse.
It can be partial (Subluxation), with the ball of the upper arm coming slightly out of the socket or a complete dislocation means the ball comes all the way out of the socket.
Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly causing pain and unsteadiness when you raise your arm or move it away from your body. Repeated episodes of subluxations or dislocations lead to an increased risk of developing arthritis in the joint.
Osteoarthritis, also known as “wear and tear” arthritis. Symptoms includes pain, swelling and stiffness, typically begin during middle age. It develops slowly and the pain it worsens over time. Osteoarthritis may be related to sports or work injuries and chronic wear and tear.
As a protective response people will avoid shoulder movements to lessen pain. This sometimes leads to stiffness and tightening of the soft tissue around shoulder joint, resulting in a painful restriction of motion.
Shoulder fractures commonly involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade).
Shoulder fractures in older patients are often the result of a fall from standing height. In younger patients, shoulder fractures are often caused by a high energy injury, such as a motor vehicle accident or contact sports injury. Fractures often cause severe pain, swelling, and bruising about the shoulder.
Which muscles are generally affected?
• Trapezius muscle (upper/middle/lower fibres)
• Deltoid muscle
• Biceps (sometimes)
• Rotator muscles (subscapularis, supraspinatus, teres minor, infraspinatus)
What can be done to help?
Manual therapy/ deep tissue release techniques to release the trigger points/trigger bands around the upper back and the peri-scapular muscles
What does shoulder rehabilitation through physiotherapy aim at?
An exercise protocol helps to improve the strength of the shoulder and return back to sports/ daily living pain free.
Strength: Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Keeping these muscles strong can relieve shoulder pain and prevent further injury.
Flexibility: Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Gently stretching after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible.
Muscles targeted are: Deltoids, Rotator cuff muscles, Rhomboids, Serratus anterior, the Triceps and biceps.
Length of protocol: May vary from 4 to 6 weeks and should be done under the physiotherapist’s supervision along with a proper understanding of the home exercise programme which will be advised by the therapist.
After thorough assessment of the joint range of motion of the shoulder and performing shoulder specific physical tests to rule out the main problem area of the shoulder dysfunction, exercise protocol will be individually designed to provide pain relief and strengthen the shoulder joint. They are a combination of eccentric (towards gravity and concentric (away from the gravity) exercises to facilitate maximum shoulder strengthening.
The exercises aim at improving:
• Shoulder External rotation (infraspinatus, Teres minor)
• Shoulder internal rotation (Subscapularis)
• Shoulder elevation/shrugging and protraction (trapezius and rhomboids strengthening)
• Elbow flexion (Biceps, Brachialis, Brachioradialis)
• Elbow extension (Triceps)
The exercises should be done under supervision as the reasons for shoulder pain may vary depending on the diagnosis. The progression of the exercises is done every week to ensure maximum strength and stability of the shoulder joint. Both static and dynamic exercises are included in the exercises protocol depending on the level of shoulder pain and instability/stiffness the patient presents with.
Simple exercises and stretches as follows help to maintain a good shoulder joint:
• Pendulum exercise
• Crossover arm stretch
• Passive internal and external rotation with the help of a stick
• Biceps curls using a light weight/ dumbbell of sub-maximal weight/ a water bottle
• Shoulder retraction/getting both the shoulder blades together in pone-lying position
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