Shoulder pain is a very common condition that we are asked to treat. We use our shoulders in many movements relying on them to perform most of our daily activities. The shoulder is a very mobile joint with a great range of movement. This enables us to reach out and pick things up. However this great range of movement is at the expense of the stability of the shoulder. This makes it possible to be injured easily by lifting something heavy, throwing a ball or trimming the hedge.
The shoulder is made up of two main bones: the arm bone (humerus) and the shoulder blade (scapula). It also consists of several ligaments that help to stabilise the shoulder, as well as four small muscles known as the rotator cuff which attach in different places to provide further stabilisation. Injury can develop imbalances in the shoulder causing pain. This leads us on to our first common condition:
The shoulder can become unstable when the muscles or ligaments are over stretched. This can feel like the shoulder might slip out of place and you may hear “crunchy” noises. Shoulder instability can be common in young people, especially athletes, caused by strong forces impacting on the shoulder through activities like tackling in rugby, throwing etc. These activities can stretch the shoulder’s ligaments leading to a feeling of weakness in the arm and a loose feeling in the shoulder. The muscles surrounding the shoulder can tighten as they try to stabilise the joint leading to pain and a deep aching sensation.
More severe cases of instability within the shoulder are known as shoulder separation where a ligament is torn within the shoulder. Our osteopaths are trained to spot this type of problem and advise you accordingly depending on its severity. Treatment normally occurs after the ligaments heal. It can be helped by appropriate physical therapy and exercise rehabilitation.
Shoulder dislocation is when the shoulder comes out of its normal position. Ligament and muscle tears are common and accompanied by severe pain. A dislocated shoulder needs immediate medical care. Specialists treat dislocations by using gentle traction to pull the shoulder back into place. When the shoulder pops out of the socket repeatedly, the condition is called recurrent instability which can be treated with surgery to repair the torn ligaments.
Rotator Cuff Tear
The rotator cuff is a group of 4 muscles in the shoulder that stabilise and move the arm. The tendons that attach these muscles to the bone can sometimes tear. If the tendons tear, you will find it difficult to move the shoulder, making it difficult to move the arm up or away from the body.
As people age and their physical activity decreases, tendons begin to lose strength. This weakening can lead to a rotator cuff tear. The tendons have a poor supply of blood, making it more difficult for them to repair and maintain themselves. As a person ages, these tendons degenerate. Doing exercises that require you to raise your arm overhead can put pressure on the rotator cuff tendons. Repetitive movement or stress to these tendons can lead to impingement, in which the tissue or bone in that area becomes misaligned and rubs or chafes.
The rotator cuff tendons can be injured or torn by trying to lift a very heavy object while the arm is extended, by falling, or by trying to catch a heavy falling object.
Symptoms of a torn rotator cuff include tenderness and soreness in the shoulder during an activity that uses the shoulder. A tendon that has ruptured may make it impossible to raise the arm. It may be difficult to sleep lying on that side, and you may feel pain when pressure is put on the shoulder.
Frozen Shoulder / Adhesive Capsulitis
This is a condition where the shoulder’s capsule tightens, causing severe stiffness and sometimes pain. The cause is unknown though particular triggers are identified such as following an infection, after an injury to the shoulder or compensation for other parts of the body. Symptoms often take a long time to reduce (up to 18 months) but there are many ways we can help with this condition. Osteopathic treatment can help the shoulder by improving other joints to aid movement and prevent further injury and stiffness. Exercise rehabilitation will normally be part of the treatment management with the aim of reducing recovery time.
Most people develop some degree of osteoarthritis, which can cause painful movement. This occurs as the smooth surfaces of the cartilage that line the bones of the shoulder joint are worn away. This causes joints to wear out. The most common cause of osteoarthritis is overuse. Osteopathy will aim to improve your pain free range of motion and help the body compensation due to this stiffness. In more developed instances, a replacement of the shoulder joint may be necessary. In this case we would refer you to your GP.