Our shoulder joint, also known as glenohumeral joint (involving the shoulder blade and the upper arm bone), is a ball and socket joint that allows a wide range of motion.
Its great freedom of mobility comes with a compromise on the stability of the joint. The rotator cuff muscles which surrounds the glenohumeral joint are the key muscles in providing stability to the joint.
Essentially, when we look at shoulder movements, we are looking at three important joints which make up the shoulder complex. They are the scapulothoracic joint, glenohumeral joint and the acromioclavicular joint.
Common symptoms of shoulder pain
Local Shoulder Discomfort
Discomfort in the shoulder region or shoulder joint alone and it’s constantly present or associated only with movements.
Common shoulder conditions with local shoulder discomfort or around the shoulder joint
A. Frozen shoulder
Frozen shoulder, also known as adhesive capsulitis, is a condition which causes inflammation and scarring of the shoulder capsule. It commonly affects people between the ages of 40 and 60, and people with a medical history of diabetes.
B. Subacromial impingement
Subacromial impingement syndrome refers to the inflammation and irritation of the shoulder muscles and tendons (rotator cuff) as they pass through the subacromial space. Sometimes, this may also affect a fluid filled sac (bursa) that is present within the same space. This can result in severe pain, weakness, and reduced shoulder range of motion.
C. Rotator cuff tears
When one or more of the rotator cuff tendons is torn, the tendon becomes partially or completely detached from the head of the humerus (upper arm bone). In most rotator cuff tears, the tendon is torn away from the arm bone. A torn rotator cuff will result in the humeral head fitting loosely in the glenoid cavity and can cause shoulder instability.
D. Rotator cuff tendinitis
An inflammation of a group of muscles in the shoulder is called rotator cuff tendinitis. This usually occurs over time after repeated stress on the shoulder muscles and tendons. Rotator cuff problems is often caused by or associated with repetitive overhead activities such as throwing, washing windows and many other types of highly repetitive motions. If the issue persist, it may even cause tendon tears.
E. Biceps tendinitis
Even though the bicep muscles is not part of the rotator cuff, it still provides significant stability to the shoulder joint. The long head of the biceps tendon is more likely to be injured. This is because it is vulnerable as it travels through the shoulder joint to its attachment point in the socket.
F. Shoulder fractures
Fractures are usually due to traumatic incidents. If a fracture is comminuted and involves the humeral head or the shoulder socket, a shoulder replacement is likely needed. If the fracture is near to the insertion of the rotator cuff tendons, it can also cause a rotator cuff problem.
G. Shoulder joint bone spurs
Bone spurs in the shoulder area are also called osteophytes and one of their main causes is osteoarthritis. Osteophytes can also occur as the result of chronic tendinitis or inflammation to the cartilage or tendons in the shoulder.
When pain is felt in a region away from its source, it’s called referred pain. For example, a pinched nerve in the cervical spine can present in the shoulder, arm or hand which is away from the source. Sometimes, left shoulder pain can signal a serious condition, such as a heart attack. A heart attack happens when an artery that feeds oxygen-rich blood to the heart becomes obstructed. Hence, there may be associated symptoms like shortness of breath, dizziness, chest pain and/or cold sweats.
Radiating pain begins in the shoulder and travels along a path. It is often due to irritation to the nerves in the shoulder or cervical region, resulting in radiating or shooting pain and/or numbness along the upper arm depending on the nerve that is involved.
Causes of shoulder pain
The cause of musculoskeletal discomforts is usually multi-factorial. Below are some possible causes:
Poor exercise technique
Lack of training or preparation for sport and exercise
Tight muscles or soft tissues
Stiffness in joints
Nerve irritation or compression
Tissue Injury (e.g. due to trauma or repetitive strain)
A physiotherapist or physical therapist is an expert in helping shoulder pain and can diagnose and identify the source and cause of shoulder problems.
Shoulder diagnosis is often made with a physical examination. These tools include:
A physiotherapist will observe a person's typical static postures (i.e. in sitting, standing and lying down) as well as the person's usual movement patterns in their daily life (e.g. walking and working) and in their sport. These observational findings provides vital information for the physiotherapist to identify risk factors for shoulder pain, the likely cause for injury or overload, and to guide subsequent assessments and tests.
2. Manual Palpation
Physically palpating (i.e. feeling) a person's area of discomfort and the regions around it would provide a physiotherapist or a physical therapist with valuable information about the texture, tightness, rigidity, temperature, and alignment of the structures. This informs the physiotherapist of the possible reason for the shoulder pain, the likelihood of inflammation, and whether it is localised or potentially referred from a different area such as the cervical spine or shoulder blade (scapula).
3. Range of Motion Testing
Shoulder movement will be assessed when diagnosing the cause of discomfort. Often, the neighbouring joints are also assessed to identify if the shoulder discomfort is arising solely from the shoulder or is related to other areas in the body.
4. Joint Mobility Testing
Joint mobilisation is a skill that physiotherapists are trained in in their undergraduate degree programs. This technique is used to assess a joint's movement and to test for joint stiffness and/or stability.
5. Strength Testing
Testing of strength in the shoulder cues the physiotherapist in on the neurological status of the person as well as to identify any issues with movement pattern or muscle function that is contributing to the shoulder pain.
6. Neurological Testing
These tests can include a series of coordination tests, strength tests, sensation tests, and an assessment of the person's reflexes.
7. Gait Analysis
A physiotherapist can analyze the biomechanical faults in a person's walking pattern and identify impairments through observation.
8. Red Flag Testing
Red flags are symptoms and alert signs that indicate serious underlying pathology and conditions. A professional physiotherapist is trained to identify them through common subjective complaints as well as through special tests.
9. Medical Imaging
Imaging tests are not necessary in the diagnosis of shoulder pain, but in cases where red flags are suspected, blood or imaging tests can help to confirm diagnoses and guide potential surgical management(s).
Shoulder pain can be treated with medical interventions such as the use of analgesics, surgical interventions, or with conservative management like physiotherapy/physical therapy.
The treatment of shoulder pain depends entirely on the cause of the problem. Therefore, it is important that you understand the cause of your symptoms before embarking on a treatment programme.
If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment plan. Not all of the treatment options listed are appropriate for every condition.
The first treatment for most conditions is to rest the joint, and allow the acute inflammation to subside. If inflammation is present and you have a severe injury, your doctor may prescribe you nonsteroidal anti inflammatory drugs (NSAIDS) to help reduce swelling and pain.
Ice and Heat Application
Ice packs are mostly used for acute injuries or arthritis pain to minimise swelling and reduce pain while heat pads are used for chronic conditions to help relax and loosen soft tissues.
Physiotherapy / Physical therapy
This is an important aspect of treatment for almost all orthopaedic conditions. Our physiotherapists can treat shoulder pain with a combination of manual therapy, use of modalities and exercises.
If you are unsure of the cause of your symptoms, you should seek medical attention. You should see your doctors for further advice when:
You have an injury that causes deformity around the joint
Your shoulder pain occurs at night, or pain worse even after resting
You have shoulder problems that persists beyond a few weeks
You are unable to move the shoulder
There are signs of an infection, including fever, redness, warmth and swelling of the shoulder area
You are unable to get any pain relief with anti inflammatory medicine, physiotherapy/physical therapy or other treatments
If you have a medical history of a heart or lung condition
This would be recommended to you by your surgeon depending on your diagnosis, severity of your condition and your physical goals. If your shoulder problem is severe and does not improve after months of conservative management, your surgeon may recommend a shoulder surgery.
How can Balance Core help you?
At Balance Core, we strive for excellence in providing an accurate diagnosis and managing pain with effective treatment(s). We believe in ensuring a systematic review of a person’s posture, body alignment, movement patterns and habits to identify the root cause of problems.
Our physiotherapists/physical therapists are highly trained in manual palpation and observation to identify the sources of discomfort. This helps our clients to minimise their symptoms in a few sessions and to empower them to manage their conditions with a targeted treatment program.
We use a combination of manual therapy, adjunct modalities such as dry needling, taping, ultrasound therapy and TECAR therapy, as well as exercises to help our clients and patients to achieve their goals.
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Frequently Asked Questions
Your physiotherapist will perform a thorough assessment to evaluate the problem and identify the problem’s root cause. A detailed explanation will be given so that you can fully understand your issues and the outline of subsequent physiotherapy treatment plans.
Thereafter, a treatment involving muscle release, specific muscle activation or joint mobilization, etc. will be rendered to provide symptomatic pain relief and address underlying root problems.