Three Common Causes of Shoulder Pain
Shoulder Pain is the second most common reason people come to our practice for help. These patents tell us they have trouble sleeping, dressing, reaching and lifting, as well as difficulty completing important tasks or jobs at work or around the home. The first step to solving shoulder pain is to understand where your pain is coming from. There are many causes of shoulder pain and our first job as experienced physio’s is to work out what type of problem YOU have. Here are 3 common causes of shoulder pain that we see in our practice every week:
Cause #1: The Neck
When patients with shoulder pain come to see us for the first time, we always ask if they have any pain or stiffness in their neck, as well as any past history of neck injury. We also have a close look at their neck movement, even if they don’t report any problems here. Why do we do this?
There are two ways that a problem in your neck can give you pain in your shoulder or arm. The first is referred pain and it works like this: The nerve supply to your shoulder and arm comes from your neck. Since our wiring system for transmitting messages about pain is not perfect, your brain sometimes codes a problem from the neck as coming from the shoulder or arm. This is usually felt as a dull or deep ache in the shoulder or arm, often occurring when sitting or resting. Patients with referred pain often have difficulty “finding the spot” in their shoulder or arm.
The second way your neck can give you shoulder or arm pain is via direct compression of one of the spinal nerves as it exits the neck. This type of pain is quite different and includes burning, numbness, “pins and needles” or weakness in the arm. If nerve compression is coming from your neck, we have to focus our treatment on your neck!
How do I know if my neck is causing my Shoulder Pain?
The relationship between the neck and shoulder is complex and it can be difficult for you to know if your shoulder or arm pain is coming from your neck. If you experience nerve-related symptoms like burning, tingling or weakness in your arm there is a good chance that your neck is causing this problem, but not always. The best thing to do is have an experienced physiotherapist take a proper history from you and then examine your neck for tell-tale signs.
Cause #2: Rotator Cuff Tear
Rotator cuff tears are very common – 50% of the population over 50 years of age will have one on MRI. The trouble is, not all these people will have shoulder pain, which means there are other factors involved in the development of pain. In our experience, these factors include your occupation and leisure activities, how fit and strong you are in your upper body and your general health. So how does a rotator cuff tear cause pain?
The rotator cuff is a system of 4 muscles that support the shoulder during movement. Their job is to keep the ball-and-socket of the shoulder joint aligned so that other larger muscles can do their job. Think of them like the pit crew for a race car – without a good pit crew the driver will struggle to complete a lap, let alone win the race.
When you have an injury or pain in the rotator cuff, it is like driving a race car without a pit crew – you may be able to get around a lap, but it will be slow . . . and painful! Your tyres might be flat, your wheel alignment is out, and it all takes a lot more effort to complete a lap – or lift your arm!
How do I know if I have a painful rotator cuff tear?
Patients with a painful rotator cuff tear have trouble lifting their arm away from their side and they struggle to hold any weight in their arm, whether this is a towel, kettle or cordless drill. The degree of difficulty a patient has depends, among other things, on the size of the tear. There are 3 key findings we look for in our shoulder examination that make it highly likely you have a painful rotator cuff tear, so the best thing to do is to get an experienced physio to take a history and complete a targeted physical examination.
Shoulder bursitis
Bursitis means inflammation and swelling of a bursa. Bursa are fluid-filled sacs that shield our tendons from the bony surfaces of a joint and they exist in every freely moving joint of our body. The subacromial bursa is an extensive bursa in the shoulder that often becomes swollen and inflamed. There are two main ways that shoulder or subacromial bursitis can occur.
The first way you can develop shoulder bursitis is from a direct hit or force to the shoulder. This can happen in contact sport or if you bump your shoulder into the wall or furniture if you stumble at home. This direct trauma causes the bursa to fill with fluid and inflammation. It is important if you have had direct trauma to rule out serious injury like a fracture or acute rotator cuff tear, but once we have done this we need to look for bursitis as a potential cause of your problem.
The second way you develop bursitis is in conjunction with a rotator cuff tear. As mentioned above, a rotator cuff tear affects the normal mechanics of the shoulder (go back to our example about the pit crew) and because of this, the bursa gets repeatedly squashed over time. This causes it to become sore and swollen.
How do I know if I have Shoulder Bursitis?
Patients with bursitis have pain to move their shoulder in most directions and typically also have pain at rest. They may find anti-inflammatories helpful in the short-term and they may have a thickened or swollen bursa on ultrasound. A diagnosis of bursitis should only really be made by linking together the findings from a good history, physical examination and any imaging you have had Bursitis often responds quickly to a combination of physiotherapy and medical treatment – If it doesn’t, we may refer you back to your doctor for consideration for an injection into the bursa..
What Should I do Next?
Shoulder pain is frustrating for patients and can be persistent and recurrent. The first step to solving shoulder pain is to understand where your pain is coming from. This can only be done by an experienced health professional who is skilled at taking a proper history, guiding you through a targeted physical examination and interpreting the results to give you an accurate diagnosis.
If you’re ready to do this, call our friendly front desk today on 6056 6616. They can help you find a day and time that works for you to come in and see one of our experienced physiotherapists, who can help you make a start to feeling better.
