by Laurens Holve | Mar 13, 2018 | Osteopathy | 0 comments
Shoulder pain is the third most common reason for musculoskeletal consultation.
At some point most of us will have had a bout of shoulder pain, with what seems like a small pull which instead of disappearing in a few days seems to continue and often gets worse, preventing us from using our shoulders, and in some cases preventing sleeping due to night time pain.
What causes it and what can be done?
To give a complete overview of shoulder problems, let alone treatment protocols, requires a book to be written, which in this article I don’t plan to do. Instead I will give a brief overview of the more common shoulder ailments, their cause, why shoulders nearly always take longer than other joints to get better and treatments that can help.
In future editions I may well go deeper into some of these conditions to give some insight into what causes them and what can be done to help you recover.
The main symptoms that bring patients to me is either inability to lift their shoulder due to restriction often accompanied by pain.
The more common conditions people bring for treatment usually fall into one of the categories below:
- Frozen Shoulder
- Impingement Syndrome: (difficulty in lifting shoulder beyond 90 degrees)
- Rotator Cuff failure/ tear
This is a condition whereby a shoulder becomes very painful and stiff to move. It just seems to occur without any history of injury. There are a few conditions associated with it:
In other words the shoulder joint is not involved in this condition, it is more a stiffening and inflammatory process that occurs in the capsule that surrounds the joint. X Rays appear normal. It is characterized, by three main phases:
- Freezing stage. Any movement of your shoulder causes pain, and your shoulder’s range of motion starts to become limited.
- Frozen stage. Pain may begin to diminish during this stage.
- Thawing stage. The range of motion in your shoulder begins to improve.
Without intervention, your shoulder will pass through each of the stages at its own pace, taking anywhere between 18 months and several years in total.
Acupuncture and some form of physical treatment are helpful in all three phases and in some cases can help the freezing stage jump to the thawing stage more rapidly.
Adjunctive treatment such as painkillers can be used in conjunction with the above treatment, and improvement should start being felt after two or three sessions.
IMPINGEMENT AND ROTATOR CUFF TENDINOPATHY
I shall cover these together as they are interrelated.
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
Your arm is kept in your shoulder socket by your rotator cuff. These muscles and tendons form a covering around the head of your upper arm bone and attach it to your shoulder blade. Tendons don’t have a good blood supply and because of this and their constant work of trying to ensure shoulder stability explain why shoulder always take some time to improve.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm.
This condition is noticed when it is difficult raising your arm above 90 degrees.
The rotator cuff is a common source of pain in the shoulder. Pain can be the result of:
Tendinitis. The rotator cuff tendons can be irritated or damaged.
Bursitis. The bursa can become inflamed and swell with more fluid causing pain.
In impingement. As you raise your arm to shoulder height, the space between the acromion (the bone at the top of your shoulder) and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.
Rotator cuff pain is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, squash, javelin and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm can also lead to this problem.
Pain may also develop as the result of a minor injury, and am afraid to say as we age tendons like the rest of us become weaker and more prone to tearing . Sometimes, it occurs with no apparent cause.
Shoulder pain symptoms
Rotator cuff pain commonly causes tenderness in the front of the shoulder. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position. Frequently patients will also complain of pain radiating down their arm. People often find putting their arm behind their shoulder is very difficult and painful as the capsule in the back of the shoulder tightens.
Patients often delay treatment thinking their shoulder is just mildly strained, however once it settles in it stays, and with time slowly worsens.
Manipulative treatment is very helpful along with acupuncture to help restore normal functioning and reduce pain. Because of the tendons low blood supply, and weakness around the area it may well take a few sessions to start establishing a reasonable response. These treatments alone can in many cases restore normal functioning quickly and thereby reduce pain and sleepless nights.
In some cases if the inflammation around the rotator cuff is too too severe, steroid injections can be used to help reduce swelling and pain. In rare cases if there is either a complete tear or the tendon is too weak surgery may need to performed to stitch the tendon back to help restore its mechanical integrity.
Usually though, osteopathy along with acupuncture suffice in helping patients recover from these painful conditions.
Should you have any further questions or to see whether I may be able to help either call me on 0207 6921818 or email me.