Shoulder pain is the feeling of discomfort in the area of your shoulder and upper arm.  You may feel constant pain or feel pain only when moving the shoulder. Shoulder pain can be caused by any of its underlying structures (muscles, tendons or joints), In this article, we will look at the different types of structures in the shoulder and how injury or damage to them causes pain. If you’re suffering from a shoulder injury, ask our expert’s opinion.

Shoulder pain is one of the most common (upper limb) complaints people seek medical advice for. This is because the shoulder is one of your body’s most mobile joints. When the mobility of the joint is increased it results in reduced stability. For this reason, your shoulder is prone to injury, especially traumatic or overuse injuries i.e. repetitive movements like a swimming stroke.

We find that neck pain can also be present with patients suffering from shoulder pain. This makes sense, because shoulder and neck injuries often overlap. The shoulder is one of the most challenging areas of treatment for any sport medicine practitioner. The structure of the shoulder is complex which makes conditions difficult to diagnose and can cause rehabilitation to be a lengthy process.

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Temporarily numbing the pain with painkillers and anti-inflammatory medicine will not correct the shoulder’s bio-mechanics!
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Shoulder Joints

Your shoulder is made up of joints, muscles and tendons. Your main shoulder joint looks like a lollipop with the ‘ball’ placed in a socket. This joint very mobile because it needs a wide range of movement. Imagine how your joints need to give you enough freedom to move while also providing stability (so that you don’t dislocate your arms). For example, when you make wild circles with your arms (moving up, down, left, right, forward and backward). Your joint also has a labrum (ring of cartilage) around the shoulder socket to help with smooth movements. The other shoulder joints connect the collar bone to the shoulder blade and the collar bone to the breastbone.

Because the shoulder joints have a wide range of movement, they need to be stabilised by muscles to prevent the joint from dislocating. The main muscles providing this function is the rotator cuff. A rotator cuff muscles work in unison to keep the joint in its socket. In patients with chronic shoulder pain these muscles can be injured, damaged or unbalanced (in a way that they don’t work together) and as a result increase the patient’s pain.

Muscle strains are often called ‘muscle pulls’ or ‘pulled muscles’ in layman’s terms. These terms refer to the way these injuries occur – the muscle tissue is forcibly stretched until it is torn. Depending on the number of torn muscle fibers, muscle strains are classified as first degree (least severe), second degree (moderate severity) and third degree (most severe) strains.

The following list identifies the three areas of shoulder muscles:

  • Anterior Deltoid: the muscle in the front of the shoulder
  • Posterior Deltoid: this muscle makes up the muscle group at the back of your shoulder
  • Mid-Fibers of the Deltoid: the outside of the shoulder

Straining rarely happens to the above-mentioned shoulder muscles but it does happen to the rotator cuff muscles deeper down in the shoulder structure.

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Causes of Shoulder Pain

Shoulder pain may be caused by:

  • Trauma – dislocations, fractures, labrum injuries, muscle or ligament strains, and sprains
  • Overuse – Tendon inflammation, labrum injuries and athritis
  • Instability – Impingement of rotator cuff muscle (swimmer’s shoulder)
  • Autoimmune – Adhesive Capsulitis (Frozen Shoulder)
  • Referral from other joints – Acromio-clavicular joint, sterno-clavicular joint, neck
  • Visceral referral – Diaphragm, gallbladder, heart, top part of lung and spleen
  • Nerve impingement – Usually in the neck
  • Rotator cuff strain, tendinopathy, calcific tendinopathy or tear (Subscapularis/supraspinatus)
  • Shoulder dislocation (anterior)
  • Shoulder instability (anterior)
  • Labrum tear (SLAP lesion)
  • Pectoralis major muscle tear
  • Biceps tendinitis
  • Long head of biceps muscle tear
  • Rotator cuff strain, tendinopathy, calcific tendinopathy or tear (teres minor/infraspinatus)
  • Shoulder dislocation (posterior) – Rare
  • Shoulder instability (posterior) – Rare
  • Referred pain from neck or back
  • Fracture of the scapula or neck
  • Nerve entrapment (Suprascapular or long thoracic nerve)
  • Rotator cuff strain, tendinopathy, calcific tendinopathy or tear (supraspinatus)
  • Shoulder impingement (Swimmers shoulder)
  • Labrum tear
  • Fracture of collar bone
  • Acromioclavicular (AC) joint sprain
  • Levator scapulae syndrome
  • Brachial plexus injury
  • Neuropraxia (burners/stingers)

Each person’s case is unique and we want to address your specific needs. If you would like us to investigate or provide some insight, we invite you to contact us by clicking the link below.

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Less Common Shoulder Injuries

  • Rotator cuff tear
  • Calcific rotator cuff tendinopathy
  • Frozen shoulder (Adhesive capsulitis)
  • Biceps tendinitis
  • Nerve entrapment (Suprascapular/long thoracic)
  • Fracture (scapula, humerus, coracoid)
  • Levator scapulae syndrome
  • Shoulder arthritis
  • Brachial plexus injury
  • Neuropraxia (burners/stingers)

Common Shoulder Injuries

  • Rotator cuff strain
  • Rotator cuff tendinopathy
  • Shoulder dislocation
  • Shoulder subluxation
  • Labral tear
  • Referred pain from neck or back
  • Fracture of the clavicle
  • AC joint sprain
  • Muscle tear (pectoralis major or biceps)
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Symptoms of a shoulder injury

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Our professional experience in the treatment of shoulder injuries

Shoulder injuries are common in most sports but happen more often in contact sports (e.g. rugby). Suffering from a shoulder injury or shoulder pain can affect and limit your activities in ways you wouldn’t expect and might have taken for granted. Examples of these include difficulty when opening a pack of chips, washing, dressing, putting clothes on, carrying children and reaching into cupboards (to name a few).

Shoulders are used in most activities in your daily life. A shoulder tends to counteract an injury (reduce the strain) by using opposite or related muscles. For example, shoulder will rely more on neck, back or arm muscles to perform actions. As a result, your shoulder pain might subside, but the injury and damage to the underlying structure of your shoulder is still there.

We often hear patients excluding or avoiding certain activities. Some patients stop reaching overhead because it is too painful even years after the original injury. If the injury is left untreated, your shoulder problems can progressively become worse and even develop into chronic shoulder pain.

Do not try to “re-locate” a dislocated shoulder if you don’t know what you are doing. You can cause more damage – seek professional medical assistance!

We commonly see and treat the following shoulder pain conditions:

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Shoulder Injury Treatment

You know when an injury occurs. There may be pain, swelling, bruising or even bleeding. The first and best thing to do is to apply the 5 step PRICE regime; a tried and tested treatment for reducing pain and swelling to minimize the effects of the immediate injury. It also prepares the body for the next stage of treatment. Many sports injuries such as muscle strains, sprains and fractures heal faster when the PRICE-regiment is used immediately following an injury.

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Protect

Protect the injured joint, muscle, nerve or tendon from getting worse by using strapping or a brace. Splints can also be used to prevent movement of the injured area and provide support in an effort to minimize the tissue damage. Immediately protect the area until you are able to get to a medical professional.

Protection also includes resting the limp using crutches for the legs and a sling for the arm. We use it to ‘immobilize’ your limbs, by restricting movements and preventing you to use it. Warning: relocating a dislocated shoulder by pulling on it can pinch a nerve or block a blood vessel

Rest

Forcing yourself to go on when there are signs of an injury is not only damaging to the tissue but also unwise.”No pain, no gain” does not apply here. It prevents healing from taking place. Rest is important to allow the injured muscle, tendon or ligament to reattach and heal. Avoid any activity or movement that produces or brings on the pain for the first 3 days. After that, you need to start moving or other problems will develop.

If you are unsure what to do, rather contact us and we can guide you.

Ice

Cold provides short-term pain relief by limiting the bleeding around the injured tissue. The bleeding from ruptured arteries and veins will cause an increase of pressure surrounding the injured tissue which will also decrease the blood flow around the injured tissue. The first priority is to stop the bleeding as fast as possible. Wrap an ice pack or ice cubes in a towel, wet the towel and place on the skin. Never apply ice directly to the skin (it can cause burns). Apply the ice for 15 minutes on, 20 minutes off. Repeat 5 times per day for the first 3 days.

Initially the ice will cause the superficial arteries and vein to constrict and close up. This will prevent the blood seeping out into the surrounding tissue. You will also experience a redness and ‘warm’ feeling after the ice as been applied. This is when the body reacts by sending cells to clean up the injured tissue and start repair.

Warning: Never apply heat (and heat rubs) to an acute injury in the first 48 hours. The heat encourages bleeding and could be detrimental if used too early.

Compression

Using a Compression bandage, elastic strapping, neoprene sleeve or brace will reduce the bleeding and swelling which occurs when cells and other substances rush to the site of an injury. Applying compression will also help to prevent the blood from pooling in you limbs and reduce the pain. Take care not to have the bandage too tight, as it will restrict blood flow.

Elevation

Resting with the injured part above the level of the heart is the best means of relieving swelling. In order to effectively use gravity, the injured area must be above your heart to assist in the drainage of excess swelling. For example lie on your back with your foot resting on a chair to drain your legs.

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Other Shoulder Treatments

  • Acute injury treatment
  • Ultrasound
  • Medications
  • Soft tissue massage
  • Electrotherapy treatment
  • Laser (Low Level Laser therapy)
  • Acupuncture & Dry Needling
  • Heat packs (Thermal therapy)
  • Kinesiology Tape
  • Rigid Strapping or taping
  • Neurodynamics (Nerve tissue mobilizations)
  • Dynamic Strapping
  • Strengthening exercises
  • Guided loading protocol
  • Stretches (Static, dynamic and ballistic)
  • Shoulder sling
  • Brace
  • Compression Bandage or Sleeve
  • Supportive strapping and taping
  • Biomechanical Analysis
  • TENS and electrical stimulation
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When is surgery necessary?

After a consultation we can assess the need and possibility of surgical intervention. You will be refer to a specialist if it is in your best interest.

  • Significant tendon and muscles tears (grade III – full ruptures) can often require surgically repairing
  • Damage to the shoulder joint itself and the labrum (such as a SLAP lesion or Bankart’s lesion)
  • If you’ve suffered a severe dislocation, or recurrent dislocations of the shoulder joint
  • Chronic degeneration of the shoulder joint surfaces accompanied by irregular connecting surfaces of the shoulder joints.
Patients that don’t opt for treatment can develop the following:
  • Abnormal Scar tissue formation which causes abnormal movement patterns leading to a cascade of compensatory mechanisms.
  • Joint stiffness due to immobility and causes abnormal joint movement, stressing adjacent joints even more.
  • Muscle weakness which leads to other muscles working harder to perform that muscle’s function and putting more strain on the surrounding muscles.
  • Joint laxity that can lead to unstable joints.

The type of surgery performed will determine the recovery time frames and the management strategy determined by your orthopaedic surgeon. Our extensive experience in rehabilitating shoulder injuries post-surgery means we can work to get you pain free in the shortest and safest possible time frames.  We tailor a sport specific rehabilitation program to get you back to where you want to be.

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Why is your shoulder pain lasting longer than expected?

  • You believed the pain would go away over time (on its own) but it didn’t

  • You went to the Doctor who told you to rest and take painkillers. The painkillers helped to relieve the immediate pain but didn’t help your injured shoulder. As soon as the painkillers wore off, the shoulder pain returned

  • A family member (or friend) told you that “Everybody experiences shoulder pain as they grow older,” and that you should just accepted it

  • In the past you went to other Healthcare Professionals (or a Physiotherapist) but nothing they said or did seemed to help

  • YouTube exercises and home remedies didn’t help relieve the pain, or in some cases made the shoulder pain ten times worse

  • You thought it would be a good idea to rest because your shoulder was so sore. However, afterwards your shoulder felt even more stiff and tight than before

  • You went for massages, hoping they would relieve the pain. The massages felt pleasant and relaxing, but didn’t do anything to fix your shoulder pain in the long term

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Experiencing these situations or applying similar advice and not getting results is a good thing. Why? Because these experiences help you know what doesn’t work for you. It means that you are closer to finding out what does work for you!

We invite you to book an appointment with a Physiotherapist (at our Pretoria practice). During an appointment we assess your symptoms, diagnose the cause, educate you about what is happening in your body and then start treatment. See our FAQ for more in depth information about what to expect from a physiotherapy session.

Alternatively, click the link below to book a FREE phone call. The phone call is complimentary and there is no obligation to book any appointments with us after the call is over. This is an opportunity to get an expert’s advice about your situation. Our goal is to help you make an informed decision about what to do next concerning your shoulder pain.

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Choose a Cilliers & Swart Physiotherapist to aid you in getting rid of your shoulder pain

What can we do for you?

  • We quickly put an end to pain and stiffness – often within a couple of sessions

  • We help you find out what is going on in your body and help you understand the root cause of your shoulder pain

  • Pain can rob you of sleep or rest. We make it easier for you to return to your normal sleeping patterns and positions so that your energy and potential for recovery increases

  • Cilliers & Swart Physiotherapists closely manage and treat your problem. We also provide you with related exercises to speed up your recovery

  • Using painkillers in the long-term can be harmful to your health. We help you lower or completely stop your need for painkillers to manage pain

  • Our physiotherapists safeguard you against dangerous and costly surgeries and painful injections

  • We reduce visits to specialists or doctors who only order you to take more pills

  • Shoulder pain can limit the activities you enjoy with your family and friends. Our experts help you get back to spending quality time on the activities you (and your loved ones) like

  • We can get you to sit comfortably and walk longer than 15 minutes, in both cases without feeling that your shoulder is weak, in pain or about to collapse

In short, we help you get back to living life free from chronic shoulder pain. For information about costs and availability, click the button below:

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4 steps to get rid of shoulder pain quickly.

  • Decide to get help.
    Many people put off going for treatment, that by the time they receive treatment the injury has worsened over time or caused other problems. Don’t think that shoulder pain will ‘just go away with time’. It might sound brave to ‘put up with pain’ over an extended period of time, but the lack of treatment could end up costing you more in terms of time (for recovery) and resources (money) the longer you wait.

  • Do the RIGHT exercises.
    One of the best things to help ease your shoulder pain is the appropriate series of progressed exercises (as advised by your Physiotherapist or Health Professional). The right kind of activities can reduce your pain and increase your range of movement. Above all, exercises ensure that problems don’t come back. However, the wrong kind of exercises have the potential to increase the pain in your shoulder even more.

  • Avoid sitting still for long periods.
    Ever tried to get up from the sofa after resting for a while, but you struggle because your shoulder feels painful and tight? That’s because one of the worst things you can do is to ‘rest’ in a sitting position for too long. Too much rest and sitting in awkward positions makes your shoulders stiff and tight. As a safety measure we recommend specific strengthening exercises for better posture. We can help you get active by combining these exercises with our Physiotherapists’ hands-on treatment.

  • Get hands-on Physiotherapy treatment.
    Physiotherapy is proven to improve the lives of people suffering from shoulder pain. Shoulder pain could be affecting your physical performance in a professional or private capacity. It could even threaten your independence or get in the way of spending quality time with family and friends. Physiotherapy can enable you to live the life you desire as quickly as possible.

If you would like to know how the Physiotherapy team at Cilliers & Swart can help you, we invite you to book a FREE, no-obligation, risk-freeCall me backphone call.

Note: This free call is a service we offer to people who are nervous or unsure. You might not know if Physiotherapy is the right treatment for you. If you are unsure, please fill out our online form. We will contact you to find out what is wrong and how we can help. There is no financial obligation or risk on your part. You have nothing to lose except your pain.

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