Shoulder pain is the sensation of discomfort in the shoulder and upper-arm area. Shoulder pain is one of the most common upper limb complaints which a person will seek medical advice for. It is common to have neck pain as well.  Shoulder injuries often overlap with neck pain. You may feel the pain constantly or only when moving the shoulder. Shoulder pain can be caused by any of the muscles, tendons or joints, so let’s look at the different types of structures in the shoulder.

The shoulder is one of the most challenging areas for any sport medicine practitioner. The structure of the shoulder  is complex. Conditions are difficult to diagnose and rehabilitation can be a lengthy process.

Temporarily numbing the pain with pain-killers and anti-inflammatories will not correct the shoulder biomechanics!

Shoulder Muscle pain

The major muscle in the front of the the shoulder is the anterior deltoid. The posterior deltoid muscle makes up the muscle group at the back. On the outside of the shoulder is the mid-fibers of the deltoid  muscle. These are the superficial muscles i.e. those you can see.

Muscle strains are often called ‘muscle pulls’ or ‘pulled muscles’ because of the way these injuries occur, with the muscle tissue forcibly stretched until it is torn. Depending on the number of muscle fibers that are torn, muscle strains are classified as first degree (least severe), second degree (moderate severity) and third degree (most severe) strains. This rarely happens to the superficial shoulder muscles but does happen to the rotator cuff muscles deeper down.

Shoulder pain, Shoulder injuries
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Causes of shoulder pain

Shoulder pain is one of the most common upper limb orthopaedic complaints which a person will see medical advice for. It is the most mobile joint and as a result of the increased mobility, stability is sacrificed. This makes it predisposed to injury, especially traumatic injury or overuse injuries i.e. repetitive movements like a swimming stroke. 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)
Shoulder Pain
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Common 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)

Less common

– 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)

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Our professional experience on shoulder pain

Shoulder injuries are common in just about all sports, especially in contact sports. It can be extremely debilitating, affecting many activities that are usually taken for granted. Washing, dressing, putting clothes on, carrying children, reaching into cupboards to name but a few. When left untreated many shoulder problems can progressively worsen and become chronic.

The shoulder can, due to its extreme necessity to most activities, compensate heavily when injured. Pain can subside, but the dysfunction is still there. We often hear individuals just excluding certain activities. Some patients stop reaching overhead because it is too painful even years after the original injury. We rarely find persons with both strong scapula muscles and rotator cuff muscles (holds shoulder in place) due to the high rate of shoulder injuries. Big shoulder muscles (i.e deltoids) don’t mean you have stable shoulders!

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:

Symptoms of a shoulder injury

Mild Shoulder Symptoms

  • Mild pain and stiffness with shoulder movements

  • Swelling

  • Reduced range of movement

  • Pain reaching behind back

  • Pain lifting or carrying

  • Difficulty sleeping on the shoulder

  • Pain into the upper arm or neck

Moderate Shoulder Symptoms

  • Moderate to severe pain

  • Unable to move shoulder

  • Locking or catching

  • Throbbing pain

  • Unable to lift or carry objects

  • Unable to put weight on the shoulder

  • Sharp electrical pain into the upper arm or neck

  • Numbness, pins and needles

Dangerous Shoulder Symptoms

  • Severe shoulder pain with traumatic incident

  • Bleeding in armpit/inner arm or bruising down the arm without trauma

  • Loss of total strength and function in a particular movement

  • Major injury with severe pain followed by redness, bruising and loss of function

  • Young children with severe dysfunction of the shoulder

Shoulder pain

Shoulder Injury & Pain Treatment

  • 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 shoulder 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)
  • Patients that have suffered a severe dislocation, or recurrent dislocations of the shoulder joint
  • Patients with chronic degeneration of the shoulder joint surfaces
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Rotator cuff tear (Strain)

Anatomy of the shoulder

The shoulder joint is a ball and socket joint which consist of five joints if the whole shoulder girdle is taken into account. The main joint is the glenohumeral joint which is the ball and socket joint. The acromio-clavicular joint connects the collar bone to the shoulder blade and the sterno-clavicular joint connects the collar bone to the breast bone.

The shoulder joint is the most mobile joint in the body and due to the increase in range of movement it is also one of the least stable joints. As the shoulder joint is not very deep, a labrum can be found around the joint to increase the congruency of the joint similar to that in the hip.

As passive stability in the shoulder is limited due to the mobile nature of the joint, the dynamic stability proved by the muscles are of the utmost importance. The is where the all important rotator cuff performs its most important function: Keeping the joint in its socket thus preventing the shoulder from dislocating with movement.

The muscles of the rotator cuff are the supraspinatus (think of it as the top one), the subscapularis (the front one which also rotates internally), the teres minor and infraspinatus (the back ones which rotates the shoulder externally).

The rotator cuff muscles work in unison when the arm is lifted to stabilise the joint and this is known as concavity compression. In individuals with chronic shoulder pain these muscles can be dysfunctional and not work together which increases the pain.

What causes rotator cuff tears?

Rotator cuff tears can be caused by:

  1. Degenerative changes: Can be caused by auto-immune diseases (Rheumatoid arthritis), diabetes Melitus or smoking
  2. Over-use/repetitive strain injuries: Micro-trauma from repeated loading as found in cricket bowlers or tennis players
  3. Traumatic injuries: Falling on the arm, a unexpected traction force and shoulder dislocations/subluxations
  4. Non-traumatic injuries: Normal age related degeneration and weakening of the tissue.

Rotator cuff tears are the most common cause of shoulder disability and pain!

Symptoms of a rotator cuff tear

  • Severe pain at time of injury (if traumatic)
  • Progressive and unbearable pain (if non-traumatic)
  • Pain at night especially if lying on shoulder
  • Pain with reaching overhead (getting items out of cupboard)
  • Painful arc of movement when taking arm from the side
  • Weakness and disability of the shoulder
  • Loss of movement and function of the shoulder
  • Keeping your arm in the front and close to the body (sling position)
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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.

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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What you need to look out for

If the pain gets worse within the first 24 hours, we recommend you give us a call and we can give you advise on how to proceed.

Danger signs

  • Severe swelling (not going down)
  • Visible deformity
  • Unable to move
  • Severe bleeding
  • Redness and puss oozing from skin
  • Open wound

If I do nothing, will it heal by itself?

In our experience patients walk through our doors daily that left their injuries untreated. These patients’ injuries take longer to heal, not to mention the lingering pain and compensatory problems that have developed. It is important to remember that symptoms lasting longer than two weeks are much harder to heal.

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

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.

If you’re unsure if we’ll be able to help you, just fill in our online form & we’ll call you back

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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