Dr Nick O’Connor Osteopath
Does your shoulder wake you at night when sleeping on it? Can’t find a comfortable position to lay or sit in? Trouble putting your shirt or jumper on in the morning? Can’t lift your arm above your head without pain? Had a big bump or fall onto your shoulder in the past that hasn’t fully recovered from?
If you answer ‘Yes’ to any of these you should keep reading & book in to see your Osteopath so we can try and help you Move Through Life pain free!
Why are shoulders hard to diagnose?
Shoulder pain is a very common presentation seen in the clinic. It may be the pain that a patient has had in the background for a number of years, or it may have only just started from a sporting incident or workplace incident, whatever the case may be shoulder pain can be difficult to diagnose.
Let’s think about the shoulder for a second:
- You unknowingly use it thousands of times throughout the day!
- Synovial joint with a range of motion in some directions over 180 degrees
- 9 main Ligaments attaching and giving structure
- 10+ muscles attaching to many different points to aid in support and mobility
- The surface that the humeral head sits in the glenoid is only the size of 50 cent piece and helping that structure is a thick fibrous tissue called the labrum (very important).
Due to the nature of the joint and as mentioned earlier, it has an extremely large range of motion, more so than any other joint in the body. Unlike an elbow joint or knee joint which only have two main movements, the shoulder can rotate, abduct, adduct, flex, extend and any combination of the mentioned to perform movements.
As you can see, there is a lot going on at a shoulder joint, even simple movements like lifting your arm to put your shirt on, encompasses multiple muscle groups, ligaments stressed and the joint taken into a big range of motion.
There are a number of very common injuries which present to the clinic which have key signs and symptoms upon presentation and examination:
- Subacromial impingement/Bursitis: a very common injury for athletes, desk workers, due to the small space between the acromion the tendon and bursa which sit here can become inflamed and irritated causing excruciating pain. Commonly in this presentation a patient will have a form of tendinopathy and more so than not an inflamed subacromial bursa. This may present over time for no apparent reason or you may be completing a movement too often, with incorrect form, which is irritating the tendon and in turn causing the bursa to swell.
- Patient symptoms: Painful arc/abduction, Pain on lying on the affected shoulder, Pain on internal rotation and elevation of the GH, Sharp pain on movement, Heat (from bursitis)
- Recovery: Typically take 6-12 weeks to recover **
- Rotator Cuff tendinopathy: the most common tendinopathy of the shoulder, with key signs being a reduction and painful initial 20 degrees of abduction of the shoulder joint. The patient may also complain of pain when sleeping on the injured side.
- Patient symptoms: Pain in morning, Clicking in painful arc, Pain on lying on the affected shoulder, Shoulder pain on movement
- Recovery: Typically for an acute tendinopathy 6-8 weeks or a chronic tendinopathy 12+ weeks **
- SLAP Lesion/Labral Tear: typically patients who have fallen, or repetitive overhead lifting results in pain and restriction of movements. This can lead to a tear of the thick cartilage (labrum) which helps to form the shoulder socket.
- Patient symptoms: Locking, catching, popping or grinding, Pain on movement- lifting objects, overhead positions, Decreased strength, Feeling it will pop out
- Recovery: Generally requires surgery with recovery typically 6-12 weeks post surgery with rehab compliance **
- Adhesive capsulitis (Frozen shoulder): A painful condition, resulting in a severe loss of motion in the shoulder. It may follow an injury, or it may arise gradually with no injury or warning. The reason it is called adhesive capsulitis is that this literally describes what is seen in this condition – adhesive meaning sticky, and capsulitis meaning inflammation of the joint capsule. It is thought that many symptoms are due to the capsule becoming inflamed and ‘sticking’, making the joint stiff and difficult to move.
- Patient symptoms: Significant pain and stiffness- dull and aching
- Recovery: Typically three stages of the condition and will more often than not take over 12months to recover **
** patient dependent, compliance with management and rehab exercises, reduction in aggravating factors
Why is Rehab so important?
Rehab is as important as manual therapy. As you may only see your practitioner once a week or even once a month to review your program, it is vitally important to stay on top of rehab. Rehab doesn’t mean you need to go to the gym, it may be as simple as completing some exercises each morning or throughout your working day.
Typically with shoulders, the stronger we can make them the better they are going to be. Shoulders are more robust than many people think, they can be put under a lot of pressure and repetitive movements without causing any pain.
In your rehab plan, you will often have mobility work for not only the shoulder but typically thoracics, cervical and lumbar spine, you will also have strengthening exercises for the shoulder. Other things that may be included are: heat/ice, compression, slings, modifying work posture or sporting activities and tips/tricks on sleeping posture and day to day activities to reduce the pain. This combination will help with your overall health of the shoulder and will give you the confidence to live pain free and move through life.
What other areas of the body impact on the shoulder?
Typically a patient who presents with shoulder pain, your practitioner should be looking at your cervicals, thoracics, lumbar spine and also down each arm. This will give them an indication of how mobile you are and how limiting the injury is. Our main focus on these other areas will be to maintain their normal range of motion and mobility which in turn will help with the recovery and returning the shoulder to normal functioning.
To get a good understanding of this, I want you to try putting your arm into a sling like position across your chest, now walk and see how this feels. Do you feel slower? Limited in power or altered in any way? Does this feel normal for you?
As you may have found, it can change your whole biomechanics of walking and gait by just holding your arm into your chest. If this is done day in and day out because of a painful shoulder it can have huge impacts on other parts of your body. Making sure that your shoulder is functioning at full capacity will help the rest of your body move at its best.