Have You Shoulder Pain or a Shoulder Joint Injury?

Some of my clients complain of shoulder pain. Not the tight shoulders that a lot of clients have with lumpy trapezius muscles, but real shoulder joint injuries where more than knotted muscles are found and referrals are required. This article gives useful (and technical) information on shoulder pain and treatment.

Background
The shoulder joint is composed of three bones: the clavicle, the scapula, and the humerus. They can become unstable as it is a non-congruent joint. To remain stable the shoulder is anchored by muscles, tendons and ligaments and this can lead to many common problems eg:- sprains, strains, dislocations, separations, tendinitis, bursitis, torn rotator cuffs, frozen shoulder, fractures and arthritis.

Rotator cuff tears are fairly common injuries affecting the shoulder. These tears can involve one or more of the four tendons of the rotator cuff muscles. The tendons of the rotator cuff, not the muscles, are most commonly torn. Of the four tendons, the supraspinatus is most frequently torn as it passes below the acromion ie because of its position between the bones. As the tendon becomes inflamed and swollen it can become pinched between the 2 bones (impingement problem). The bursa that cushions the tendon can also be damaged. This subacromial bursa can be sore after activities such as painting, lifting or playing a sport, which require you to lift your arms.

The major muscle groups of the rotator cuff are the supraspinatus, subscapularis, infraspinatus, and teres minor. They all contribute to the stability of the shoulder. The infraspinatus and the teres minor are the only muscles that externally rotate the arm.

Injuries
Acute injuries (tears) can occur from a fall on an outstretched hand, or following a powerful throw, or a collision. Occupations requiring heavy lifting also place a strain on rotator cuff tendons and muscles. Normally tendons are strong, but long-standing wear may lead to a tear. Chronic tears develop over a period of time and usually occur at or near the tendon. Chronic tears occur among individuals that constantly participate in overhead activities, such as pitching or swimming.

Torn Rotator Cuff Symptoms
Pain from a rotator cuff tear is usually located over the outside of the shoulder and upper arm. Pain while performing overhead activities (with the arm above head height) and pain sleeping on the affected shoulder. There is difficulty performing activities such as combing their hair or reaching behind their back. Significant rotator cuff tears may affect a patient’s ability to raise their arm over their head and inability to hold the arm directly out from the body. Shoulder pain is variable and does not always correspond to the size of the tear.

Pain or weakness on outward or inward rotation of the arm may indicate a tear in a rotator cuff tendon. The patient may also feel pain when lowering the arm to the side after the shoulder is moved backward and the arm is raised.

Diagnosis is based upon an assessment and a detailed history of the patient, previously activities and symptoms experienced. The physical examination of a shoulder covers palpation, range of motion, strength testing (painful arc, the drop-arm sign, and weakness in external rotation). The shoulder examination can be non-conclusive requiring a MRI scan to detect if there is a tear and is the most commonly used to diagnose a rotator cuff tear. The MRI can also show evidence of shoulder bursitis and other common shoulder problems. .

Torn Rotator Cuff Treatments
Patients with a rotator cuff injury need to rest the shoulder, apply heat or ice packs (acute injuries) to the sore area, and take medicine to relieve pain and inflammation. Other treatments might be added, such as electrical stimulation of muscles and ultrasound. The patient may need to wear a sling for a while. Once a tear happens in the rotator cuff, it is much more likely to recur. To avoid this, proper strengthening exercises can be performed. Muscles around the injured area will also need to be checked as these often get tight as protection mechanism to an injured area. A complete tear usually requires surgical procedures.

Summary
Shoulders are complicated areas with many associated muscles. An experienced sports massage therapist can advise on an injury and treat many common problems eg supraspinatus muscle injuries etc but other areas including rotor cuff ruptures and tears etc will require referrals to health professionals with MRI scans etc.