The shoulder is a complex ball and socket joint which is capable of movement in many different directions. Due to the very large range of movement available at the shoulder joint, it is less stable than the other joints in our body which may mean an increased risk of injury. Shoulder injuries can occur at any stage of life and happen to people who range from very minimal load or activity levels to elite athletes.
There are many structures which work together to form the shoulder joint and allow full movement including bones, ligaments and muscles supported by nerves and blood supply. The humerus (upper arm bone), the scapula (shoulder blade) and the clavicle (collarbone) are the three bones responsible for forming the shoulder complex.
There are many muscles which surround the shoulder joint. The main ones to be aware of are the rotator cuff muscles- a group of four small muscles which act to stabilise the shoulder joint, and the deltoid muscle- the bulky muscle which covers your shoulder.
The shoulder joint is passively supported by an array of ligaments and the capsule, which work to keep the humerus in the socket of your scapula and prevent dislocation.
Many nerves run through and around the shoulder complex and down into your arm, so at times shoulder issues can lead to symptoms down into the arms and hands.
Some common pathologies of the shoulder include:
Your physiotherapist will be able to determine the cause of your shoulder issues based on what you tell them about your symptoms, load and the onset of the issue as well as with physical assessment.
Shoulder assessment will likely involve you moving your arm in a variety of directions while your physiotherapist assesses your range and quality of movement. In some cases, your physiotherapist will move your arm for you to further assess the available movement at your shoulder. They will then likely assess your strength and pain by getting you to repeat those same movements against their resistance. Physiotherapists also know a variety of tests for specific shoulder conditions, which they will perform if they feel it is necessary. Depending on your usual activities and requirements in day to day life, they may then ask you to show them some of your usual activities such as work and sporting related movements.
Your physiotherapist will determine the best course of action depending on what they determine the issue to be. Depending on your issue, treatment may involve hands on therapy, taping, at home exercises and activity modification. Your physiotherapist will also give advice on what activities are and are not appropriate for you to be completing.
Different shoulder issues take different amounts of time to resolve. Some issues may resolve more quickly in a couple of days, others may take weeks or months. Your physiotherapist will be able to give you a more specific idea about how long you can expect resolution of the issue to take.
The team at CSSM have developed years of experience with assessing and treating shoulder injuries. Our assessment will be specific to you as an individual and what you hope to achieve out of treatment. Our treatments focus on achieving the best possible outcomes for you as quickly as possible, so you can get back to doing what you love pain free. We will offer you different options for treatment and ongoing management to ensure you get the most out of your time and do our best to resolve your shoulder issues and prevent them coming back. Whether this is the first time you’ve experienced a shoulder issue or this has been a reoccurring issue for you, book an appointment and we look forward to helping you.
Content for this page on Rotator Cuff Injuries was prepared by Camberwell Sports and Spinal Medicine Physiotherapist, Peter Stath. Peter has a clinical interest in shoulder injury and rehabilitation, particularly injuries involving the rotator cuff.
It is not uncommon for shoulder pain to be referred from elsewhere, usually the neck. If you are experiencing shoulder pain when you move your neck and your shoulder/arm stays still, it is potentially not your shoulder that is the issue. If your shoulder pain came on as a direct result of an injury to the shoulder itself, or it most often occurs with shoulder and arm movements, then it is more likely to be your shoulder that is causing the pain.
In most cases, shoulder pain and injury may be treated effectively with physiotherapy without a scan, however, in some cases it may be necessary to determine the full extent of your injury. Your physiotherapist will be able to determine whether or not a scan is necessary based on your mechanism of injury, the severity of your symptoms, whether they think more serious pathology is likely and based on your potential need for surgery.
Most shoulder issues will be able to be treated conservatively with physiotherapy, however, some more serious issues may require a surgical opinion. Some issues which may require surgery are recurrent dislocations, labral tears and full thickness rotator cuff tears. However, this isn’t the case for everyone and the decision to have surgery or not will be based on your goals, required level of function, age and risk factors.
The answer to this question depends on the requirements of your job and sport. If during the usual expected activities of work and sport you are experiencing pain, it would be best to see a physiotherapist who will be able to determine whether or not you are risking further damage to your shoulder. If you are able to complete the activities that are required of you with minimal issues, you should be fine to continue playing sport and going to work. Our physiotherapists are able to provide unfit for work/sport certificates where appropriate if this is a requirement of your organisation and you are unable to complete these activities due to your shoulder pain.
As a general rule, if you are comfortable sleeping in a certain position, it should be safe. Often people with shoulder injuries will find sleeping on their side difficult. While most of us struggle to sleep directly on our backs, sleeping on your back with a pillow supporting your painful shoulder can make it feel supported. The typical recommended way to do this is to form an upside down L shape with two pillows, so that one is running horizontally behind your head and one is running vertically under your shoulder and arm.
The use of anti-inflammatories is increasingly becoming debated. Our body’s natural healing properties use inflammation to facilitate recovery and the reliance on anti-inflammatory medication can be seen to interrupt this valuable healing property. In the case of shoulder pain, it depends on the situation of your injury. There is a grey area in the research regarding the effectiveness of anti-inflammatories on muscle and tendon injuries, and whether it may slightly impede recovery. However, if there is persistent swelling or osteoarthritic changes/pain within the joint itself, anti-inflammatories may provide relief for these conditions given the constant irritation of local nerves in the area.
As physiotherapists it is important to note that we are not experts in the prescription of medication. Any information given is advice that should be followed up with your GP if you have any further questions or concerns.
To make an appointment for treatment of your shoulder pain you do not need a referral.
Appointments can be made with any of our team by calling the clinic directly. Alternatively you can make an appointment via our online portal at our website – www.cssm.com.au
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