Treating Shoulder Pain and Injuries
Posted in Rehabilitation
The management of shoulder injuries is one of the most challenging areas of physiotherapy. With the inherent complexity of the shoulder joint and the wide variety of injuries and conditions associated with the shoulder, it can make diagnosing shoulder pain tricky. The shoulder joint is one of the most mobile joints in the body, which, unfortunately, also makes it one of the most unstable joints and therefore, highly susceptible to injury. Shoulder injuries make up a large proportion of the musculoskeletal injuries that we see, with 1 in 10 people experiencing some form of shoulder pain in their lifetime. [i]
CAUSES OF SHOULDER PAIN
Regardless of whether the pain is felt squarely in the shoulder, there are several different anatomical structures that can trigger pain. In some cases, the source of pain may be referred from other areas of the body, such as the neck or chest. When talking to a health professional, a thorough medical history is essential, as more severe health conditions can also present as shoulder pain. Shoulder pain may also present in the form of more chronic conditions such as frozen shoulder, adhesive capsulitis, osteoarthritis or rheumatoid arthritis. For most people, however, shoulder pain is either the result of trauma via a fall or a sporting injury or from repetitive overload or strain. Such injuries can be treated as a musculoskeletal injury.
Occupational related shoulder pain is a common occurrence across industries. Higher incidences of shoulder pain are reported with jobs that involve more manual labour, as well as repetitive movements or overhead movements. Unsurprisingly, shoulder pain is quite prevalent among those who work in the construction industry, trades and the armed forces. However, any role involving repetitive hand or arm elevation and shoulder loading is at risk of developing shoulder pain [ii].
TYPES OF SHOULDER CONDITIONS
There are a number of terms used to identify different types of shoulder pain. Subacromial pain syndrome (SAPS) and rotator cuff related shoulder pain (RCRSP) are two terms that are used in physiotherapy today. SAPS includes all non-traumatic shoulder problems from one side where the pain is localised to the acromion and worsens during or after lifting the arm[iii]. Conversely, rotator cuff related shoulder pain (RCRSP) is an over-arching term that encompasses a spectrum of shoulder conditions. RCRSP conditions include subacromial pain (impingement) syndrome, rotator cuff tendinopathy and symptomatic partial and full-thickness rotator cuff tears [iv]. Even with high tech-imaging, it is often difficult to identify which structure within the shoulder is causing pain or dysfunction as individuals may experience pain differently, or report no pain at all, despite tissue damage.