Shoulder Pain – How Can We Help?

Shoulder pain and dysfunction can significantly impact your daily life, limiting your ability to perform simple tasks. People often “just put up with it”, but we can do a lot to help eliminate shoulder pain and improve the function of a shoulder back to normal!

Here’s some info about common shoulder conditions and how our physios can help:

Rotator Cuff Injuries

The rotator cuff is a combination of 4 muscles and tendons that come together to provide most of the stability and movement of the shoulder. The tendons are subject to a lot of forces over a lifetime and injuries of the tendons in the cuff are very common. Rotator cuff injuries can be best categorised as acute/traumatic injuries and chronic/wear and tear injuries.

Acute Rotator Cuff Injuries – These injuries occur through a traumatic moment, for example falling off a skateboard. If too much force goes through the shoulder on a certain angle, one or more of the rotator cuff tendons can tear either partially or completely, which will often hurt a lot at the time and for a period of weeks after and will result in a lot of weakness in the shoulder in the short term. If you have had an injury like this, it’s often best to get an MRI or ultrasound to get a specific diagnosis as there is a chance that surgery will be required if there is a ruptured tendon. If there is a partial tear, working with a physio over a period of 2-3 months will help restore strength and function in the shoulder and there’s a good chance that you will have a reasonably normal shoulder after this time. If there is a complete rupture of a tendon, in a younger patient (~<55 years old) it’s often best to see a surgeon to discuss whether surgical repair is an option for you. In older patients, surgery is still an option but there is more of a chance that you’ll be just as good without the surgery – note that these decisions come down to the individual and we can have a good discussion about what your options are as well as recommend a good surgeon if we think it is appropriate to pursue surgical options. With or without surgery, a rotator cuff repair will require a long period of rehab to regain strength and function of the shoulder and this is something we can help with.

Chronic Rotator Cuff Injuries – One of the most common causes of shoulder pain, particularly in the over 40 age group, is when the rotator cuff starts to show signs of wear and tear and cause painful symptoms. Essentially this is a deconditioning issue and when you use your shoulder more than what it is conditioned to do, the rotator cuff itself can be painful but the dysfunction in the stability of the shoulder can also lead to other structures getting irritated. As we get older, the structures in our body take longer to recover and generally the structural integrity of tendons gets gradually weaker, so even activities that you’ve been doing all your life become more stressful on the rotator cuff. If you’re getting seemingly random shoulder pain, there is a fair chance it is due to the rotator cuff being not quite as good as it used to be – often there will be tendinopathy or small tears within the rotator cuff showing on scans if they are done. If we assess your shoulder and find that the rotator cuff is an issue, we can help reduce pain and improve function quite quickly with manual therapies like dry needling, massage or shockwave. As the pain gets under control, we will then work with you to strengthen the rotator cuff and surrounding shoulder muscles so that they have more resilience and can keep up with the work you are putting your shoulder through. It does take time for the strength to improve enough but if you stick with it, more often than not you will have a pain-free shoulder again!

Shoulder Bursitis/Impingement:

Every day we see patients who have been diagnosed with bursitis in their shoulder. Most of the time, the bursitis is just a symptom of chronic rotator cuff issues as described above, and treatment will be the same and have a high success rate. The bursitis is just an irritation of the bursa that has occured to due the rotator cuff not functioning properly and generally when the rotator cuff improves, so does the bursa. In some circumstances, if the pain is too limiting to exercise and you don’t respond to physio techniques, it can be helpful to get a cortisone injection to reduce the inflammation, however we strongly advise against getting a cortisone injection before trialling physio treatment as it does not address the cause of the issue and all the time we see people come in who have had multiple injections that feel good for a while but then wear off which is a waste of time and money.

Frozen Shoulder:

Frozen shoulder is a mystery in the medical world as no one really understands why it happens. Essentially it is a condition where the capsule surrounding the shoulder joint becomes contracted and significantly inflamed which results in pain around the shoulder and a loss of movement in all directions. In the early stages of frozen shoulder it can be constantly painful and make sleeping difficult, generally it will progress to a point where the pain subsides but the movement stays locked which can last for around 12 months (longer in some cases) and eventually the shoulder will “defrost” to a point where it is normal again, though sometimes there are small movement limitations that persist. There is no quick fix for frozen shoulder unfortunately and it will generally run it’s course regardless of any physio or medical interventions, however we can help along the way by reducing some of the pain, maintaining as much movement as possible, and providing exercises to keep the shoulder as strong as possible within the movement limits so that when it does resolve, the shoulder is ready to go again without developing further issues. In severe cases, cortisone injection or surgery can bring some improvements, but in most cases these interventions don’t have as much impact as people hope they will.

Shoulder Arthritis:

Like any joint in the body, shoulder joints can wear out and get osteoarthritis. Symptoms will usually include stiffness and pain deep in the shoulder that develops over time. It is a common belief that there’s nothing you can do about arthritis, but in fact there are many people living a perfectly normal life with arthritis. Our goal is to optimise everything around the shoulder so it can move well with minimal stress on the joint itself, which can result in great improvements for those with arthritis! It is not a condition that we expect to get immediate results with, but over time there is a good chance that you will have significant reduction in your pain levels. Of course, it won’t work for everyone and there are surgical options available for those who are suffering significant symptoms. We also deal with rehab following shoulder surgery to get the new shoulder working as well as possible and minimising future issues.

If you have shoulder pain and need a hand, we’d love to help! Call us during business hours on (02) 4023 2797 or book online anytime to get started!