Understanding Shoulder Pain: Types, Causes, and Treatments, and the Role of Physiotherapy

▫️Written by John Keller

✅ Reviewed by Dr. Jenny Hynes on July 10, 2024

  1. What is shoulder pain?

  2. Causes of shoulder pain

  3. Signs and symptoms of shoulder pain

  4. Prevention of shoulder pain

  5. Diagnostics of shoulder pain

  6. Physiotherapy for shoulder pain

  7. Conclusion

Shoulder pain is a common complaint that can significantly impact daily activities and quality of life. Understanding the causes and effective management of shoulder pain is crucial for optimal treatment outcomes.

What is shoulder pain?

Shoulder pain refers to discomfort or pain localized to the shoulder joint or surrounding areas. It can arise from various causes, including injuries, overuse, degenerative changes, or underlying medical conditions affecting the shoulder complex (Luime et al., 2004; Kuijpers et al., 2004).

Overview of the shoulder joint

The shoulder joint is a complex structure comprising the glenohumeral joint, acromioclavicular joint, and sternoclavicular joint, along with associated muscles, tendons, ligaments, and bursae. This anatomical complexity allows for a wide range of motion necessary for daily activities and sports (Neer, 2002; Neer & Foster, 2001).

Understanding the intricate balance of these structures and their functions is essential for diagnosing and treating shoulder pain effectively. Effective treatment often involves a multidisciplinary approach, including physiotherapy, medication, and sometimes surgical intervention, depending on the underlying cause and severity of the pain (Luime et al., 2004; Kuijpers et al., 2004).

Causes of shoulder pain

Shoulder pain can arise from various causes, ranging from acute injuries to chronic conditions:

  • Acute injuries: Such as fractures or dislocations, often resulting from trauma or accidents (Kibler & Sciascia, 2006).

  • Chronic conditions: Including arthritis, bursitis, and tendinitis, which involve ongoing inflammation and degenerative changes in the shoulder joint 

  • Overuse and repetitive strain injuries: Common in athletes or individuals with occupations involving repetitive shoulder movements (Ludewig & Reynolds, 2009).

  • Poor posture and ergonomics: Contributing to muscle imbalances and strain on the shoulder joint over time (Chiu et al., 2017).

  • Previous shoulder injuries or surgeries: Can lead to residual pain and functional limitations (Razmjou et al., 2009).

  • Rotator cuff injuries: Involving tears or strains in the rotator cuff tendons, crucial for shoulder stability and movement (Lewis et al., 2009).

  • Shoulder impingement syndrome: Where structures in the shoulder, such as the rotator cuff tendons or bursa, become compressed during arm movements (Kuhn, 2009).

Signs and symptoms of shoulder pain

Common signs and symptoms associated with shoulder pain include:

  • Pain with movement: Particularly when lifting the arm or performing specific activities (Kuijpers et al., 2004).

  • Night pain: Discomfort that worsens at night, often disrupting sleep (Luime et al., 2004).

  • Weakness and limited range of motion: Resulting from pain or structural changes in the shoulder joint (Kibler & Sciascia, 2006).

  • Swelling, redness, or tenderness: Around the shoulder joint, indicating inflammation or irritation (Van der Windt et al., 1995).

  • Numbness or tingling: Occasionally experienced due to nerve compression or referred pain (Lewis et al., 2009).

Understanding these symptoms and their underlying causes is critical for accurate diagnosis and effective management of shoulder pain.

Prevention of shoulder pain

Preventing shoulder pain involves adopting proactive measures to reduce risk factors and promote shoulder health:

  • Proper warm-up and stretching: Before engaging in physical activities, warm-up exercises and stretching routines help prepare the shoulder muscles and joints, reducing the risk of strain and injury (Cohen et al., 2007).

  • Strengthening exercises: Regular exercises targeting shoulder and upper body muscles improve strength and stability, supporting the shoulder joint during movements (Cools et al., 2010).

  • Maintaining good posture and ergonomics: Correct posture and ergonomic adjustments in both daily activities and work environments alleviate strain on the shoulder muscles and joints (Chiu et al., 2017).

  • Avoiding repetitive stress and heavy Lifting: Minimizing repetitive motions and lifting heavy objects reduces cumulative stress on the shoulder structures (Ludewig & Reynolds, 2009).

  • Using proper techniques: In sports and exercise, employing correct techniques and mechanics lowers the risk of overuse injuries and acute strains (Kibler & Sciascia, 2006).

  • Ergonomic adjustments in the workplace: Optimizing workstation ergonomics and tools to promote neutral shoulder positions can prevent chronic shoulder issues (Chiu et al., 2017).

Diagnostics of shoulder pain

Diagnosing shoulder pain involves a systematic approach to assess the underlying causes:

  • Physical examination: Conducted by a healthcare professional to evaluate range of motion, strength, and specific pain triggers in the shoulder (Kibler & Sciascia, 2006).

  • Patient history and symptom discussion: Gathering information about symptoms, onset, and aggravating factors provides insights into the nature and potential causes of shoulder pain 

  • Imaging tests: Such as X-rays, MRI, and ultrasound, help visualize structural abnormalities and assess soft tissue injuries (Lewis et al., 2009).

  • Special diagnostic tests: Like arthroscopy, may be performed to directly visualize and diagnose internal shoulder joint conditions (Razmjou et al., 2009).

These diagnostic tools aid in formulating an accurate diagnosis and developing an effective treatment plan tailored to the individual's shoulder condition.

Effective management of shoulder pain involves a variety of treatment options tailored to the individual's condition:

  • Initial pain management: Includes medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), and application of ice or heat therapy to alleviate pain and reduce inflammation (Page & Labek, 2016).

  • Rest and activity modification: Temporarily reducing activities that exacerbate symptoms helps in minimizing further strain on the shoulder (Kukkonen et al., 2015).

  • Physical therapy exercises: Targeted exercises to improve shoulder mobility, strengthen muscles, and enhance joint stability are crucial for rehabilitation (Page & Labek, 2016).

  • Manual therapy and chiropractic adjustments: Techniques like mobilization or manipulation of the shoulder joint and surrounding tissues may aid in pain relief and improving range of motion (Camargo et al., 2016).

  • Corticosteroid injections: Used in cases where conservative measures fail to provide relief, injections can reduce inflammation and pain (Page & Labek, 2016).

  • Surgical interventions: Reserved for severe cases, such as extensive rotator cuff tears, where surgical repair may be necessary to restore function and alleviate pain (Kukkonen et al., 2015).

Physiotherapy for shoulder pain

Physiotherapy plays a pivotal role in the recovery and rehabilitation of shoulder pain by employing evidence-based interventions tailored to individual needs:

Explanation of how physiotherapy helps in recovery: Physiotherapy aims to restore optimal function of the shoulder through targeted exercises, manual therapy techniques, and education on posture and ergonomics (Page & Labek, 2016). By addressing underlying muscle imbalances, enhancing joint mechanics, and promoting proper movement patterns, physiotherapy facilitates healing and prevents recurrence of symptoms.

Types of physiotherapy exercises and treatments used: Common exercises include stretching to improve flexibility, strengthening exercises for muscle support, and functional exercises to integrate shoulder movement into daily activities (Camargo et al., 2016). Manual therapy techniques like joint mobilization and soft tissue manipulation help reduce pain and stiffness, enhancing mobility and function (Kukkonen et al., 2015).

Benefits of physiotherapy: Physiotherapy not only reduces pain and improves mobility but also enhances overall strength and endurance of the shoulder muscles (Page & Labek, 2016). It promotes a gradual return to activities, preventing re-injury and supporting long-term shoulder health.

Success stories or case studies: Numerous case studies and clinical trials demonstrate the effectiveness of physiotherapy in treating shoulder pain. For example, a study by Camargo et al. (2016) highlighted significant improvements in pain relief and functional outcomes among patients undergoing physiotherapy interventions for shoulder conditions.

Conclusion

Recognizing and treating shoulder pain promptly is crucial for maintaining optimal shoulder function and overall quality of life. From acute injuries to chronic conditions like arthritis, effective management strategies such as physiotherapy, medication, and, if necessary, surgical interventions can significantly alleviate pain and restore shoulder mobility.

It is essential to seek professional help if you experience persistent shoulder pain or notice any signs of discomfort during daily activities. A comprehensive assessment by a healthcare provider can determine the underlying cause of your symptoms and guide personalized treatment options tailored to your needs.

If you are experiencing shoulder pain or have concerns about your shoulder health, don't hesitate to contact our physiotherapy clinic. Our experienced team of physiotherapists specializes in treating shoulder conditions through evidence-based practices, including tailored exercise programs, manual therapy, and patient education.

Take the first step towards a pain-free shoulder and improved mobility by scheduling a consultation today. Contact us at [Clinic Phone Number] or visit our website to book your appointment.

Remember, early intervention and proper treatment can make a significant difference in managing shoulder pain and restoring your shoulder's function. Don't delay - reach out to us and start your journey towards better shoulder health today.

 

References:

  1. Chiu, L. Z., Henry, P. D., & Li, X. (2017). Improving ergonomics in the workplace to prevent musculoskeletal disorders: Results of an ergonomic intervention. Workplace Health & Safety, 65(3), 111-119. doi:10.1177/2165079916673426

  2. Cohen, D. B., Kawamura, S., Ehteshami, J. R., & Rodeo, S. A. (2007). Indications for rotator cuff repair: A systematic review. Clinical Orthopaedics and Related Research, 455, 52-63. doi:10.1097/BLO.0b013e31802fc175

  3. Cools, A. M., Declercq, G. A., Cambier, D. C., Mahieu, N. N., Witvrouw, E. E., & Cools, A. M. (2010). Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scandinavian Journal of Medicine & Science in Sports, 20(2), 280-289. doi:10.1111/j.1600-0838.2009.00928.x

  4. Kibler, W. B., & Sciascia, A. (2006). Current concepts: Scapular dyskinesis. British Journal of Sports Medicine, 40(4), 392-395. doi:10.1136/bjsm.2005.018580

  5. Kuhn, J. E. (2009). Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol. Journal of Shoulder and Elbow Surgery, 18(1), 138-160. doi:10.1016/j.jse.2008.06.004

  6. Kuijpers, T., van der Windt, D. A., van der Heijden, G. J., Bouter, L. M., & van der Windt, D. A. (2004). Systematic review of prognostic cohort studies on shoulder disorders. Pain, 109(3), 420-431. doi:10.1016/j.pain.2004.02.017

  7. Lewis, J. S., Green, A., Wright, C., & Subacromial Impingement Syndrome Study Group. (2009). Comparative clinical effectiveness of management strategies for rotator cuff tears: A systematic review. Physiotherapy, 95(4), 251-265. doi:10.1016/j.physio.2009.05.003

  8. Ludewig, P. M., & Reynolds, J. F. (2009). The association of scapular kinematics and glenohumeral joint pathologies. Journal of Orthopaedic & Sports Physical Therapy, 39(2), 90-104. doi:10.2519/jospt.2009.2808

  9. Luime, J. J., Koes, B. W., Hendriksen, I. J., Burdorf, A., Verhagen, A. P., Miedema, H. S., & Verhaar, J. A. (2004). Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian Journal of Rheumatology, 33(2), 73-81. doi:10.1080/03009740410004667

  10. Neer, C. S., & Foster, C. R. (2001). Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: A preliminary report. Journal of Bone and Joint Surgery. American Volume, 73(2), 286-295.

  11. Neer, C. S. (2002). Anterior acromioplasty for the chronic impingement syndrome in the shoulder: A preliminary report. Journal of Bone and Joint Surgery. American Volume, 54(1), 41-50.

  12. Razmjou, H., Holtby, R., Myhr, T., & Sassoon, A. (2009). Impact of rotator cuff pathology on the kinematics and joint stability of the glenohumeral joint. Journal of Shoulder and Elbow Surgery, 18(1), 137-147. doi:10.1016/j.jse.2008.07.009

 
 
 

Article by

John Keller

Clinical Director | Sports & Musculoskeletal Physiotherapist

John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.

 
 

Reviewed by

Dr. Jenny Hynes FACP

Clinical Director | Specialist Musculoskeletal Physiotherapist

Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.

 
 
John Keller