Shoulder Pain

Shoulder pain can either occur suddenly with acute incidents or develop gradually over time. In chronic shoulder problems, it is often challenging to determine the exact cause of pain, and thus making a definitive diagnosis is not always possible.

With any chronic shoulder problem, you will most probably experience pain at night, especially when you sleep on the affected side. With time, you may also have increasing difficulty using your arm, particularly with tasks that involve lifting your arm over your head (such as washing your hair), or moving your hand behind your back (like tucking in your shirt).

With any shoulder problem, we encourage you to commit to the full treatment and rehabilitation program, and not stop treatment prematurely once your pain is under control. Rehabilitation is vital to prevent injury recurrence and must be progressed over time. Shoulder problems may take weeks, or even months to resolve completely. Trust Just Physio to “Empower You Toward (Complete) Healing”.

Pain at the Front of Your Shoulder

The majority of cases, shoulder pain is located at the front of the shoulder. Pain may be very specifically localised to one area, or it may be diffuse and even radiate down your arm. You may experience sharp pain, or pain may be dull, aching, and deep. Most often, pain directly in front of the shoulder indicates a problem with the biceps tendon, or early onset of frozen shoulder.

If you have instability of your shoulder, perhaps after a dislocation toward the front, you may also have pain here.

Rotator cuff injuries such as tears and tendinopathies can also cause pain at the front of the shoulder. Injuries of the rotator cuff will often give constant pain, meaning you will have pain during rest, during arm movement, and at night. Occasionally, people with rotator cuff injuries will have associated symptoms. This may include shoulder instability and/or stiffness, muscle weakness and poor control over shoulder movements. Our initial treatment in this case will focus on healing the tear or tendinopathy. Thereafter, we help you to regain your shoulder movement and function, and also look at potential movement errors or other body areas that may be weak or unstable, and address these in a holistic rehabilitation program.

Treatment for biceps tendinopathy will follow a similar path to that for rotator cuff injuries. For shoulder instability, our primary aim will be to reduce any associated pain and discomfort. We will try to stabilise your shoulder joint, passively at first using e.g. taping techniques, then actively by starting a rehabilitation program with you.

Treatment for frozen shoulder will depend which phase of the condition you are in. Usually, frozen shoulder resolves by itself, but may result in long-term problems if it is not managed well. Physiotherapy will help to manage your pain, regain shoulder joint movement, and ultimately allow you to use your shoulder again. The primary phase of frozen shoulder is the painful phase. Therefore treatment is focused on pain management. We can offer ultrasound, electrotherapy modalities, massage, heat application and advice to get you through this phase. The second, stiff phase, is focused on reducing muscle tension and improving joint mobility. Joint mobilisations, dry needling, myofascial release techniques, and therapeutic exercises will be potential treatment approaches we will use here. Finally, when the condition starts to resolve, we will help you regain strength and function of your shoulder. Frozen shoulder may take up to 2 years to resolve. At Just Physio, we understand the frustration and difficulties people go through during this time, and will do our best to guide and help each person through it.

Another, more traumatic cause for pain at the front of your shoulder is a fracture, either of your clavicle, where pain will then be slightly more inward toward your neck area, or of your upper arm, where pain may be radiating from the front of your shoulder down into your arm. Fractures will frequently require surgical fixation, after which we can help you with your rehabilitation and recovery.

Muscle tears, such as that of the pectoral (chest) muscles, will initially cause pain at the front of your shoulder, but may then radiate to other areas. Partial-thickness tears can be successfully treated with physiotherapy.

Pain at the Top of Your Shoulder

Pain right at the top of the shoulder is often very localised and specific. It usually feels like a sharp, or stabbing sensation and is worse when you lift your arm or try to place your hand behind your back. Crossing your arm over your chest may also cause pain at the top of your shoulder. Most frequently, pain in this area is caused by impingement syndromes or acromioclavicular (AC) joint pathology. The AC joint is a very small joint at the tip of your shoulder. Injuries to this joint can occur when you fall directly on your shoulder, or when your arm is pulled forcefully. Rotator cuff injuries and frozen shoulders sometimes also cause pain on the top of the shoulder.

Impingement is not a real diagnosis, but rather a sign or symptom. Therefore, our treatment is focused on managing your symptoms, and gradually regaining pain-free shoulder movement.

AC joint injuries are easily treated with initial management of pain and swelling, stabilising and resting the joint, and finally recovering shoulder movement and function.

Pain can sometimes be referred to the top of the shoulder from other areas, specifically from your cervical spine (neck). We will always do a neck assessment when you present with a shoulder problem to rule out any neck problems.

Pain at the Back of Your Shoulder

Pain at the back of your shoulder may be caused by traumatic injuries such as glenoid labrum tears, a dislocation that is directed toward the back, or fractures of the shoulder blade. The glenoid labrum is a deep structure within your shoulder joint, which serves to deepen the socket and acts as an attachment for muscles.

Falls, or sudden muscle pulls can tear the labrum, resulting in sudden, severe pain. This type of injury may require surgery, after which we will help you with your rehabilitation and recovery. The glenoid labrum can also be injured by minor traumas over time, which will then cause gradual onset of pain at the back of your shoulder, instead of a single incident causing sudden pain. This type of injury typically causes instability of the shoulder joint over time. This type of injury can be treated without surgery. We start with pain management and advise you on how to get about your daily activities. Then, a progressive rehabilitation program should be started, through which we will guide you, and manage any symptoms that arise during this time.

Other, often more chronic, causes of pain at the back of your shoulder include frozen shoulder, rotator cuff tendinopathies, referred pain from your spine, or trigger points in surrounding myofascial structures. Rarely, nerve entrapments occur, causing generalised pain around the back of your shoulder. Each of these conditions will be thoroughly assessed and treatment will follow similar principles.

Pain on the Outer Part of Your Shoulder

Pain localised to the outside of your shoulder may be coming from trigger points in muscles around your shoulder girdle, neck and even your chest. In the later stages of frozen shoulder, you could experience pain more diffuse around this area. A traumatic fracture, especially of the upper arm, will also give you pain here.

Pain may be referred from your cervical spine (neck) or thoracic spine (upper back) such as in Thoracic Outlet Syndrome (TOS). TOS pain pattern can spread to the top and back of your shoulder too.

Pain associated with arthritis in the shoulder will come on more gradually, feel like it spreads around your entire shoulder, and occasionally it may radiate down your arm.

For any of these causes for shoulder pain, our treatment follows the same principles as for most shoulder problems. Our initial aim of treatment will be to reduce your pain and swelling, if present. We have different treatment approaches to address pain and swelling, including ultrasound, electrotherapeutic modalities, massage, dry needling etc. Then, once your acute symptoms have resolved, we work with you to decrease shoulder stiffness, release tight myofascial structures, and therefore restore your shoulder movement and function. This is achieved through therapeutic exercises, stretches, and symptom management as they arise.