Shoulder

The Shoulder

14% of individuals in the UK at any one time are troubled with a shoulder complaint. Shoulder pain is often accompanied with either weakness, stiffness or instability.

Common conditions that affect the shoulder are:

Painful and weak Shoulder

Rotator Cuff Related Shoulder Pain (Subacromial shoulder pain)

Rotator cuff related shoulder pain (RCRSP) is the most common cause of shoulder pain. The broad term relates to pain arising from a number of shoulder conditions that are related to rotator cuff tendon pathology and from tissues situated around the tendon.

Evidence indicates that physiotherapy, including exercises, have been shown to be effective in helping to manage and improve pain associated with RCRSP.

For information and exercises specific for rotator cuff related shoulder pain please visit

https://www.youtube.com/playlist?list=PLm3YXeV2B6557jHXJLgi2rxjFsZTJn3Md

https://bess.ac.uk/subacromial-pain/

Painful and Stiff Shoulder

Shoulder stiffness can occur with a number of shoulder conditions. If stiffness is the main feature with your shoulder problem the 2 most common causes of this are either a condition known as frozen shoulder or glenohumeral joint (shoulder “ball and socket joint”) osteoarthritis.

Frozen shoulder

Frozen Shoulder is an extremely painful condition associated with a marked reduction in movement at the shoulder. It often starts without any history of trauma/injury but can in some cases occur after shoulder injury or surgery. The average age for onset is 50. There is a slightly higher reported incidence in patients with diabetes.

Below is a link to our advice and exercise booklet for the management of frozen shoulder which helps explain the condition and how best to treat it in more detail.

Frozen Shoulder.pdf [pdf] 1MB

Glenohumeral joint (shoulder “ball and socket” joint) osteoarthritis

Osteoarthritis is a very common condition that affects a number of joints, including the Glenohumeral Joint. It occurs where the smooth, tough cartilage layer overlying the ends of two bones, where they meet, becomes worn. This results in pain and stiffness affecting the joint. It is more common later in life as we age. Glenohumeral joint osteoarthritis can be diagnosed by X-ray findings.

In the early stages physiotherapy may be useful to help manage symptoms and to help maintain range of movement and function. In the exercise library below is a link to an exercise booklet, depending on your symptom presentation the early and intermediate shoulder range of movement (ROM) exercises may be helpful.

You may also find some of the exercises in the leaflet below useful to help maintain range of movement.

We recommend you seek advice from a physiotherapist to assist in choosing appropriate exercises. In the later stages of the condition an orthopaedic opinion may be required to explore whether corticosteroid injections or surgery are needed to help manage symptoms. This can be discussed with your physiotherapist should shoulder symptoms remain intrusive.

Shoulder Range of Motion.pdf [pdf] 92KB

Painful and Unstable Shoulder

Joint instability can be a source of pain affecting the shoulder.

Shoulder instability occurs where the ball, or humeral head, moves completely out of the socket or Glenoid, this being a dislocation of the joint. A subluxation occurs where there is a partial dislocation of the humeral head.

This can be due to a force acting on the shoulder associated with a trauma, for instance during a fall. This may also occur with minimal force where an individual has a more mobile shoulder or “loose joints”. This type of instability, referred to as atraumatic instability, often occurs with a feeling of the shoulder slipping, catching or clunking.

Management of an unstable shoulder depends upon the type of instability and direction of the shoulder dislocation or subluxation.

Atraumatic shoulder instability is generally treated with physiotherapy and rehabilitation in the first instance. Surgery is only very rarely required. It is important that any exercises undertaken to address shoulder instability are discussed and agreed with a qualified physiotherapist to ensure their suitability and safety.

Physiotherapy, including guided exercises and advice, is also important in the recovery of an individual following a traumatic shoulder dislocation that has been reduced (relocated) or after shoulder stabilisation surgery.

If you suspect a dislocation affecting the shoulder it is important to seek medical advice at the Emergency Department immediately.