If you have a sore shoulder, you’re not alone. Shoulder pain is the third most common joint complaint after back and neck pain. There are several reasons your shoulder might be sore, such as dislocation, fracture, osteoarthritis or frozen shoulder. However, the majority of the time (70%) it’s hard to pinpoint the specific structure that is causing pain. In the past, we commonly referred to as “rotator cuff related pain”. Read on to find out more about the rotator cuff and what we now know about scans and imaging results for diagnosing shoulder pain.
What is the rotator cuff?
The rotator cuff is the name given to a group of muscles and their tendons that wrap around the shoulder joint from the front and the back. They are called:
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
These muscles work together with very specific timing to provide support for the shoulder and to assist other larger muscles with shoulder movements. In the past, clients with shoulder pain have routinely been referred for an ultrasound scan of their shoulder to check for a tear in this area. However, the management and future of shoulder pain is changing, and below is some information on why. This is a conversation we have frequently in the clinic with our clients.
My scan says I have a tear in the rotator cuff, don’t I have to ‘fix’ that tear in order to get better?
You may have received a scan that picked up a tear in the rotator cuff muscle or tendons. However, this does not automatically mean that the tear seen is the cause of your pain, and this is why…
The latest research tells us that if you performed an ultrasound scan on 100 people who have no symptoms, quite a large number of them would come back with a report saying they had a full thickness rotator cuff tear. But how is that possible? If all of them were pain free when they had the scan, why do they have tears?
This is because not all tears or degeneration within the body are the cause of the pain. Hence, if you receive a scan showing a tear or degeneration, that does not mean, necessarily, that it IS the cause of your symptoms.
We do still request scans of shoulders occasionally when we believe it will change the treatment plan for your shoulder, such as to confirm if there is a fracture etc. However, in most cases we can assess your condition, reduce your pain and improve your function, despite having no scan, or a scan that shows a tear.
If the tear is not necessarily causing the pain, what is?
The tear may be causing your pain. But we want our clients to understand that it’s not the case 100% of the time. We need to keep our minds open and allow the physio to use their clinical reasoning to determine what is the cause of the pain.
The physio will use the answers to many questions they ask you, as well as a whole range of clinical tests to determine where they believe the pain is coming from. This will direct what treatment they provide you with. Whether this is:
- Manual therapy (such as massage, dry needling etc.)
- Short term taping for pain relief
- Advice and recommendations for at home
- And what exercises they will provide
This is more complicated then it sounds. Everyone’s shoulder is different and unlike the knee joint which only bends and straightens, the shoulder joint can move forward, backwards, sideways and rotate around. There are muscles, tendons, ligaments, joint capsule, bones, cartilage and much more that all has to work and move in unison and perfect timing with each other – like in a ballet. Any dysfunction in these movements can lead to pain and problems.
Why do I have pain now if my shoulder has always been moving incorrectly?
One of the main reasons the shoulder may become irritated and inflamed is because it started getting used it in a different way. This might be that you are using it for a new task or using it more than you did before.
Unfortunately, knowing the exact source of the injury starting can be difficult, as along with the things mentioned above, there are several factors that can influence your shoulder that you may have not thought were related.
These include:
- Lifestyle
- Social factors
- Psychological factors such as stress
- Environmental factors
- Genetics
- Age
- Sleep
What do I do now? How do I make the pain go away?
Although shoulder pain can be complicated, the good news is that physiotherapy can help. By performing a thorough assessment, we can determine where the pain is coming from and how to address the issues in the shoulder. Physiotherapy treatment can help provide pain relief, promote movement back into the shoulder and get you back to the important things in your life.
Do I have to do the exercises? Isn’t there a faster way to fix this?
Sadly, there is no quick fix for the shoulder. As mentioned before, the shoulder often gets sore from being overworked or used incorrectly. Increasing the strength of your shoulder through an individual exercise program, targeting the weak areas, will ensure the problem does not return. You will need to learn how to use the shoulder correctly, what things to avoid and how to perform the exercises with good technique. Improving your strength, posture and control will allow you to then withstand the load from the new activities that may have upset your shoulder in the first place.
But what if I’m too sore to do exercises?
Depending on the length and severity of your symptoms, there can be a role for other treatments in the early stages to reduce your pain and support your ability to exercise and move your shoulder. This includes:
- Massage for tight muscles
- Dry needling
- Taping to modify position of the shoulder on the scapula
- Activity modification
- And in some cases, we may ask you to speak to your Doctor about pain-relief medications or anti-inflammatories
These types of treatments can be useful in the short term; however, the underlying cause of pain needs to be addressed to prevent the pain from coming back.
At Back in Motion, we can complete a full assessment, let you know which part of the shoulder we believe is causing the pain, what we would recommend as treatment, and how long we think it will take to get better. This is all done during our FREE INITIAL ASSESSMENT. If you choose not to continue with treatment, it is free of charge!
If you choose to go ahead with treatment, we can help manage your pain, achieve your goals, and help prevent this from reoccurring in the future.