Shoulder Pain

Rotator cuff tears are generally characterised by pain and limited movement of the shoulder,  that was initiated by an injury event. The pain of a rotator cuff tear can be very sharp and have a ‘catchy’ quality with certain movements and in certain positions.

It is impossible to know for sure whether you have a rotator cuff tear, diagnosing rotator cuff tears involves a combination of specific orthopaedic tests and imaging techniques like ultrasound. 

There are many cases of rotator cuffs settling down and functioning quite happily despite having a tear in one of the tendons. This is most likely because there are multiple tendons,  in the instance of a tear in one tendon stability can still be enforced by the remaining intact tendons. It is not advisable to decline surgery without at least pursuing an extended and professionally prescribed rehab program to strengthen your rotator cuff. It may also be inadvisable to decline survey if you have a major tear that is not improving with attempts at treatment and rehab. 

The best treatment for rotator cuff injury depends on many factors. The severity and location of the injury, your lifestyle and even your genetics play a role in what will work best for you treatment wise. The smartest way to treat rotator cuff injury is with a ‘flexible’ and ‘conservative’ approach. Flexible in this context means using a variety of treatments and tools to see what works for you (eg. acupuncture, stretching, deep tissue release). Conservative in this context means starting with the least invasive options possible (eg. consider acupuncture and rehab exercises before considering surgery).

The most likely cause if you cannot lift your arm without pain is ‘impingement’. Impingement is the term we use to describe the ‘pinching’ of soft tissue between bones. The most common impingement in the shoulder is the pinching of the rotator cuff tendons between the head of the humerus (arm bone) and the acromion (upper tip of shoulder blade). Other possible causes of not being about to lift the arm include frozen shoulder , bursitis and rotator cuff tears.

The overwhelming majority of shoulder pain cases are caused by things like injuries and bad posture. There are of course rare instances where a case of shoulder pain turns out to be cancer, thankfully these are extremely rare. Having stubborn pain is always a call to get the right professional help, rather than ignore the problem or self diagnose using google. If you have pain in combination with night sweats, night pain and/or unexplained weight loss then you are in need of help from a team who can help you make sure all the necessary tests are performed to rule out cancer.  

Chances are you have some damage or inflammation in the muscles or connective tissue of your shoulder. Lying on your side in bed puts complex stretch and compression into the connective tissue and muscle in your shoulder. If you get help from the right practitioner they should be able to figure out what causing it and help you get it sorted. If you are lying awake in significant pain for much of the night it is considered a clinic ‘red flag’ and you should get some tests done immediately to find out for certain what is causing it. 

If you have a persistent feeling of pain or a knot next to the inner margin of your shoulder blade it either means that one of your ribs has become locked up or you have developed some scar tissue in that area. Other cases have a combination of both scar tissue and rib locking. 

The ends of your ribs attach to your spinal column just inside your shoulder blade via small knuckle sized cartilage joints. These joints act as little hinges that enable movement during respiration. This area is a major focus of strain when your posture isn’t great, and the ribs often get locked up. Scar tissue can also form in this area over time. People with this type of issue often feel that they want very deep massage but that it never brings lasting relief. The good news is that by mobilising the ribs and breaking up scar tissue relief is possible. 

By mobilising the locked up ribs where they attach to the spine just inside the shoulder blade and by breaking up scar tissue using special massage tools. Many people with pain inside or behind the shoulder blade also need specific strength exercises for their postural muscles in the back of the shoulder and upper back. 

Massage can bring some level of relief in many cases of shoulder pain. There is a strong tendency for shoulder pain sufferers to find that massage brings frustratingly temporary relief. This is a sign that there is some deeper issue that the muscles are trying to protect, they relax after the massage but then tighten up again quickly afterwards because they are providing extra support to some deeper issue that needs to be addressed. 

Shoulder pain has several possible causes. Assessment helps guide the next steps.

The best exercises for shoulder pain are those that strengthen the rotator cuff, the back of the shoulder and the postural muscles in the upper back. A big part of this is about building up and restoring the muscles that ‘set & stabilise’ the scapulas (shoulder blades). Building up the rotator cuff muscles is also often important because they hold the shoulder joint in place. 

The other type of exercises that are helpful for shoulder pain are exercises that stretch out the front of the body. Part of most shoulder pain cases is shortening of the muscles at the front of the body.

When it comes to rehab you most certainly can treat your own shoulder pain, it’s not like anyone else can do your exercises for you. It is however a lot harder to treat your own pain. It is also not advisable to prescribe your own exercises either because they might not be the right ones for you and there is also a good chance you won’t do them right. Your shoulders are a precious enough asset to spend some money and time getting professional help to heal them. 

Shoulder pain often can and often does get worse, if it is not treated. This is due to the fact that most cases of shoulder pain are caused by ongoing postural issues. If the posture doesn’t improve the shoulder pain may not improve and could also worsen. Some cases of shoulder pain are more self limiting and temporary, these are generally milder cases in people who’s posture and lifestyle are not affecting the shoulder too severely. 

The best treatment for pain behind the shoulder blade is mobilisation of the ribs where they meet the spine. If your ribs are trapped or locked in behind your shoulder blade you tend to feel like you have a knot that won’t respond to massage. Some people with pain behind the shoulder blade also need scar tissue to be broken up with a blunt scraping tool. 

The best treatment plan for shoulder bursitis is one that aims to relieve the pain by reducing inflammation in the bursa, then looks to identify and address the reasons behind the problem developing in the first place. Pain relief can often come by techniques like acupuncture and ultrasound. Dealing with the underlying issues generally involves exercise prescription.

It is important to understand that an inflamed bursae is a ‘symptom’ of some underlying issue with movement or posture. This underlying postural or movement issue is the true diagnosis, the inflamed bursa was just a reaction to that underlying issue. 

Assessment can help determine appropriate management or referral for ongoing symptoms after an AC joint injury.

Frozen shoulders are notoriously stubborn and inpredictable in terms of treatment and resolution. Most cases of frozen shoulder do resolve within 6-12 months, although it can go on a lot longer. Some cases leave some level of permanent restriction, if you find this to be the case you should make every effort to seek physical therapy treatments that might restore the residual movement loss.