The shoulder is a complex ball and socket joint that allows more movement than any other joint in the body. Movement involves an impressive number of muscles, tendons and ligaments, with bones and minor joints sitting alongside. As such, we can overuse it, especially in sports or physical work tasks and it’s prone to injury. Let’s talk you through some common injuries, so you can recognise when to seek help.
As a general rule, if it’s persisted for more than 2 weeks without improvement, it’s best to get a professional opinion – you can book with your doctor or a physiotherapist. Your doctor may allow direct access to NHS physiotherapists.
If you find it painful to lift your jumper over your head or other similar actions, this could mean that a muscle or tendon is catching on a bone. This most commonly involves one of the rotator cuff muscles, the supraspinatus, pinching against a knobbly bone you can feel at the top of the shoulder, the acromion. It’s known as impingement or painful arc syndrome. If you lift your arms straight out from the flat against the thighs, pain kicks in as the arm reaches shoulder height, then eases off straight overhead (pain is worst from 60 to 120 degrees, if you remember your protractor from school).
Try to avoid exercises that bring pain on. Rest may allow it to repair, or you may need specific exercises depending on the cause, such as strengthening weak muscles or stretching out tight muscles. If pain persists or movement is very limited, this may require more investigations, as the muscle may be torn. A physiotherapist is well-placed to assess you and advise on exercises or other treatments.
A shoulder dislocates when the top of the humerus, the bone in your upper arm, pops out of the shoulder socket. This usually occurs with a sudden pulling or pushing trauma, and can tear the muscles, ligaments and tendons around it. This is intensely painful until it pops back in (by itself or with emergency treatment), and there may be pain and weakness in certain movements while it recovers. Hypermobility may make you more vulnerable to this.
It can leave the shoulder with instability in the long term, making it more likely to dislocate again, and the shoulder may feel weak or it may click or lock on movement. It can put your shoulder at risk of wear-and-tear arthritis.
Once you’ve recovered from the initial pain and trauma, you should seek a physiotherapist’s input to rebuild strength and stability, to avoid dislocation happening again.
A bursa is a little fluid-filled cushion that helps a joint glide easily through movement. Your shoulder joint has six bursae. These can get inflamed, causing pain on particular movements, especially lifting the arm up and extending it. It may affect very mundane tasks such as brushing hair or getting dressed and it may also disturb sleep if you roll onto the injured shoulder.
It may be caused by a repetitive movement such as overhead bowling or lifting, or an inflammatory condition affecting the shoulder joint such as gout or arthritis. Pain starts gradually and builds over weeks or months. Pain is initially inside the shoulder but may move to the outside and down towards the elbow. It’s more likely to occur in those over 30 years old, and it’s more common in women.
This is when the shoulder gets inflamed and painful, and later stiffness sets in. It’s also known as adhesive capsulitis. It’s a tough one to recover from, usually taking several months or even a couple of years. It can have a huge impact on everyday activities, and it’s one to see your doctor or physiotherapist about early on to try to prevent stiffness setting in.
People describe the pain usually as a dull ache, often worse on movement or at night, and it gets worse over the first two to nine months. This is followed by increasing stiffness that can prevent the shoulder moving well. It gradually improves, with heat packs and painkillers when needed during the painful stage, then movement and strengthening exercises once pain has subsided.
See your doctor initially to get the correct diagnosis and advice, and see them again if you’ve had no improvement in symptoms after six months.
The cause isn’t really clear – sometimes an injury or surgery comes before frozen shoulder, and diabetes seems to put people at higher risk. It’s most common in those aged 40 to 60, and it may affect as many as 1 in 20 of us during our lives.
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