What is Shoulder Pain?
Pain can be felt at the shoulder following an injury or from low level repeated movements that may be gradually irritating tissue within. Pain is likely to be located around the shoulder region or down the upper arm to the elbow with pain sometimes even extending down into the forearm at times. It is also worth noting that pain in the shoulder or arm may sometimes be originating in the neck.
There are four common conditions when we look locally at shoulder pain:
- Rotator Cuff Related Shoulder Pain / Shoulder Impingement
- Frozen Shoulder
- Osteoarthritis
- Instability Related Pain
While shoulder pain is rarely due to anything serious, you should attend A&E urgently if:
- Pain is the result of a recent substantial trauma
- You are unable to move your arm due to pain and / or extreme weakness or have loss of feeling through the arm.
- The arm appears ‘out of joint’ / ‘dropped’.
- There is a new significant change in arm colour or swelling / redness.
1. Rotator cuff related shoulder pain at work?
Rotator cuff related shoulder pain is a common occupational health condition affecting the soft tissues which lie in-between the bony structures of the acromion and the humeral head (the subacromial space), such as the subacromial bursa and rotator cuff tissue. Pain and tenderness occur in the shoulder, sometimes referring down to the upper arm. It can be aggravated with repetitive movements of reaching out or with overhead reaching activities, and often sore with sleeping on the affected side. These movements can often be associated with manual activities in the workplace so if you are suffering from shoulder pain at work then seek help and support early on as you may need alternative duties for a temporary period.
What causes rotator cuff related shoulder pain?
Pain is likely multifactorial and can be affected by many health and wellbeing factors such as anatomy, muscle imbalances, static postures, mental health and increased age. It may commonly affect individuals who participate in repetitive overhead activities, as this can lead to progressive overload of the supraspinatus tendon, one of the rotator cuff muscles which give stability and function to the shoulder joint.
When this happens, the tendon has exceeded its load tolerance capacity, and is unable to cope with the demands of the activity, therefore causing pain. If the amount of load placed on the tendon isn’t managed appropriately, it can become chronic through continual overloading of the tendon.
2. What is frozen shoulder?
Frozen shoulder, also known as ‘adhesive capsulitis’, is a condition in which the shoulder becomes initially very painful and then gradual stiffens until there is significant restriction in functional movements such as those needed for every-day tasks and work-related activities. Overhead activities and bringing your hands behind your back can be particularly difficult. These required movements are often associated with manual activities in the workplace so if you are suffering from frozen shoulder at work you may need to seek help and support or look for alternative duties for a temporary period.
Frozen shoulder progresses through three phases which tend to overlap:
- Acute/freezing phase – this phase can last anywhere from 3-9 months. Symptoms start with shoulder pain with movement and at rest.
- Adhesive/frozen phase – this phase can occur from about 4 months and last up until 12 months. Pain starts to reduce, and range of movement becomes more restricted. You may only notice pain at end ranges of movement.
- Resolution/thawing phase – spontaneous improvement in symptoms and range of movement. This phase can last anywhere between 1-3 years.
What causes frozen shoulder?
Frozen shoulder can be either primary or secondary. It is considered primary if the condition has come on spontaneously, with no known cause or trauma, whereas secondary frozen shoulder is often associated with trauma, surgery, period of extended immobility or other pathology such as subacromial pain.
Ultimately the cause of frozen shoulder remains unclear and is most likely multi-factorial with risk factors such as diabetes and is more prevalent in women and those aged 40-65.
Osteoarthritis of the Shoulder
Just like our hair turns more grey with age, our shoulder joint, or any joint in our body, may gradually become achy and stiff as osteoarthritis progresses and local tissue reacts.
Whilst pain is predominantly felt in the shoulder of the effected side it may also radiate a pain down the arm or up into the neck and front of the chest too.
Manual activities in the workplace may place strain on an osteo-arthritic shoulder so if you are suffering from shoulder pain at work then seek help and support early on as you may need alternative duties for a temporary period.
What causes Osteoarthritis related shoulder pain?
Osteoarthritis is a natural process of ageing increasingly seen through each decade of life with people having evidence of osteoarthritis in their joints on specialist scans despite having no pain even to report. Symptoms of osteoarthritis however may be more typically experienced as people age past 45-55 years of age.
There is some indication however that certain factors may predispose someone to a higher risk of developing shoulder osteoarthritis:
- Secondary to past trauma
- History of rotator cuff tears
- Glenoid dysplasia / history of instability
- Avascular necrosis
Instability issue of the shoulder
The shoulder joint’s anatomy evolution allows it to have the largest range of motion in various directions compared with other joints in the body. With this freedom of motion however the shoulder joint is exposed to a reduction of integral stability. Stability refers to a structures ability to maintain a functional position at rest, with movement and under external force. If the shoulder joint has issues of instability, you may notice weakness or fatigue of muscles, pops/ clunks, limited arm movements, pain or a feeling ‘it’s not quite in joint’.
What causes instability?
Instability of the shoulder joint may come from a few potential causes:
- A genetic or congenital disorder (e.g. Ehlers-Danlos Syndrome)
- New Trauma or past dislocation/ subluxation injury
- Repetitive strain often in end of range positions
- Injury or significant weakness to the rotator cuff
Manual activities in the workplace may place strain on a shoulder issue with instability so if you are suffering from shoulder pain at work then seek help and support early on as you may need alternative duties for a temporary period.
What can I do about my shoulder pain?
If you have been affected by shoulder pain at work it can be treated conservatively with physiotherapy treatment and advice, however, your attitude and the actions you take are the most important factors in preventing long-term problems. The most effective way to manage symptoms of shoulder pain are to
- Identify what factors may be contributing to your pain (e.g. slumped postures, repeated overhead activity, smoking or stress) and modifying your activity to try to minimise these factors.
- Talk to your GP or pharmacist about what pain relief or anti-inflammatory medication may be right for you. If your pain is controlled, you will be able to maintain more movement, while anti-inflammatory medication such as ibuprofen may help to reduce any inflammation present.
- Apply an ice pack (wrapped in a towel) to reduce pain and inflammation.
- Report any issues to your line manager immediately so they can make any necessary work-related changes.
How can physiotherapy help?
At Physiotherapy Matters, our physiotherapists can conduct a thorough assessment to confirm the diagnosis and work with you to help you manage pain and return to normal activity by
- Helping you understand your condition
- Helping identify the factors that may be aggravating your symptoms
- Providing advice on how to minimise your aggravating factors
- Completing ergonomic workplace assessments to minimise any work-related risk
- Develop symptom management strategies so you always feel in control
- Provide an individualised exercise program to improve range of motion, strengthen the rotator cuff tissue, increase stability, function and confidence.
- Provide additional manual therapies that may help ease symptoms, such as
- Taping to improve postural awareness and reduce the amount of load/compression on the tendon and therefore relieve pain.
- Soft tissue massage to reduce any muscular tension in the surrounding muscles
- Mobilisation of the upper back to reduce any stiffness that may be causing altered posture and movement patterns at the shoulder or secondary to pain.
- Acupuncture for reduction of pain and inflammation
- Refer for additional services if required including
- Shockwave therapy to improve the healing processes
- Corticosteroid injection – to reduce pain and allow exercise management
It is often the situation that pain effects a person’s mood and behaviour and consequently certain movements and activities may become feared and avoided. Unfortunately, this then limits a person’s abilities to return to their activities and can further increase stiffness and weakness. Coming to see one of the team at Physiotherapy Matters will help minimise this problem and get you back on the right road to recovery sooner.
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