Shoulder Pain

Shoulder is the most flexible joint in our body which can easily develop pain from daily wear and tear. Individuals who reach middle age, and use their shoulders frequently in their specific occupation are particularly susceptible. Common causes of shoulder pain include Frozen Shoulder, Shoulder Impringement Syndrome and Rotator Cuff Injury.

Frozen Shoulder, also called Adhesive Capsulitis, means the contraction of capsule surrounding the shoulder joint and the formation of scar tissue, which results in pain and restriction of shoulder motion. The cause of Frozen Shoulder is usually unknown, but it can be a complication of diabetes, arthritis, trauma and prolonged immobilization. Females aged 40 to 60 years are more easily affected.

Frozen Shoulder follows 3 stages of clinical presentation:

  1. Freezing Stage (up to 4 months from onset):

    Intense pain is felt even at rest and there is mild limitation of motion.

  2. Frozen Stage (1-12 months):

    Pain is felt only with movement, there is significant adhesions, limited glenohumeral motions with substitute motions in the scapula, and weakness in deltoid, rotator cuff, biceps and triceps muscles.

  3. Thrawing (2-24 months):

    No feeling of pain but there is significant limitation of motion for 2-24 months, followed by spontaneous recovery or persistent loss of range of motion.

Frozen shoulder can predispose the affected side to impingement and rotator cuff injury.

Shoulder Impringement is caused by repetitive compressive loads on the rotator cuff and subacromial bursa due to inadequate joint play, faulty scapular posture, joint degeneration and joint laxity. It causes chronic inflammation at the shoulder joint which may lead to fibrosis, tendonitis, and tears in the rotator cuff and biceps, even bone spurs. Usually pain is felt on palpation and during movement, with poor endurance of shoulder activities. Those who are heavily involved in overhand throwing or lifting are most susceptible. Patients with Shoulder Impringement may also develop frozen shoulder in the affected side.

Rotator Cuff Injury is caused by repetitive strain to the rotator cuff due to continued use of the upper extremity and impingement, or fall on an outstretched arm. Repetitive strain first causes microtrauma and inflammation in the muscle and tendon, where pain and weakness are felt, and progressive damage or degeneration can lead to calcification and eventually tendon rupture. Those who are heavily involved in forward, overhead or swinging activities are most susceptible.

Physiotherapy can manage pain, limitation of motion and muscle weakness associated with these shoulder pathologies.