There is a narrow space at the top of the humerus (arm bone) where a group of muscles known as the rotator cuff, and the long head of biceps tendon thread through. This area of space is created by the coracoacromial arch and the and greater tuberosity of the humerus. The tendons within this space can rub against the arch, causing it to “pinch” and become inflamed.
Pain at the shoulder, usually over the front and outer part. It’s common to notice the pain when laying on that side or raising the arm over the head, this is due to the subacromial space narrowing further when the arm is in this position, thus triggering any contact of the tendons.
This is often caused by repetitive overhead activities, it can also be caused by weakness of the rotator cuff and/or other supportive musculature of the shoulder, creating an imbalance.
Strengthening the rotator cuff is usually a main priority in rehabilitating the shoulder. If other areas are not moving optimally such as the thoracic spine (upper back) this can also predispose the shoulder to injury, which can be aided through manual therapy and education.
The rotator cuff is a group muscles and tendons that act to stabilise the shoulder and assist with internal and external rotation of the arm. These muscles, like any other can become torn by direct trauma, sporting injury, or sudden unguarded movement.
This condition will often present similarly to subacromial impingement. You might notice raising the affected side overhead causes an increase in pain, and trying to perform internal or external rotation or the arm (trying to rotate your shoulder inward and outward) against resistance causes pain.
Unfortunately, this is a common condition, what the shoulder achieves in terms of great mobility it sacrifices in stability. The shoulder is therefore at a delicate balance and the rotator cuff is prone to becoming torn or inflamed. Weakness to the rotator cuff, and/or repetitive overhead movement may predispose to this injury.
The strength of the rotator cuff needs to be addressed, alongside the function of areas of the body such as the upper back and neck. By getting a full picture and we can strengthen weaker areas and stretch and release those which might be too tight or causing dysfunction.
The labrum is type of articular cartilage, enabling a congruent surface for the head of the humerus (arm bone) to sit within the shoulder joint (glenoid). Tearing can occur to this surface, causing joint movement disruption and pain.
Pain deep within the shoulder, may radiate down to the elbow. You experience locking or feelings of instability when moving the shoulder, dependant on its location and severity.
This is often caused by trauma, and may accompany a dislocation as the head of the humerus if forced abrasively out of its socket. It can also be degenerative, where as we age the cartilage thins and tearing may recur as result.
The labrum is poorly vascularised (low blood supply) meaning it struggles to heal itself. Unfortunately, tears may gradually get bigger over time. This can usually be managed well conservatively however by strengthening the supportive musculature of the shoulder and providing education to the patient on daily activities and homecare advice. In some instances, surgery might be a good option to repair the tear directly.
Commonly known as a frozen shoulder this is a thickening and fibrosis of shoulders joint capsule. This leads to lack of mobility in the shoulder (particularly being able to raise the arm) and pain accompanying movement. The condition often comes on slowly and is often misdiagnosed as a strain or sprain early on. It is unknown why this condition occurs.
Pain on moving the shoulder, and feeling of general stiffness. At early stages, may mimic the feeling of a sprain or strain to one of your muscles or ligaments. Overhead movement tends to be the most painful and difficult, especially when combined with external rotation.
Certain factors predispose to this condition, but it is largely unknown why this condition occurs. If you are diabetic, pregnant, have had previous trauma to the shoulder (especially if it has been immobilised as a result) this can increase the chance of it developing.
Frozen shoulder with treatment can still take several months or years to fully resolve. Regular prescriptive exercise completion from the patient is very important for the best outcome. The therapist can assist the process by helping to mobilise the joint directly.