Common Problems and Diagnoses of the Shoulder
1. Shoulder Impingement
Shoulder impingement occurs when the top part of your shoulder blade pinches (or "impinges") your rotator cuff. This can cause pinching and sharp pain with movement. If left untreated, it can wear down your muscle- think about putting a rope over a rock, if you pull it back and forth over that hard edge enough it can tear! This irritation increases inflammation which gives you less joint space and so the vicious cycle continues! Working to improve your positioning and joint space will give your muscles enough space to travel without being pinched. According to The Cleveland Clinic 44-65% of all reported shoulder pain is believed to be from impingement. Good news, proper exercises and stretches do WONDERS for this.
2. Rotator cuff tear (full or partial)
Your rotator cuff is a group of 4 muscles that surround your shoulder (the supraspinatus, infraspinatus, teres minor and subscapularis) these muscles all help your shoulder to move in different directions and keep your arm bone stable in your shoulder socket. If one muscle becomes irritated or even tears it can cause shoulder pain and significant loss of motion. Tell tale signs for a rotator cuff tear are inability to move arm behind back or overhead. These occasionally require surgical correction but therapy should always be the first step to see if exercise can help to bring that irritated or partially torn muscle back to life!
3. Arthritis
Your shoulder is made up of several joints, the main one being your glenohumeral joint, which is where your arm bone meets your shoulder blade. Just like any joint in the body, arthritis can happen with wear and tear as we age. This is typically worse in people that require overhead reaching at work on a frequent basis. Tell tale signs of arthritis in the shoulder are a crunching sensation called crepitus where you can essentially feel the bones rubbing on each other due to lack of space and cushioning in there. Overhead reaching can be painful and limited due to this lack of joint space. People with severe arthritis typically have difficulty raising their arm to shoulder height.
4. Biceps Tendonitis
We all think of our bicep as that big muscle in our arm that bends our elbow which is true… BUT the bicep actually starts in the shoulder and also helps to raise your whole arm up from the shoulder. It travels down the front of your shoulder, sitting in a groove before it travels down into your arm to the classic bicep region we think of. When this bicep is tight or irritated it can cause pain in the front of the shoulder that is usually worse when reaching over shoulder height. It can also cause a clicking specially in the front of your shoulder. This clicking typically does not hurt but is so very annoying! When our shoulders roll forward that bicep essentially acts as a seat belt to hold the shoulder joint in place. Making sure you have good posture can limit further pressure on that front of your shoulder.
5. Frozen Shoulder
Also known as adhesive capsulitis, this condition is caused by inflammation in the shoulder which can lead to significant loss of motion and pain. Just as the name suggests, this condition freezes your shoulder up making motion difficult. People typically loose the ability to reach out to the side and behind their back FIRST, but can progress to loose just about all motion of the shoulder. Although the exact cause is unknown we know it causes it is more common in individuals with diabetes. This diagnosis is crucial to get therapy early to stretch things outs and prevent it from worsening.
Testing:
X-rays of the shoulder can show us how the bones and joints look. It can show us if there is arthritis in the joint which could account of your symptoms or if there is limited joint space which can cause that pinch in shoulder impingement. It can be helpful to look at overall bone alignment or see if there is a broken (aka fractured) bone. An X-ray does NOT show muscle or tendon.
An MRI shows muscles and tendons. This is there we can see if something is torn, partially torn or irritated. It can also show us if there is a lot of inflammation in the joint. This is considered more advanced imaging then an x-ray which means insurance might not always cover it.
Treatments:
Therapy should almost always be a first option for shoulder pain. Especially if it is pain that has been gradually getting worse over the last several weeks or months.
If there is an acute injury like a fall or accident going to the hospital or seeing a doctor can be important to make sure nothing is seriously damaged but if it is a muscle problem them will most likely send you right to therapy anyways! An occupational or physical therapist can guide you in the right direction, whether that means exercise, stretching. We can complete manual muscle testing and assessments to know exactly where your problem is and give you a custom program to get you back in action.
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