How to treat shoulder-pain

While it is best to have your physician or physical therapist evaluate your own shoulder-pain, the article below is intended for educational purposes and to provide you with more information about treating shoulder pain.

I have limited the scope of this article to one of the most common sources of shoulder-pain. Pains in the shoulder can often be a sign of shoulder impingement syndrome, rotator cuff tendinitis or even shoulder bursitis.

Description of these types of shoulder-pain:

Impingement syndrome is characterized by pain in the shoulder due to inflammation of the tendons of the rotator cuff or the bursa (subacromial bursa) that sits between the rotator cuff and the roof of the shoulder (acromion).

The rotator cuff is a series of four muscles that surround the ball of the shoulder (humeral head). The subacromial bursa sits over the top of the cuff, allowing for the cuff tendons to slide near the roof of the shoulder without undue friction. Normally the humeral head gets closer to the acromion when the shoulder is moved, particularly as you reach overhead.

When the rotator cuff becomes inflamed because of injury or overuse, or when the bursa becomes inflamed, then both the swollen tendon and swollen bursa may become pinched between the humeral head and the acromion.

Impingement syndrome may represent a grade 1 - 3 strain of the tendon.

A grade 1 strain is a mild strain.

There is a slight pull without obvious tearing (it is microscopic tendon tearing). There is no loss of strength, and the tendon is the correct length.

A grade 2 strain is a moderate strain.

There is tearing of fibers within the substance of the tendon or where the tendon meets the bone or muscle. The length of the whole muscle-tendon-bone unit is increased, although there usually is decreased strength.

A grade 3 strain is a complete rupture of the tendon.

Signs and Symptoms

  • Pain around the shoulder,often atthe outer portion of the upper arm
  • Pain that is worse with shoulderfunction, especially when reaching overhead or lifting
  • Occasionally, aching when not usingthe arm
  • Often, pain that awakens you at night
  • Occasionally, tenderness, swelling,warmth, or redness over the other aspect of the shoulder
  • Loss of strength
  • Limited motion of the shoulder,especially reaching behind (such as to back pocket or to unhook bra) oracross your body
  • Crepitation (a crackling sound) whenmoving the arm
  • Biceps tendon pain and inflammation(in the front of the shoulder); worse when bending the elbow or lifting

Causes

  • Strain from sudden increase in amountor intensity of activity
  • Direct blow or injury to the shoulder
  • Aging, degeneration of the tendonwith normal use
  • Acromial spur

Risks Increase With

  • Contact sports such as football,wrestling, and boxing
  • Throwing sports, such as baseball,tennis, or volleyball
  • Poor weightlifting techniques or "monkey-see monkey do" bodybuilding programs
  • Heavy labor
  • Previous injury to rotator cuff,including impingement
  • Poor physical conditioning (strengthand flexibility)
  • Inadequate warm-up before practice orplay
  • Inadequate protective equipment
  • Increasing age
  • Spurring of the acromion

 PreventiveMeasures

  • Appropriately warm up and stretchbefore practice or competition.
  • Allow time for adequate rest andrecovery between practices and competition.
  • Maintain appropriate conditioning:
    • Cardiovascular fitness
    • Shoulder flexibility
    • Muscle strength and endurance
  • Use proper technique.

 ExpectedOutcome

      This condition is usually curable within 6 weeks if treated appropriately with conservative treatment and resting of the affected area. Healingis usually quicker if injury is caused by a direct blow (versusoveruse).

 PossibleComplications

  • Prolonged healing time if notappropriately treated or if not given adequate time to heal
  • Chronically inflamed tendon, causing persistent pain with activity that may progress to constant pain (with or without activity)
  • Shoulder stiffness, frozen shoulder, or loss of motion
  • Rotator cuff tendon tear
  • Recurrence of symptoms, especially ifactivity is resumed too soon, with overuse, with a direct blow, or whenusing poor technique

 General Treatment Considerations

      Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer may be recommended.

An injection of cortisone to the area around the tendon (within the bursa) may be recommended. Surgery to remove the chronically scarred bursa and spur from the acromion may be necessary, but this is usually only considered after at least 3 monthsof conservative treatment. Surgery may be performed arthroscopically or with an open incision. Return to full activity is usually possible in 3 months.

Medication

  • Nonsteroidal anti-inflammatorymedications, such as aspirin and ibuprofen (do not take within 7 daysbefore surgery), or other minor pain relievers, such as acetaminophen,are often recommended. Take these as directed by your physician.Contact your physician immediately if any bleeding, stomach upset, orsigns of an allergic reaction occur.
  • Pain relievers are usually notprescribed for this condition. If prescribed, use only as directed andonly as much as you need.
  • Cortisone injections reduceinflammation, and anesthetics temporarily relieve pain. There is alimit to the number of times cortisone may be given, because it mayweaken muscle and tendon tissue.

Heat and Cold

  • Cold is used to relieve pain andreduce inflammation for acute and chronic cases. Cold should be appliedfor 10 to 15 minutes every 2 to 3 hours for inflammation and pain andimmediately after any activity that aggravates your symptoms. Use icepacks or an ice massage.
  • Heat may be used before performingstretching and strengthening activities prescribed by your physician,physical therapist, or athletic trainer. Use a heat pack or a warm soak.

For tips on using Ice Massage to treat your condition follow this link


Shoulder Stregthening Exercises


rotator cuff exercises

  ROTATOR CUFF STRENGTH PART 1

A Physical Therapist should prepare a customizedtherapeutic exercise program for you as part of your comprehensive care plan. The exercises below are simply a demonstration of some of the movements designed to strengthen the deep shoulder muscles.
Exercise
Manual-Notes (if any)
Retraction
1) Stand facing the bands.
2) Start position: Position arms perpendicular to body like the letter“T” with thumbs pointing up and elbows straight.
3) Pull arms back by squeezing shoulder blades together.
4) Return to start position.
5) Remember to keep head in neutral position.


Physical Therapist's comments:
Sets Reps Weight/
Resistance
1 20   
2 20   
 
Protraction (Pushup)
1) Lie face down on the floor with hands palm down, fingers pointingstraight ahead, and aligned at the nipple line.
2) Place hands slightly wider than shoulder width, and feet should beat hip width with toes on floor.
3) Start position: Extend the elbows and raise the body off the floor.
4) Extend at the elbows and pressing up at the shoulders separating theshoulder blades and arching the upper back.
5)

Remember to keep the head and trunk stabilized in a neutral position byisometrically contracting the abdominal and back muscles. Avoidhyperextension of the low back.

Physical Therapist'scomments:

Sets Reps Weight/
Resistance
1 20   
2 20   
 
Dumbbell Shoulder Raise
1) Lie back onto an incline bench (45° or less) with a DB in each hand.(You may rest each DB on the corresponding thigh.)
2) Start position: Bring the DB’s to your shoulders. Press the DB’s updirectly above the head with palms facing forward.
3) Lower the DB’s by retracting your shoulders. Then raise theshoulders toward the ceiling.
4) Return to starting position and repeat.

Physical Therapist'scomments:
Sets Reps Weight/
Resistance
1 20   
2 20   
 
Seated Cable External Rotation
1) Adjust pulley to approximately waist height.
2)

Stand 2-3 feet away from pulley or machine with the working arm facingaway from pulley. Feet should be shoulder width apart with kneesslightly bent.
3) Start position: Grasp handle and flex elbow 90°keeping elbow in at side. Forearm should be rotated inward with fistpointing towards pulley.
4) Rotate arm outward keeping elbow at 90°.
5) Return to start position.
6)

Remember to keep elbow firmly secured to side. You may put a rolledtowel between the elbow and side to facilitate rotation and secure form.


                                                  Physical Therapist's comments:

Sets Reps Weight/
Resistance
1 20   
2 20   
 
 
 


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