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This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
The acromion is a piece of bone protruding off the front of your shoulder blade over the shoulder. Below the acromion there is a space called the sub-acromial space. The tendons of the rotator cuff muscles that surround and support the shoulder joint pass through this space. There is also a fluid filled sac called the bursa that lies between the tendons and the acromion. Impingement is when the acromion rubs against the tendons or bursa when you lift your arm and this can give rise to pain on the front or the outside of the shoulder when doing activities which involve rising the arm above your head. Your physiotherapist will be able to perform specialized tests to help determine whether impingement is the cause of your shoulder pain.
Physiotherapy techniques that can help include taping, soft tissue techniques, advice on controlling any inflammation. The most effective treatment is teaching of exercises to improve posture and stretch tight muscles and strengthen weak muscles around the shoulder to improve shoulder movement. This then helps to stop the rubbing of the tendons or bursa on the acromion. Also manual therapy on the upper back when it is stiff can help. If your symptoms do not improve with a course of physiotherapy we can recommend a top London consultant to review you.
The shoulder is a ball and socket joint where the ball of the humerus (top of upper arm) rotates around in the socket (glenoid). This type of impingement occurs when the back top part of the socket rubs with certain areas on the head of humerus and rotator cuff tendons. It happens in the last bit of throwing as you take your arm back. The symptoms include a widespread pain in the back of the shoulder during or after sports involving throwing. Your physiotherapist can perform specialized tests to determine whether this type of impingement is the cause of your shoulder pain.
Physiotherapy techniques that can help include taping, soft tissue techniques, advice on controlling any inflammation. The most effective treatment is teaching of exercises to stretch tight muscles and strengthen weak muscles around the shoulder to improve shoulder movement therefore helping to stop the rubbing. Also manual therapy on the upper back can help. If physiotherapy does not improve your symptoms we can recommend a top London shoulder consultant to review you.
Osteoarthritis of the shoulder
Wear and tear in the shoulder over time can lead to pain that is normally an ache at rest or when moving the shoulder. The shoulder will often feel stiff first thing in the morning and the pain can sometimes also be felt in the arm. The pain can be worse with different weather when lifting heavy objects.
Physiotherapy can help with ad ice, pain relief, setting exercises and manual treatment.
Dislocation / instability
The shoulder joint is the most likely joint in the body to become unstable or dislocate. Sometimes the dislocation can happen as a result of trauma if unstable or without trauma.
Physiotherapy can help by working on stiffness in the spine and other joints that may be contributing. Most importantly they can take you through a progressive strengthening programme for the muscles around the shoulder to increase its stability. Taping and advice on braces can also help to prevent the shoulder from dislocating during sport. If your physiotherapist feels you require a review by a top London shoulder consultant we can organize this for you.
Injury to the labrum
The labrum circles around the shoulder and provides a site for attachment of the capsule, ligaments and the long head tendon of biceps muscle. This labrum can be torn by repetitive overhead throwing or falling on an outstretched hand (FOOSH injury) or from a sudden violent contraction of the biceps muscle. There are also other ways the labrum can be torn. Symptoms include a deep pain in the shoulder that is hard to determine where the pain is. The pain is worse when lifting arm over your head or putting your hand behind your back. There may be feelings of a pop, crack or grind in the shoulder. Sometimes it feels like you have a dead arm.
Physiotherapy can help to assess your shoulder and determine whether this may be a possible cause of your pain. If a labrum injury is suspected then a medical referral will be required and we can recommend a top London shoulder consultant to review you.
Rotator cuff tendinopathy
There are 4 rotator cuff muscles around the shoulder that help to stabilize the shoulder. Tendinopathy of the tendons of the rotator cuff muscles is when they become swollen and weaken. The pain is usually felt when using the arm overhead and causes include instability, muscle weakness or tightness and poor movement control when using the arm.
Your physiotherapist will be able to perform tests on the rotator cuff muscles to determine whether this is the cause of your shoulder pain. Physiotherapy techniques that can help include taping, soft tissue techniques, advice on controlling any inflammation. The most effective treatment is teaching of exercises to stretch tight muscles and strengthen weak muscles around the shoulder to improve shoulder movement. Also manual therapy on the upper back can help.
Rotator cuff muscle strain or tear
A tear in one of the rotator cuff muscles can happen. It is more common to happen in athletes and produces a sudden pain and often twinges of pain are felt around the shoulder area. Sleeping on the shoulder can be painful and the pain is often worse at night. Your physiotherapist can perform specialized tests to determine whether a tear or strain may have happened.
Physiotherapy techniques that can help include taping, ultrasound, soft tissue techniques, massage, acupuncture and advice on controlling any inflammation. Exercises can be taught to help the collagen fibers that lie down in response to healing are aligned in the most effective way. If your physiotherapist feels you require a medical review we can recommend a top London shoulder consultant to you.
Calcific tendinopathy of the rotator cuff tendons
The cause of this is undetermined but it can occur in any of the tendons and means that calcium deposits have formed within the tendons. The pain is often severe at rest, with movements and at night. Their presence can be confirmed by x-ray and ultrasound. Referral to a shoulder consultant is recommended in this case.
The biceps muscle is attached by 2 different tendons called the short head and the long head. The long head attaches over the front of the shoulder and can become overused and lead to pain.
Physiotherapy can help determine whether this is the cause of your pain.
Frozen Shoulder (Adhesive Capsulitis)
A capsule surrounds the shoulder joint. This capsule can become inflamed and tighten as a result. The condition is more common later in life and quite often both shoulders can become affected. There are 3 stages involved in this condition. The first is the freezing stage where often severe pain and a loss of shoulder movement is experienced which can last anytime between 2 and 9 months. The second phase is known as the 'Frozen' stage where the lost of movement in your shoulder continues but the pain becomes significantly less and lasts between 4-12 months. The final stage is the 'Thawing' stage where the movement in your shoulder starts to return. Often the pain will be dull and often felt in the upper arm also and sometimes in the forearm, neck and shoulder blade. Pain is often felt at night if lie on the painful shoulder and often stiffness will be more in the morning. Activities such as dressing, fastening a bra, combing hair, or reaching for wallet in backpocket can become difficult.
Physiotherapy can help the condition with advice and helping the pain in the early stages. Manual treatment and exercises can help with the shoulder movement. In some cases a corticosteroid injection will be required to help reduce the inflammation of the capsule that needs to be carried out by a medical professional. We can recommend top London consultants to you that carry out this procedure.
Fractured clavicle (collar bone)
Fracture of the collarbone can result from falling onto the shoulder or through direct contact with an opponent in sport. The fracture usually happens in the middle third of the collarbone and its severity will be classified depending on the injury to the ligaments that are attached to each end of the collarbone. If the injury is severe surgery may be required otherwise a sling will help support the bone in a position to help it heal effectively. It is recommended if a fractured collarbone is suspected that you have a review with a top London shoulder consultant who we can recommend to you.
Physiotherapy will be required during rehabilitation after this fracture to help you do controlled exercises to stop your shoulder becoming stiff and then to fully return your arm movement and strength once the fracture has healed.
Acromioclavicular joint injury
The acromioclavicular joint is the joint between the outside end of the collarbone and the acromion bone which comes of the top front part of your shoulder blade. There are ligaments that can be affected when this joint is injured called the acromioclavicular and costoclavicular ligaments and the injury will be classified on how badly the ligaments are injured. If severe injury then surgery is required.
Physiotherapy can help with pain relief and taking you through a rehabilitation programme to restore movement and strength if the injury straight away if the injury was mild. If severe and surgery required they will recommend a top London shoulder consultant to you.
Acromioclavicular joint pain that develops over time
Pain can develop in the acromioclavicular joint without an injury due to osteoarthritis where there can be wear and tear to the joint surfaces and bony structures develop called osteophytes. Symptoms include pain over the joint and when raising your arm up to your furthest reach. Reaching across your body often produces pain as well as trying to move your arm behind your back.
Physiotherapy can help by taping over the joint, performing manual treatments to the joint itself and setting exercises. If no improvement with physiotherapy medical help such as corticosteroid injections or surgery maybe required in severe cases of arthritis. We can recommend top London shoulder consultants to review you if this is the case.
Tear of the pectoralis major muscle (main chest muscle)
If a tear happens in the muscle then there will be sudden pain on the inside of the upper arm where the muscle attaches. Feeling the muscle and making it contact can produce the pain.
If the tear is only small then physiotherapy can help with ice, ultrasound, taping and going through a strengthening programme. If the muscle is completely ruptured then surgery is indicated. We can recommend a top London shoulder consultant to review you if this is suspected.
Tear of the subscapularis muscle
This muscle is located behind your shoulder blade and can be torn if the arm is forcefully turned outwards.
Physiotherapy can help with advice, taping and going through an exercise programme. If severe then a surgical repair may be required. We can recommend a top London consultant to review you if this is suspected.
Stress fracture of the scapula (shoulder blade)
This can occur if you fall onto the shoulder or during a forceful throw during sport. There will be pain over the point of fracture and shoulder movement reduced due to pain. If suspected a medical referral is required and we can recommend a top London shoulder consultant to you in this case.
Fracture of the neck of humerus (upper arm)
This usually happens from a traumatic incident and more common in the elderly who have restricted neck and spine movement. There will be pain at the fracture site and significant reduction in arm movement. Sometimes the radial nerve, which spirals around the upper arm can be affected as a result. If a fracture is suspected an immediate medical referral is required and we can recommend a top London shoulder consultant to you in this case.
Physiotherapy is required to maintain shoulder, elbow, wrist and hand strength as is possible and then once the fracture is healed to restore full arm movement, strength and function. If the radial nerve is affected specific exercises for the nerve can be set.
Thoracic outlet syndrome
The thoracic outlet is a area between the collar bone, 1st rib, neck muscles that the nerves and blood supply passes through. Sometimes these nerves and blood vessels can be compromised in overhead sport activities, from poor posture, birth abnormalites and other previous traumatic changes. Symptoms include pins and needles and numbness of the arm and weakness in the arm and hand. Pain can result in the neck, arm, shoulder and chest.
Physiotherapy can help by advising on how to improve your posture, massage, stretching, soft tissue techniques, taping, joint mobilisations and other exercises.
Axillary vein thrombosis ('effort thrombosis')
It is referred to as 'effort' as frequently related to activities that require vigorous activity. The compression of the vein can take place in 4 different areas and leads to a dull aching pain and numbness or tightness. The arm or shoulder can feel heavy and often tired after doing activities involving the arm. Coldness and swelling of the arm can happen. Rest and anticoagulation medication is required. If your physiotherapist suspects this is the cause of your symptoms they will recommend you have a review with your doctor.
Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. Affected joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.
We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment that includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function. Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmmes, massage, taping, acupuncture and mobility programmes.
We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:
- Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
- Wheelchair assessments
This condition does not involve inflammation but affects the fibrous tissues in many parts of the body ie. tendons, muscles, connective tissue etc. There can be a large number of tender points and a feel of generalized aching. Some of the common tender points are around the shoulder. There a number of other symptoms including fatigue, sleep disturbances, sensitivity to temperature, morning stiffness, numbness and tingling, irritable bowel, depression and dry eyes and mouth.
Physiotherapy can help people with this condition. There are pain relieving techniques that can be used and they are experienced in pacing you back to being able to exercise again and return to activities whether sport, work or hobbies that you were able to do before the condition started. They also are able to provide advice on how to cope with your condition and manage flare ups of pain.
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants to help you.
Other possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- disease process
- psychological problem ie. depression, anxiety
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