Since the ball is so big relative to the socket it gives the shoulder significant mobility, but also makes it vulnerable to injury. The shoulder joint relies on key structures to ensure that the shoulder functions properly, such as:
The rotator cuff: A group of muscles and tendons that stabilize and move the shoulder
The joint capsule and ligaments that stabilize the shoulder
The integrity of the bone and cartilage of the shoulder joint
The labrum: A ring of specialized cartilage that lines the rim of the socket and deepens it to help make the joint more stable
The subacromial and subdeltoid bursae: Sacs of fluid that cushion and protect the tendons and muscles of the shoulder.
The alignment, position and stability of the shoulder girdle: Composed of the scapula (shoulder blade), the clavicle bone the related joints and muscles
Shoulder pain can come from one or more of these following common causes:
1. Rotator Cuff Injury
Rotator cuff injuries can range from mild to severe.
Tendonitis is an injury caused by overuse of the rotator cuff and causes it to become inflamed.
Athletes, who use overhead movements such as baseball players or people with jobs that require repeatedly reaching upward commonly suffer this injury. The rotator cuff muscles can also strain (overstretch) or tear partially or completely, from a sports injury, after a fall, a car accident, or from poor posture and degenerative changes.
This is a wear and tear condition of the soft tissue that can cause pain and disability. It’s associated with small tears in the rotator cuff or long head of a bicep tendon.
4. Frozen Shoulder
Also known as adhesive capsulitis, is a shoulder condition that causes significant loss in range of motion.The first sign of a frozen shoulder is usually pain that limits your arm movement, resulting in stiffness.
Before long, reaching behind your back, or for an item on a high shelf, and everyday tasks that involve shoulder movement becomes extremely difficult. Frozen shoulder typically develops slowly, and in three stages; the freezing stage characterized by pain, frozen where pain subsides and stiffness begins, and thawing where mobility begins to improve. Each stage can last from about three to six months. The condition is more likely to form in middle age and more prevalent in women.
Osteoarthritis can accumulate over time, which is why the older you are, the more wear and tear you may have on the cartilage of your joints. Cartilage protects the ends of bones within a joint and allow them to move easily against each other.
When cartilage breaks down with age, it becomes pitted and rough. This can cause pain within the joint, and irritation in surrounding tissues. Damaged cartilage can’t repair itself as it does not have a blood supply. When cartilage completely wears, the cushioning to bone that it provides disappears, causing bone-on-bone contact. This can result in intense pain, loss of mobility, and grinding noises from the joint.
It can be a painful condition that affects the small, fluid-filled sacs called bursae that cushion the bones, tendons and muscles near your joints which reduce friction between structures during movement.
When bursae become inflamed, it’s called bursitis. In the shoulder, the sub-acromial bursa that is located beneath the deltoid muscle is typically involved. The most common causes of bursitis are repetitive motion, trauma, or positions that put pressure on the bursae.
7. Labral Tears
Athletes commonly suffer tears to the labrum, especially those involved in overhead sports. It is a common injury in the non-athletic population also, particularly the middle-aged and usually associated with degenerative changes.
Often, they won’t even be aware they have one, as some tears are completely asymptomatic and cause no problems. Others can trigger shoulder pain, specifically when moving the arm in an overhead motion or across your chest.
8. Shoulder Impingement
Shoulder impingement usually occurs after repeated overhead activity, like throwing or swimming. Shoulder tendons and bursae get impinged, or pinched, between the bones of the shoulder, making it painful to move your arm.
Symptoms may worsen with overhead motion, reaching back, or lying on the sore shoulder. Shoulder impingement can weaken the rotator cuff, further contributing to the problem. This symptom is often associated with tendinopathy or pathology of the AC (acromio-clavicular) joint.
9. Shoulder Instability
The term instability is a diagnosis that is given to the shoulder when it causes pain due to the ball of the joint being too loose and unable to move normally in the socket.
Chronic strain and more instability can occur when the loose shoulder is overused, as it repeatedly challenges the ligaments that help hold the shoulder in the socket. This is the case in the throwing athlete or swimmer, who uses their shoulder repeatedly through its full range of motion. Instability is commonly the cause of shoulder pain in younger people.
10. Dislocated Shoulder
Complete dislocation is when the ball of the joint fully comes out of the socket. The person usually holds their arm against their belly unable to move it.
Sometimes there is a fracture or torn labrum associated with this injury. A partially dislocation of the shoulder, is called a subluxation, which occurs when the ball incompletely shifts out of the socket, and usually pops back in. With subluxation, the shoulder feels loose and slips in certain positions especially when their arm is elevated and rotated backwards like when throwing a baseball. Both subluxation and dislocation can result from trauma or from underlying instability.
11. Separated Shoulder
A separated shoulder is an injury to the ligaments that hold your collarbone (clavicle) to your shoulder blade. In the case of a mild separated shoulder, the ligaments may just be stretched.
In severe injuries, ligaments can be torn. If severe enough, the end of the collar will be elevated. The most common cause of a separated shoulder is a blow to the tip of the shoulder or a direct fall on the shoulder.
12. Post-Surgery Shoulder
If rehabilitation of shoulder pain fails, or there is a large rotator cuff tear or other significant tissue damage, your surgeon may recommend a surgical procedure.
Physiotherapy treatment when recovering from surgery is a critical part of recovery to ensure best outcomes for patients.
Physiotherapy treatment and management of the above conditions has been proven to be helpful to improve pain, help in recovery and deal with chronic symptoms in the shoulder. Treatment tools such as education, self-care management, exercise therapy, and manual therapy are commonly used by a registered physiotherapist to treat shoulder pain. Other treatments such as acupuncture, soft tissue release and massage therapy may also help.
A registered physiotherapist can conduct a skilled assessment and examination of the spine and initiate appropriate treatment. Call Us today at 416-691-3943 or contact us here to start your recovery.
Frequently Asked Questions About Shoulder Pain & Injury
How do you prevent shoulder instability?
There are active and passive structures surrounding a joint that help with stability. In a shoulder joint, muscles such as the rotator cuff will provide active stability, whereas ligaments provide passive stability. If you are focusing on prevention and have not had any previous injuries to your shoulder, neck or back, strengthening the muscles surrounding the joint through exercise may be beneficial. However, there are many muscles that make up your shoulder joint (17 muscles that attach to your shoulder blade!). A physical assessment by a Physiotherapist will be able to determine any muscular imbalances and prescribe specific and individualized exercises. It is also a good idea to engage in a proper warmup and cooldown prior to any strenous physical activity/demand of the shoulder.
What should I do after shoulder therapy?
Depending on the injury, your physiotherapist will prescribe an individualized exercise program for you to carry out at home until your next visit. Being consistent with your treatment plan (which includes your exercise program) will lead to the best prognosis for any shoulder injury. Once you complete your shoulder rehab and are discharged from Physiotherapy, maintenance is going to be crucial to prevent any future injuries. Which your physiotherapist will go over prior to discharge.
What is the most common cause of shoulder pain?
One of the most common causes of shoulder pain is tendinopathy. Other causes of shoulder pain may include: muscle strain, ligament sprain, cartilage tear, bursitis, frozen shoulder, fracture, dislocation, adverse neural tension, and even a heart attack. During your assessment, your physiotherapist will be able to diagnose what is causing your shoulder pain.
How can I prevent tendonopathy?
"Some ways to prevent tedonopathies include:
Proper work and sleep ergonomics
Frequent rest breaks during any strenous and/or repetitive activities
Proper warmup and cooldown prior to any strenous or repetitive physical activity
Exercises (including resistance and flexibility) for the muscle
General postural exercises
Is shoulder therapy painful?
Generally, no. But it depends on the injury as well as the stage of healing at time of therapy. For example, treatment techniques for tendonopathies, which include manual therapy (soft tissue tehcniques, mobilization, etc), modalities (ultrasound, laser, acupuncture/dry needling, etc) and individualized exercises, are typically not painful. However, mobilizations for Frozen Shoulder, which has been shown to be quite effective, can be uncomfortable. Prior to beginning any treatment technique, your physiotherapist will inform you of the benefits, contraindication, risk and alternative methods of treatment.
Can stress cause shoulder pain?
Yes! When under stress, our body enters a "fight or flight" state which increases heart rate, respiratory rate, blood pressure and causes muscles to contract/tense. If muscles are constantly contracted or tensed, they may become painful, weak, tight, develop trigger points and not function properly. Whereby increasing ones risk of developing shoulder pathologies. Stress has also been linked with mental health problems, cardiovascular disease, gastrointestinal, mental health and more. Luckily there are many ways to manage stress including but not limited to meditation, exercise and help from healthcare professionals.
Is hot or cold good for shoulder pain?
It depends. There's a lot of mixed literature out there between hot and/or cold therapy. Ultimately, it will depend on the type of injury you are dealing with as well as what stage of healing you are in. Generally, if you are dealing with acute pain and notice that there is inflammation, ice would be your best bet. If you are dealing with chronic pain and stiffness, heat would be most likely be recommended. However, consult with your physiotherapist and they will be able to help determine what would be the most beneficial for you.
East Toronto Orthopaedic & Sports Injury Clinic - Greektown
Adam was super. Always positive and very encouraging thru my rehab.
10 August 2023
Excellent service . I highly recommend this clinic. Teresa the receptionist is very helpful and nice . Adam is a knowledgeable physiotherapist. And Fatima is a very good acupuncturist .
25 July 2023
Excellent experience with Adam - thorough and very personable.
26 June 2023
Marshall was very helpful and professional and worked with me on a very painful knee injury. i began a few months ago barely able to bend it or walk up and down stairs and have improved greatly with his program. i am now able to run up and downstairs with no problems and am almost back to 100%. the receptionists are also accommodating and professional and were easily able to process insurance claims, answer questions, and reschedule appts when i was sick or something came up. i was very impressed by my experience here and would recommend it wholeheartedly to anyone looking for a new physio!
13 June 2023
Great experience. I had foot pain that wouldn’t go away so I came here and found so much assistance in regaining my mobility.
8 June 2023
Went to the Pape and Danforth clinic for a massage with Robert. Customer service from initial onset was with Therese. Was very patient with me when it came to form filling and billing. Robert was also extremely good at working on my pain points and being thorough with his explanations. Overall great massage, experience and education!
26 March 2023
Everyone at this clinic is very kind and professional- Would recommend!
7 January 2023
Trevor is great! He has guided me on my road to recovery. Staff is also friendly and knowledgeable. Nachi is also great!
5 December 2022
I would highly recommend the services of Trevor - he provided excellent care. I received a thorough assessment and a clear treatment plan. Trevor is knowledgeable, friendly and is a good communicator. The office is well-equipped and Mina at the front desk was always very welcoming.
15 November 2022
I have seen Trevor for several different problems over the years and he has always done an amazing job helping me with my recovery. He is knowledgeable in many areas and always happy to answer questions and explain what he is doing. He is thorough with assessment and treatment so you always feel like you are in good hands. He is also very honest and won't push you to keep coming if he doesn't feel you need it. Mina at the front desk is really welcoming and the clinic is very clean and comfortable. Overall a great physio experience and would highly recommend to anyone!