What causes Shoulder pain?
Most shoulder problems fall into four major categories:
- Tendon inflammation (bursitis or tendonitis) or tendon tear
- Fracture (broken bone)
Other much less common causes of shoulder pain are tumours, infections, and nerve-related problems.
What are the Symptoms of Shoulder Pain?
As you can read above, there are four major categories of shoulder problems.
So, everything starts with a competent history and examination to reveal the cause of your shoulder pain and therefore directs how we treat your symptoms and the homework we give you to support our treatment.
The Main Symptoms of Tendonitis:
- pain and tenderness in the affected tendon, often worse on movement
a grating sensation as the tendon moves.
- a lump on the tendon.
- weakness in the affected area.
- decreased range of motion.
A tendon tear will usually be referred to your GP or consultant for possible surgery if it is a Grade 2 or 3 tear.
The Main Symptoms of Bursitis:
Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.
Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa which presents as pain and reduced shoulder mobility.
The Main Symptoms of Shoulder Instability:
Shoulder instability is both functional and structural.
Functional instability occurs when there are traumas to the soft tissue (muscles, tendons and ligaments) which keep the shoulder joint ‘in place’ so you can get on with your life. When minor tweaks do not fully resolve the result can be a cascade of localised inflammation, muscle weakness, localised trigger points and spasm. Now, everyday activities will trigger pain and restriction both locally and after a short time a more widespread pattern of adaptation will occur. This pattern of symptoms have now become chronic ie your new ‘normal’.
Unfortunately without treatment these symptoms are prone to becoming longstanding (chronic) and slower to respond to any form of treatment. The good news is that they will respond to treatment.
Our expert practitioners here at the Backcare and Acupuncture Clinic will listen carefully, examine thoroughly and put together a comprehensive and individualised treatment plan to set you free of pain and getting back into life!
Structural instability occurs when the head of the upper arm bone is forced out of the shoulder socket which is called shoulder dislocation. This typically happens as a result of a sudden injury, such as a fall or accident.
We will always refer you to your GP or an orthopaedic specialist for immediate assessment and treatment as this may result in a trip to your local A&E department!
Arthritis in the shoulder:
There are five types of arthritis which can affect your shoulder joint:
1 – Osteoarthritis
Osteoarthritis occurs when the cartilage that cushions and protects the ends of your bones gradually wears away. This process is often called ‘wear and tear’. It leads to pain and stiffness that worsens over time, making it difficult to do daily activities.
Osteoarthritis is the most common form of arthritis. It develops slowly and most often occurs during middle and older age.
Although there is no cure for osteoarthritis, there are many treatment options available to help manage pain and keep people active. Curiously, there is no clear relationship between the severity of joint wear and tear as revealed by imaging (x-ray or MRI) and the severity of pain.
Osteoarthritis is usually accompanied by inflammation, and it is the process of inflammation that is impacted by the treatment delivered in the clinic. In particular, acupuncture and massage appear to help many joint pain sufferers.
2 – Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic autoimmune disorder that affects multiple joints in the body. It is symmetrical, meaning that it usually affects the same joint on both sides of the body, including both joints of the shoulder.
The condition can affect people of any age, although it is more common in women and typically develops between the ages of 40 and 60.
In RA, the immune system mistakenly attacks the synovium, which is the lining of the joints. This results in inflammation and swelling of the joints, causing pain, stiffness, and reduced mobility.
Over time, the chronic inflammation can damage the cartilage and bone in the affected joints, leading to deformity and disability.
In the Backcare and Acupuncture Clinic we always treat this condition with acupuncture to reduce the degree of inflammation. We will never ask you to change your medication or ignore the advice of your consultant.
The aim of treatment is to help your body to respond to the treatment, not to be in competition with it. As symptoms ease we would begin to include physiotherapy to support any improvement in your symptoms and increase your capacity to engage with your activities of daily living.
3 – Post Traumatic Arthritis
This is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder. The analogy we use in the clinic is that the joint is (metaphorically) ‘cold’ and ‘stuck’ – concepts freely borrowed from Traditional Chinese Medicine. The aim of treatment is to ‘warm’ the joint and create movement.
This is done with acupuncture, cupping and Gua Sha – all techniques borrowed from TCM and used in the clinic for the past 40 years. Once the pain has subsided then we will move into the rehabilitation phase of treatment consisting of strengthening weak muscles, re-educating the brain-joint connection to create smooth and efficient movement patterns, working on joint stability and regional mobility in the neck and mid and upper back.
4 – Rotator Cuff Tear Arthropathy
Rotator cuff tear arthropathy is a condition that occurs when arthritis develops after a long-standing rotator cuff tendon tear. This can cause the surfaces of the bones in the shoulder joint to become damaged, leading to pain, weakness, and limited range of motion.
The rotator cuff is a group of four muscles and tendons that help to keep the upper arm bone in the shoulder socket. When the rotator cuff is torn, it can no longer function properly, leading to instability and damage to the joint.
As the joint becomes more damaged, the bones can rub against each other, causing further wear and tear and the development of arthritis. This can cause severe pain and weakness in the shoulder, making it difficult for patients to perform daily activities or even lift their arm.
Treatment for rotator cuff tear arthropathy aims to alleviate pain and improve range of motion in the joint. This may involve a combination of physical therapy (physiotherapy and osteopathy for rotator cuff tears), anti-inflammatory medications, and acupuncture.
The concept of ‘warming’ the joint and creating movement, as borrowed from Traditional Chinese Medicine, is often very helpful in managing symptoms and improving overall joint health. In addition to acupuncture, this can include gentle exercises, stretching, and other forms of movement therapy to increase blood flow and promote healing in the joint.
5 – Avascular Necrosis
Avascular necrosis (AVN) of the shoulder is a condition that occurs when the blood supply to the head of the humerus bone in the shoulder joint is disrupted. This can be caused by a variety of factors, including trauma, corticosteroid use, alcohol abuse, and certain medical conditions.
When the blood supply is disrupted, the bone cells in the affected area begin to die, leading to a condition known as osteonecrosis. As the bone tissue breaks down, the head of the humerus can collapse and deform, leading to severe pain and limited mobility in the shoulder joint.
Over time, the breakdown of bone tissue can also lead to the development of arthritis in the shoulder joint. This can cause further pain, stiffness, and reduced range of motion.
Treatment for AVN of the shoulder typically involves a combination of pain management, physical therapy, and surgical intervention.
In the early stages of the condition, non-surgical treatments such as medication and physical therapy may be effective in managing symptoms and slowing the progression of the disease.
In more advanced cases, surgery may be necessary to repair or replace the damaged bone and joint tissue. This can involve procedures such as core decompression, bone grafting, or joint replacement surgery.
This condition requires careful management by your medical team. It is not suitable for treatment in our clinic.
How can I treat my shoulder pain at home
Most musculo-skeletal pain can usually be safely self managed at home. You’ll find below the best evidenced ways to treat your shoulder pain at home.
- Rest: Resting the affected shoulder and avoiding activities that cause pain can help reduce inflammation and promote healing.
- Ice: Applying ice to the affected area can help reduce pain and inflammation. Apply an ice pack for 15-20 minutes at a time, several times a day.
- Heat: Applying heat to the affected area can help increase blood flow and promote healing. Use a heating pad or take a warm shower for 15-20 minutes at a time.
- Stretching: Gentle stretching exercises can help improve range of motion and reduce stiffness. However, be sure to avoid any movements that cause pain.
- Over-the-counter pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help reduce pain and inflammation.
- Massage: Gentle massage of the affected area can help reduce muscle tension and promote relaxation.
- Posture correction: Improving your posture can help reduce strain on the shoulder and prevent further injury.
It’s important to remember that while self treatments can be effective for mild cases of shoulder pain, they may not be sufficient for more severe cases.
If your shoulder pain is causing significant discomfort or interfering with your daily activities, it is a good idea to seek medical attention from a healthcare professional who can assess your condition and recommend appropriate treatment options.
When should I worry about Shoulder pain?
Shoulder pain can be caused by a variety of factors, including injury, overuse, and underlying medical conditions. While many cases of shoulder pain can be managed with rest, ice, and over-the-counter pain medications, there are some instances where you should seek medical attention.
You should seek medical attention for your shoulder pain if:
- Your shoulder pain is severe or persistent and does not improve with rest, ice, and over-the-counter pain medication.
- Your shoulder pain is accompanied by swelling, redness, or warmth in the affected area.
- You have difficulty moving your arm or lifting objects, or if you experience weakness or numbness in your arm or hand.
- You have a history of shoulder injury or surgery.
- You experience shoulder pain that is accompanied by shortness of breath, chest pain, or other symptoms that may indicate a heart attack.
- Your shoulder pain is associated with fever or other signs of infection.
In general, if your shoulder pain is causing significant discomfort or interfering with your daily activities, it is a good idea to seek medical attention from a healthcare professional who can assess your condition and recommend appropriate treatment options.
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Frequently Asked Questions
What happens during my initial consultation?
Our priority upon your arrival is to ensure that you feel welcome, comfortable, and well-informed about your appointment. Typically, your initial consultation will last between 45 minutes to an hour. One of our experienced osteopaths will meet you and begin by attentively listening to you. We will inquire about your general health, any current pain you may be experiencing, your medical history, medications you may be taking, and review any medical examination results.
After this initial discussion, we may conduct specific tests to make a diagnosis. You may be asked to perform some gentle movements to allow us to evaluate your posture and mobility.
Using this important information, we will then create a personalized treatment plan tailored specifically to your needs.
What will happen AFTER an initial consultation?
During your second visit to our clinic, we will provide a detailed explanation of our findings from your history and examination. By the end of this session, you will be able to answer several crucial questions, including:
- What is causing my symptoms?
- What are the available treatment options?
- How long is the expected recovery time?
- How much treatment will be necessary based on your personalized treatment plan?
- How much will your treatment cost?
- What can I do to help myself?
- What changes do I need to make to get better, faster?
We take the time to explain and clarify the causes of your symptoms and what can be done to alleviate them. At this stage, we will have created a personalized treatment plan tailored to your specific needs.
What can I expect after my first treatment?
The response to treatment varies from person to person, as everyone is unique. The initial treatment is a crucial step in gauging the patient’s reaction to treatment and determining the best course of action to meet their individual needs.
Immediate relief may be experienced by some patients after the first session, while others may require multiple sessions to see significant progress. It’s vital for patients to realize that treatment is not a one-time fix and that it may take a number of sessions to achieve long-term results, particularly for chronic issues or long-standing musculoskeletal imbalances.
Is treatment painful?
The treatments themselves are not painful, but there might be some discomfort after the spinal manipulation as your body adjusts to the treatment and improved posture. This can result in stiffness in certain regions, which is a natural occurrence, and we recommend using an ice pack on the area for 10 minutes after your session and staying hydrated.
What causes the cracking sound during the treatment?
The cracking or popping sound heard during an osteopathic treatment is caused by the release of nitrogen gas from the joints. This is a normal and common occurrence and may not always happen depending on the technique used. The sound itself is neither significant or important to your progress.
What is the cost of the initial consultation?
The initial consultation is priced at £65, which comprises a thorough spinal evaluation including muscle and nerve testing, orthopaedic examination, as well as posture and movement analysis.
What is the cost of the each treatment?
Each treatment is £45 if you pay as you go. However, we do have discount options available depending on what works best for you.
What days and times are you open?
Monday – Friday 8am – 8pm,
Saturday – 8am – 2pm
Sunday – closed
How long will it take for me to feel better?
The length of time it will take to start to feel better varies a good deal between patients. This difference is based on several factors, including the how long you’ve had the problem and how severe it’s become, your lifestyle and demands of work and family as well as your individual capacity to respond to treatment.
Generally, patients with acute conditions (recent onset) may experience significant improvement within a few sessions, while those with chronic conditions (your symptoms have been present for more than 12 weeks) may require more treatment sessions to attain long-lasting outcomes.
The secrets to getting well are to always turn up for your treatment, follow the guidance of your practitioner and get involved in your own recovery. Don’t delegate your health to your practitioner. It is always a partnership!
What happens if I miss an appointment?
We recognize that we all have busy lives beyond the Backcare and Acupuncture Clinics, but please let us know as soon as possible if you are unable to keep your appointment, and we will make every effort to reschedule it for you. We will make every effort to accommodate your particular schedule