In our experience shoulder pain and injury are very common. This is because the design of the shoulder joint allows it to be very mobile. It is in fact the most mobile joint in the body allowing you to place your arm in almost any position desired. However this large range of mobility comes at the expense of stability, so whilst the shoulder joint is the most mobile joint in the body, it is also one of the most unstable.
At Walker and Hall we know through personal experience how shoulder pain in all its forms can have an enormous effect on every aspect of your life e.g., dressing and caring for yourself and family, sleeping, working and sports and leisure activities.
The most common types of shoulder pain we treat are
The frozen shoulder
Rotator cuff injuries / Impingement syndrome
Shoulder dislocation
Shoulder instability
AC (acromio-clavicular) joint problems
Bicipital tendonitis
Fractured collar (clavicle) bone.
Referred pain
We have extensive experience in treating these conditions and managing your recovery.
To see how Walker and Hall can help you please click on the links below:
- The frozen shoulder
- Rotator cuff injuries / Impingement syndrome
- Shoulder Dislocation
- Shoulder Instability
- AC (acromio-clavicular) joint problems
- Bicipital tendonitis
- Fractured collar (clavicle) bone
- Referred pain
Frozen shoulder (also known as adhesive capsulitis)
This is a very painful condition which can last up to 18 months unless given the appropriate treatment.
Anatomy
The shoulder joint is made up of three bones viz., the large bone in the upper arm (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The top of the humerus is shaped like a ball. This ball sits in a socket on the end of the scapula. The ball is called the head of the humerus and the socket is called the glenoid fossa, so this part of the shoulder joint is called the “glenohumeral joint”. The glenoid fossa has a rim of tissue around it called the glenoid labrum. The glenoid labrum makes the glenoid fossa deeper. The glenohumeral joint is the most mobile joint in the body. There is a smaller joint directly above the glenohumeral joint, between the outer edge of the clavicle and a projection on the top of the scapula called the acromion process. This joint is called the acromio-clavicular joint. The scapula sits on the back of the ribs and moves as the arm moves. Ligaments join the bones together and also provide support. The glenohumeral joint is surrounded by a large, loose “bag” called a capsule. The capsule has to be large and loose to allow for the large range of movement within the joint. Ligaments also reinforce the capsule and connect the humeral head to the glenoid fossa of the scapula. These ligaments work with muscles to provide stability to the glenohumeral joint.
Causes of a frozen shoulder
The exact cause of a frozen shoulder remains unknown. However what is known is that a frozen shoulder causes the capsule of the shoulder to shrink around the bones it covers. This causes pain and a loss of shoulder movement. It is more likely to occur in people who are between the ages of 35 and 60.
There are a number of risk factors predisposing you to developing a frozen shoulder which include
- shoulder trauma
- inflammatory conditions
- inactivity of the shoulder
- surgery
- diabetes
Approximately 20% of people who have had a frozen shoulder will also develop the condition in their other shoulder in the future.
Signs and symptoms of a frozen shoulder
In our experience a frozen shoulder has three stages of development, each of which has different symptoms.
Stage 1 – characterised by pain around the shoulder initially progressing to the arm and followed by a progressive loss of movement. During this stage all movements are painful and it is difficult to sleep on the affected shoulder.
Stage 2 – minimal pain, with no further loss or gain of movement. During this stage the shoulder joint is particularly limited in the movements of flexion and rotation.
Stage 3 – a gradual return of range of movement and some weakness due to non-use of the shoulder.
Without treatment each stage can last up to 6-8 months.
NB. In our experience a frozen shoulder that presents with
- Pain in the shoulder radiating below the elbow
- A loss of rotation, particularly lateral rotation i.e., dressing and putting your arm in a coat or jacket
- An inability to sleep on the shoulder
will not respond well to physiotherapy treatment and if your shoulder presents in this way you should seek the opinion of your General Practitioner.
How Walker and Hall can help you
A thorough musculoskeletal examination is required to confirm the diagnosis of a frozen shoulder and determine what stage you have reached. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for a frozen shoulder will include
- pain relieving techniques e.g., gentle joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- shoulder mobilizing techniques e.g., stretching and muscle release techniques. Care must be taken with stretching techniques or the capsulitis may be aggravated and the shoulder become more painful
- a home exercise programme to improve mobility and strength
- anti-inflammatory advice
Rotator Cuff Injuries
In our experience rotator cuff injuries are very common.
Anatomy
The rotator cuff is a group of muscles that originate on the shoulder blade (scapula) and pass around and over the shoulder joint to attach to the upper end of the arm bone (head of the humerus). They comprise four muscles – subscapularis, supraspinatus, infraspinatus and teres minor and together stabilise and control the movement of the shoulder joint on the shoulder blade. As the tendons travel towards the head of the humerus they pass under a bony arch formed by the outer end of the collar bone (clavicle) and a process from the scapula (acromion process). Together these two bones form the acromioclavicular joint and the area underneath is known as the sub-acromial space.
Causes of Rotator Cuff Injuries
The rotator cuff muscles and tendons are susceptible to full and partial tears, tendinopathies and impingement related disorders. The injuries vary from mild tendon inflammation (tendonitis), bone forming within the tendon (calcification of the rotator cuff) and partial and full thickness tendon tears which may require surgery.
Some shoulder injuries are more common than others and in our experience these include
- Rotator Cuff Tendonitis
- Rotator Cuff Tears
- Rotator Cuff Impingement Syndrome
- Calcification of the Rotator Cuff
Rotator Cuff Tendonitis
This is caused by irritation and inflammation of the tendons of the rotator cuff muscles. It tends to have a sudden (acute) onset and there is often a specific activity preceding the onset e.g., a history of recent heavy lifting or activities involving repetitive movements of the shoulder.
Signs and Symptoms of rotator Cuff Tendonitis
The two main symptoms are pain and a loss of movement
- Pain – sudden (acute) onset and made worse with movement. The pain is over the shoulder and may spread into the arm and neck. It is made worse with activities involving the use of the arm above shoulder height e.g., combing your hair or dressing yourself. It may also affect your sleep.
- Loss of movement – as a consequence of the acute pain it becomes painful to move the shoulder.
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine whether the rotator cuff is the cause of the pain and if so which muscle(s) is affected. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for a rotator cuff injury include
- Pain relieving techniques e.g., gentle joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Shoulder mobilizing techniques i.e., stretching and muscle release techniques.
- Home exercise programme. It is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you keep your shoulder moving.
- anti-inflammatory advice
Rotator Cuff Tears
These are more common in people over the age of 40 years. The tear tends to occur in the tendon rather than the muscle belly and is often the result of trauma such as a fall on an outstretched arm following a specific incident e.g., lifting and or catching a heavy object. In older people it may also be the result of wear and tear (rotator cuff degeneration) or impingement syndrome (see below).
Signs and Symptoms of rotator cuff tear
- Pain. This is the main symptoms and is often felt over the front and outer part of the shoulder. It is made worse when your shoulder is moved in certain positions e.g., when your arm is placed above your head whilst dressing or washing your hair, or moved forwards as you reach for something.
- Loss of movement
- Feeling of weakness in the arm
- A clicking sensation associated with movement
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine whether the rotator cuff is the cause of the pain and if so which muscle(s) is affected. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for a rotator cuff tear include
- Pain relieving techniques e.g., gentle joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Shoulder mobilizing techniques e.g., stretching and muscle release techniques.
- Home exercise programme. It is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you keep your shoulder moving.
- anti-inflammatory advice
Rotator Cuff Impingement Syndrome
The rotator cuff tendons pass through the subacromial space (the bony arch formed by the outer end of the collar bone (clavicle) and a process from the scapula (acromion process)) before they attach to the head of the humerus. As the tendons pass under the bony arch in certain circumstances they can scrape against it during movement and this can lead to wear and tear of the tendons. As the tendons become worn they may become weaker and eventually tear.
Impingement syndrome can be caused by long-standing wear and tear of the tendon, arthritis of the acromio-clavicular joint (the joint under which the tendons pass in the bony arch) or bony projections (spurs) growing down from the acromion process.
Signs and Symptoms of Impingement Syndrome
- Pain – felt over the shoulder and chronic in nature – long standing. It is made worse with movement, in particular activities involving placing your arm above your head e.g., dressing and washing your hair. It will often disturb your sleep and make it uncomfortable if you sleep on the affected shoulder
- Loss of movement
- Painful arc (a painful “catch” in the shoulder as it is moved between 70 to 120 degrees from away from the body). You will often be unable to sleep on the painful shoulder.
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine whether the symptoms are the result of impingement syndrome or another rotator cuff condition. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for an Impingement syndrome are
- Pain relieving techniques e.g., gentle joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Shoulder mobilizing techniques e.g., stretching and muscle release techniques.
- Home exercise programme. It is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you keep your shoulder moving.
- Anti-inflammatory advice
Calcification of the Rotator Cuff
Calcification of the rotator cuff is a condition where bone (calcium) is formed within the tendons of the rotator cuff. The deposits tend to be about 1-2 centimetres in size, are usually found in patients who are 30-40 years old and have a higher incidence in diabetics. They are not always painful and can spontaneously resolve within one to four weeks of presentation.
Signs and Symptoms of Rotator Cuff Calcification
- Pain. In the early stages the main symptom is acute pain over the shoulder which can radiate into the neck and down the arm. As the condition becomes more chronic, the pain often becomes more diffuse and although still painful, the shoulder movements may increase.
- Loss of shoulder movement. In the acute stages of the presentation the movement will be dramatically reduced. However as the condition progresses and the pain subsides, the movement will begin to increase
- Difficulty sleeping. Sleep in the early stages is nearly always disturbed and it is not uncommon to be unable to sleep on the painful shoulder. As the condition progresses sleep becomes easier although it can remain disturbed almost until a full recovery has been made
How Walker and Hall can help you
In the acute stages of presentation it is often difficult to distinguish between rotator cuff calcification and impingement syndrome and therefore a thorough musculoskeletal examination is essential if optimum recovery is to be achieved.
Because the calcium deposits are usually spontaneously re-absorbed, physiotherapy treatment is usually very effective.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for an Impingement syndrome are
- Pain relieving techniques e.g., gentle joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Shoulder mobilizing techniques e.g., stretching and muscle release techniques
- Home exercise programme. It is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you keep your shoulder moving.
- Anti-inflammatory advice
Shoulder Dislocation
At Walker and Hall the most commonly treated dislocated joint is the shoulder. Due to its unique anatomy, the shoulder joint has a large range of movement at the expense of stability. It is this lack of stability that enables the joint in certain circumstances to be dislocated.
Anatomy
The shoulder joint is a ball and socket joint. The shoulder blade (scapula) gives rise to the socket of the shoulder, whilst the ball of the shoulder arises from the top of the upper arm bone (humerus). Surrounding the ball and socket joint is a strong ligament known as the shoulder joint capsule and its associated ligaments. In addition, a group of muscles known as the rotator cuff cross the shoulder joint and collectively help to hold the shoulder joint in position, increasing the shoulder’s stability.
Causes of Shoulder Dislocation
In our experience the most common causes of shoulder dislocation are trauma and underlying joint instability.
Trauma. This type of shoulder dislocation occurs when your shoulder is placed in a vulnerable position e.g., out to the side, and a force is applied, such as a rugby tackle or a fall.
Joint instability. This occurs either due to a personal predisposition – some people have lax joints to begin with and need little force for the joint to dislocate or as a result of repetitive exercise / training during which the ligaments of the shoulder become looser. Sports that require repetitive overhead movements can overstretch the shoulder joint capsule and ligaments, leading to a predisposition to dislocation e.g., swimming, tennis and cricket.
Signs and Symptoms of Dislocated Shoulder
The most common symptoms of shoulder dislocation are
- Shoulder pain – generally all around the shoulder, radiating onto the front of the chest and often down the arm
- Loss of shoulder movement
- Holding the arm protectively against the chest
- Squaring of the edge of the shoulder – the normal rounded appearance of the shoulder will have changed
How Walker and Hall can help you
The immediate treatment is to reduce (put back) the shoulder joint following which it will be immobilised in a sling for 3 – 6 weeks. During this time it is important for the elbow, forearm and hand joints to be moved frequently.
Once the sling is removed physiotherapy treatment is very effective and will include
- Gentle shoulder mobilizing to increase the range of movement in a controlled manner
- Pain relieving techniques e.g., electrical therapy i.e., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Muscle strengthening techniques particularly for the rotator cuff muscles to increase joint stability
- Home exercise programme to continue with the treatment and in particular to maintain joint range and muscle stability and strength
- Advice with regards to returning to active sport, usually at the 6 week mark depending upon the improvement achieved during treatment.
Shoulder Joint Instability
Shoulder instability is a relatively common condition and is characterised by loosening of the joint capsule and ligaments surrounding the shoulder joint which allows excess movement to occur.
Anatomy
The shoulder joint is a ball and socket joint. The shoulder blade (scapula) gives rise to the socket of the shoulder, whilst the ball of the shoulder arises from the top of the upper arm bone (humerus). Surrounding the ball and socket joint is a strong ligament known as the shoulder joint capsule and its associated ligaments. In addition, a group of muscles known as the rotator cuff cross the shoulder joint and collectively help to hold the shoulder joint in position increasing the shoulder’s stability.
Causes of Shoulder Instability
In our experience there are three main causes of shoulder instability – trauma, a gradual over stretching of the shoulder capsule and ligaments and other pathologies.
Trauma – this can include a fall onto the shoulder or out-stretched hand or direct trauma to the shoulder e.g., contact sports such as rugby where the injuring movement is a combination of movement away from the side of the body and outward rotation (abduction with lateral rotation).
Overstretching of the ligaments – this occurs gradually as a result of repeated stresses to the shoulder joint associated with repetitive end of range shoulder movements e.g., cricket, tennis, swimming etc.
Other pathologies – any pathology that presents with a general ligament laxity may lead to shoulder instability
Signs and Symptoms of Shoulder Instability
These often occur following a specific incident / activity where the arm has been put into a particular position e.g., a combination of abduction and lateral rotation.
- Pain – felt at the time and then on certain activities, sometimes felt at rest and sometimes at night.
- A clicking and or clunking sensation within the shoulder during certain movements.
- A loss of power in the shoulder particularly with activities involving the use of the arm above the head.
- A feeling of apprehension that the shoulder may dislocate when it is put into a particular position.
- The feeling that the shoulder has never felt the same since.
- In more severe case you may experience recurrent episodes of subluxation or dislocation.
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the extent of the shoulder instability. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall include
- An intensive exercise programme – this is essential and involves strengthening the shoulder and shoulder blade stabilisers (rotator cuff and scapular muscles). It will have a particular emphasis on strengthening the muscles that oppose the direction of the instability.
NB – certain stretches should be avoided as they may contribute to further instability. The treating physiotherapist will advise which
- Pain relieving techniques where appropriate – electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- An intensive and progressive home exercise programme to continue the treatment and maintain muscle stability and strength
- A graduated return to sport or activity programme. This is essential if a safe return to sport or activity is to be achieved in a safe and effective manner.
AC (Acromioclavicular ) Joint
In our experience this is a commonly injured joint and it respond well to physiotherapy treatment.
Anatomy
The AC joint is the joint between the acromion process of the scapula (shoulder blade) and the lateral end of the clavicle (collar bone). It is an important joint as it allows a full range of movement of the shoulder (glenohumeral) joint. It is surrounded by a joint capsule and has several ligaments to hold it in place. The joint is also supported by two extra ligaments i.e., the trapezoid ligament and the conoid ligament. These connect the scapula to the middle outer end of the clavicle.
Causes of AC joint problems
In our experience there are two main causes of AC joint pain – trauma and arthritis (osteoarthritis).
Trauma. This is usually the result of a direct blow to the joint with the arm by its side e.g., a tackle in rugby or a fall onto the point of the shoulder. It may also occur as the result of repetitive minor trauma e.g., activities that require repeated overhead movements such as weight lifting.
Trauma to the AC joints can also occur as a result of whiplash injury. In our experience the joint(s) are injured when you are involved in a collision and are holding onto the steering wheel. At the time of impact the force is transferred via the arms to the AC joint(s) or alternatively the joint closest to the seat belt may be injured during the impact.
Arthritis (osteoarthritis) – the AC joint moves as part of the shoulder joint and as such is prone to the same wear and tear (degeneration) that affects all joints.
Signs and Symptoms of the AC joint
- If it is of traumatic origin there will usually be a history of trauma and severe pain over the outer and upper part of the shoulder. If it as a result of wear and tear then there may be a general ache in the shoulder
- There will be pain on palpation of the AC joint
- There may be a visible deformity over the joint – a ‘step’ rather than a smooth top to the shoulder
- There will be a loss of shoulder movement, particularly taking the arm across the body (horizontal adduction) e.g., washing under the opposite arm
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the cause and extent of the AC joint injury. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for an AC joint problem are
- Pain relieving techniques e.g., gentle joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Shoulder mobilizing techniques e.g., stretching and muscle release techniques.
- Home exercise programme. It is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you keep your shoulder moving.
- anti-inflammatory advice
Bicipital Tendonitis
At Walker and Hall we have considerable experience of treating bicipital tendonitis. We have treated all types – ranging from mild inflammation of the biceps tendon to total rupture.
With accurate diagnosis and the appropriate treatment this is a condition that responds well to physiotherapy.
Anatomy
The biceps muscle (biceps brachii) is located on the front of the arm between the elbow and the shoulder. It has two tendons attached to the shoulder and one to the elbow. The tendons at the shoulder are called the long head and short head of biceps. The long head attaches within the shoulder joint and the short head to a process on the shoulder blade (coracoid process). Bicipital tendonitis commonly occurs to the long head of biceps as it leaves the shoulder joint at the front of the shoulder, passes through a groove (bicipital groove) on the front of the arm bone (humerus) and down the arm.
Causes of Bicipital Tendonitis
The main causes of bicipital tendonitis are repetitive use, trauma and degeneration.
Repetitive use. This commonly occurs as a result of repeated or prolonged activities involving the use of the biceps tendon. This includes excessive lifting (especially overhead), arm elevation activities (e.g. putting the washing on the line), heavy pushing or pulling, stretching the arm behind your back, throwing sports, sleeping on the affected side or use of the arm in front of the body (e.g. housework)
Trauma. With certain sports e.g., weight lifting, the bicep tendon can be suddenly subjected to a high force which can place too much strain through the tendon and cause tendonitis
Degeneration. More commonly seen in older patients, this is a gradual wear and tear of the tendon
Signs and symptoms of Bicipital Tendonitis
The symptoms of bicipital tendonitis usually develop gradually over a period of time and may include
- Pain – often felt as an ache over the front of the shoulder which increases to a sharper pain or catching pain with certain activities. It may also be experienced in the upper arm, upper back or neck.
In a minor condition it may be present on commencing an activity and may reduce as you warm up. In a more established condition (chronic) it may prevent you from continuing with the activity. The pain usually makes it difficult to lift heavy objects (especially above the head), perform overhead activities and use the arm in front of the body.
- Loss of shoulder movement.
- Muscle wasting and weakness in the arm particularly when rotating the forearm e.g., in DIY.
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the cause and extent of the bicipital tendonitis. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for bicipital tendonitis are
- Pain relieving techniques e.g., gentle joint mobilizing techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Shoulder mobilizing techniques e.g., stretching and muscle release techniques.
- Home exercise programme. It is important to achieve a balance between rest and exercise. Whilst you should try to avoid activities that aggravate the pain, it is also essential that you keep your shoulder moving.
- anti-inflammatory advice.
Fractured Collar Bone (Broken Collar Bone, Broken Clavicle, Fractured Clavicle, Collar Bone Fracture)
In our experience this is one of the most common fractures in sporting activities and it responds very well to physiotherapy treatment.
Anatomy
The collar bone (clavicle) is a bone that runs between the breast bone (sternum) and the shoulder (acromion process). It is the only bony link between the body and the upper limb and as such, when the upper limb is jarred, it is subjected to excess force. It the force is severe enough the collar bone breaks.
Causes of a fractured collar bone
Trauma in all forms is the main cause of a fractured collar bone. This may be as a result of a fall onto the point of the shoulder e.g., fall from a horse, bicycle or motorbike, collision with another player during sport e.g., rugby tackle or a fall onto the point of the elbow.
Signs an symptoms of a fractured collar bone
- Sudden sharp pain located somewhere between the neck and the point of the shoulder. The pain may increase when attempting to perform movements of the upper limb such as arm elevation, overhead activities, taking the arm across the chest or heavy pushing, pulling or lifting activities. It may also increase when lying on the affect side, applying pressure to the shoulder, or on firm palpation at the site of injury
- Localised swelling at the injury site with possible deformity of the contour of the collar bone
- Reduced range of shoulder movement and all movements being associated with pain
- An audible ‘pop’ or ‘snap’ at the time of injury
How Walker and Hall can help you
The immediate treatment is to immobilise the collar bone. This used to be done with a figure-of-eight bandage but now it is more often done by resting the arm in a sling for 3 – 4 weeks. During this time it is important for the elbow, forearm and hand joints to be moved frequently.
Once the sling is removed physiotherapy treatment is very effective and will include
- Gentle shoulder mobilizing to increase the range of movement in a controlled manner
- Pain relieving techniques e.g., electrical therapy i.e., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Muscle strengthening techniques particularly for the rotator cuff muscles to increase joint stability
- Home exercise programme to continue with the treatment and in particular to maintain joint range and muscle stability and strength
- Advice with regards to returning to active sport, usually at the 6 week mark depending upon the improvement achieved during treatment.
Referred Pain
Not all pain experienced in the shoulder or arm is necessarily coming from the shoulder joint. Occasionally pain felt in the shoulder and arm can be referred or caused by a problem in another area of the body such as the neck or spine. This is called referred pain.
What is Referred Pain?
Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, an example being sciatica, where pain is felt down the leg whilst the problem is in the back, or a heart attack, where the pain is felt in the shoulder, arms and neck.
What structures can refer pain into the shoulders and arms
The main source of referred pain into the shoulders and arms is the cervical and upper thoracic spines (from the 3rd cervical vertebra to the 4th thoracic vertebra – C3 to T4). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic a shoulder problem.
How can Walker and Hall help you distinguish between a shoulder problem and referred pain
At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for your shoulder symptoms.
It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.
You will be involved in all stages of your treatment given every opportunity to ask questions.
