Our shoulders are put to work every day to perform even the simplest actions: putting on a coat, trying on a sweater, opening a closet or carrying a backpack.
Our daily practices can sometimes put a strain on them, which is why many conditions can affect this joint: rotator cuff tendinitis, shoulder bursitis or shoulder capsulitis, to name the most common.
If your shoulder is hurting, do not let the pain go untreated and make an appointment for a physiotherapy or occupational therapy consultation.
Muscles, bones, tendons, ligaments: understanding the anatomy and function of the shoulder joint
Before going into details, it may be helpful to take a quick look at the anatomy and function of the shoulder.
The shoulder joint can perform many movements: rotation, adduction, abduction or elevation.
The shoulder is made up of bones (clavicle, scapula, humerus), ligaments, tendons and muscles. The bones are attached by ligaments, which are there to support the joint.
There are many muscles involved in the movements of the shoulder, and one group of muscles in particular covers the humerus: the rotator cuff. This group of four muscles (the supraspinatus, the infraspinatus, the lesser tuberosity and the subscapularis) helps to support the joint and to perform rotational movements.
Two other structures most often affected in the shoulder are the bursa and the capsule.
Pain when lifting the arm, clicking, pain in the clavicles or neck: how can I identify shoulder pain?
Shoulder pain can be a symptom of many different conditions. On its own, it is extremely complicated, if not impossible, to pinpoint the cause of the pain.
For example, a feeling of decreased mobility and muscle strength can be a sign of tendinitis or bursitis or capsulitis, especially if there is a loss of mobility.
Shoulder pain could also be a referred pain coming from the neck.
So how can you find the origin of the problem? The best thing to do when symptoms appear is to consult a healthcare professional. He or she can assess you to determine the cause of your pain.
If you suffer from shoulder pain, make an appointment with one of our physiotherapists or occupational therapists. Both professionals will take charge of your condition to optimize your chances of recovery and a safe return to your activities.
Tendinopathy, bursitis, capsulitis, osteoarthritis: the different conditions that can affect the shoulder
Rotator cuff tendinitis: what are the symptoms and what should you do about it?
Tendinitis (which refers to the inflammatory period of tendinopathy) is a condition that affects muscle tendons. It is important to understand that tendinitis can technically affect any tendon.
The most commonly affected tendons in the shoulder are those of the rotator cuff, due to the shoulder’s high mobility and their role in controlling it.
A tendon is a band of connective tissue responsible for transmitting the energy released by the contraction of the muscle to the bone. The tendon also absorbs and maintains this energy. Tendinitis occurs when the tendon’s ability to adapt to stress is exceeded, which results in inflammation in the acute phase.
It is important to remember that pain can occur even if there is no inflammation. This is actually the case for many consultations at the stage of a tendinopathy.
It usually results from the overuse of the joint, either during sports or occupational activities. Repetitive movements or prolonged posture are often the cause.
Please note that tendinitis can also be linked to other factors besides overuse, such as an impact, a wrong movement or sudden efforts. For example, this could happen to a person with a sedentary lifestyle who puts their body under an intense effort.
Pain when raising the arm is usually the first symptom of tendinitis. The pain tends to be stronger when performing the repetitive movement that creates the irritation.
You may also experience a decrease in flexibility, exercise tolerance and strength.
- What should you do when symptoms occur?
If you experience symptoms similar to tendinitis, it is strongly recommended to modify your movements to help manage the symptoms. However, you should only rest the joint partially, not completely.
You can also apply ice for short periods of time if the cold relieves you. If using heat reduces your pain even more, go for it. Use what works for you.
Once the pain subsides, you can gradually resume your activities. If the pain persists after a few days (or even for prevention), make an appointment with one of your healthcare professionals.
Capsulitis: what are the related pains?
Adhesive capsulitis, commonly called frozen shoulder, is a condition that affects the joint capsule, the tissue that covers the joint. This injury is related to the reactivity of the capsule.
These causes are not necessarily identifiable. However, certain factors could explain its appearance. For example, untreated or poorly treated bursitis or tendinitis can lead to capsulitis.
It can also be caused by a trauma such as a fall or a fracture. Finally, a great deal of stress in someone’s life could be a contributing factor.
Other health factors such as diabetes, a thyroid problem, or hormonal changes such as menopause could have an influence, although there is no clear explanation of causality.
Are you experiencing shoulder pains that are progressively becoming part of your daily routine, to the point where you can no longer lift your arm? This may be a sign of shoulder capsulitis.
There are three phases: the freezing and pre-adhesive phase, the freezing phase and the thawing phase.
During the first phase, which is the period of inflammation, pain appears gradually, and can disrupt your sleep. You may also experience a loss of mobility.
The drop in shoulder mobility is usually greatest during the second phase. This, as well as a reduction in pain and/or inflammation, varies from one person to another. You may have difficulty getting dressed or combing your hair.
The last phase is the progressive return of joint mobility and elimination of pain.
- What to do if symptoms appear?
Capsulitis usually resolves itself naturally. The healing time varies between 6 and 12 months. In some cases, however, symptoms may persist and the loss of mobility may last.
Physiotherapy may be a good tool to help relieve pain and optimize and accelerate healing.
A follow-up in physiotherapy aims to reduce pain and optimize a return to daily activities.
Bursitis: What are the symptoms?
Bursitis is a condition that affects the bursae. These are small sacs of liquid that act as cushions around the joints, and their role is to facilitate movement and sliding between the various structures (bones, muscles, tendons). The subacromial bursa is the one most frequently affected by bursitis.
In the vast majority of cases, bursitis is of mechanical origin. It is related to the overuse of the shoulder, through repetitive or excessive movements. Bursitis affects many athletes (racket sports, ball throwing) but is not exclusive to this population.
People whose professional activity requires significant shoulder mobilization also have a high risk factor. Manual jobs can be examples of this.
Please note that while it is uncommon, a trauma may lead to the development of bursitis.
Pain is the main symptom of bursitis. It is not always sharp, and can vary greatly from one person to another.
You may experience muscle tension, swelling or stiffness in the shoulder. Over time, bursitis may affect shoulder mobility and lead to a loss of muscle strength. These conditions take a long time to regain if the bursitis is not dealt with in time.
- What should you do if symptoms appear?
If you start feeling pain that sets in over time, the first thing to do is to limit as much as possible the activity or movement that causes the pain. Reducing the effort should help you manage the inflammation. You can use other strategies such as ice if it provides relief.
If you can’t stop the activity completely, for instance if it is related to your job, stretching or gentle mobility exercises could be beneficial.
If the natural treatment does not provide any relief, do not wait to consult a healthcare professional to reduce your pain and optimize your recovery.
Osteoarthritis: how to relieve it?
Osteoarthritis of the shoulder is a disease characterized by the progressive degeneration of cartilage. While the causes are not always identifiable, age and frequent mobilization of the joint (repeated movements, excessive mobilization) are often among the risk factors.
Osteoarthritis can disrupt a person’s daily life more or less severely, depending on the progression of the disease and the individual.
This may result in difficulties in performing simple daily gestures, such as lifting the arm to put on a bra, getting dressed, or opening a window or a closet.
The pain may vary and can come and go during inflammatory attacks. You may also feel like your shoulder is frozen, or that it is clicking.
Physiotherapy can be an effective tool for pain management during inflammatory episodes or throughout the disease. An appropriate exercise program will help manage the pressure on your shoulder.
How to treat shoulder pain? A closer look at physiotherapy and occupational therapy
If your shoulder is painful and/or you are having difficulty performing simple daily tasks, make an appointment with a healthcare professional. Physiotherapy and occupational therapy are used to treat musculoskeletal problems.
A physiotherapy follow-up begins with an evaluation to identify the origin and cause of your pain. This assessment also aims to understand the extent of your injury and how it affects your daily life, in order to develop an appropriate treatment plan for your condition and your needs.
The first step in the treatment plan is all about pain management and making sure that the injury does not get worse, while maintaining shoulder mobility. Mobilization of the shoulder is more effective than rest.
Afterwards, your therapist will work with you to strengthen and rehabilitate your shoulder. Your treatment plan will be customized and adapted to your needs depending on your responsiveness and tolerance.
Your exercises at home and appointments may include techniques to manage the pain, to maintain shoulder movement, to restore range of motion, and to gradually build strength.
Eventually, your therapist will reintegrate more dynamic movements and exercises that are more specific to your sport or activity, and help you resume your regular activity.
Education is also part of the treatment plan. Through advice on symptom management or on the best habits to adopt on a daily basis, your therapist’s goal is to allow you to return to your activities in a safe and sustainable manner.
Shoulder pain: when should you consider an injection (cortisone, viscosupplementation)?
Before we discuss injection, you should know that this is outside the realm of physiotherapy. We can tell you about the different techniques, but a conversation with your doctor or a team of therapists is recommended before making your decision.
Injections are typically used when conservative treatment is not effective. There are different options: cortisone injection, viscosupplementation, or platelet-rich plasma (PRP).
Each of these options has its own specificities and effects. Depending on your condition and/or the stage of your injury, one technique or another may be more appropriate.
For example, in cases of osteoarthritis, viscosupplementation may be used to make up for hyaluronic acid deficiencies, to slow down the process of cartilage degradation.
In the event of an inflammatory episode that medication is not able to calm, a cortisone infiltration may also be recommended.
If you have persistent shoulder pain and physiotherapy treatment does not relieve your pain, make an appointment with your doctor to discuss your options. He or she will be able to guide you towards the most appropriate technique for your condition.