Rotator Cuff Dysfunctions

This is the most common problem we come across when it comes to shoulder problems. Your rotator cuff is a group of muscles which keeps the top end of your arm bone centered in its socket. Problems arise when we try to use these muscles to hold static postures such as when you are at your desk. The larger rotator cuff muscles becomes stiff and instead of stabilizing the shoulder they start to jam the arm bone into the socket and limit both the accuracy and range of movement. You tend to feel this either as tightness or pain with lifting the arm up to around 90 degrees away from the side of your body.

These kinds of dysfunctions can lead to tearing of smaller, weaker rotator cuff muscles - most commonly the supraspinatus, as the larger muscles lead to its fraying. This can be confirmed on ultrasound imaging if we suspect it - but we can also diagnose it fairly well with a few tests in the clinic. If the tears are serious they may require surgery in which case we would need to refer you to a specialist. A frequently inflamed rotator cuff can also develop calcifications within itself. Think of it as a small bit of bone growing within the muscle. This little bit of bone can then squish a piece of muscle up against other bones in the vicinity causing minor bruising and inflammation of the muscle. This can usually be settled with structural osteopathy, but in severe cases we may need to refer you for an ultrasound or a cortisone injection. Then after that, treatment can remedy the remaining symptoms and help you greatly decrease the chances of the same condition happening again. Another structure called a bursa can become squashed and inflamed. See the appropriate section on this page for more information.
Bursitis

Where ever a tendon or a muscle is likely to rub over another structure the body there is a fluid sac (like a water balloon) called a bursa which prevents fraying from taking place. When a sudden impact or a repetitive movement which irritates it takes place, a bursa can swell. In the case of the shoulder where space is already tight, this leads to a pinching sensation when reaching out or lifting your arm away from the side of your body.

Bursas have trouble recovering from inflammation because their circulation is very poor. Also it is quite common to keep compressing them with simple everyday movements if they are quite swollen. Osteopathic treatment is aimed at keeping the pressure off the bursa. We also tend to show you some exercises and stretches which you can do on your own at home to speed up the process. This is still a slow recovery process usually. If the bursa is completely resistant to conventional treatment, we can also refer you for an ultrasound guided cortisone injection to get rid of the inflammation of the bursa if you would like to take that approach.
Referred Pain

The shoulder can hurt as a result of other structures sending pain to it. The neck is the most common structure to send pain to the shoulder as a result of a disc problem. In this case you will generally not feel much pain in the neck, just in the shoulder. The shoulder pain will be eased if you put the hand of the affected side onto your head. Tilting your head back will also make it worse after several seconds, or laying on a thin pillow with your head dipping back. In these cases we need to double check with a series of neurological tests in clinic. If they are positive we may need to order some imaging or we may need to refer you to a specialist.

Organs from the upper abdomen can also irritate your biggest breathing muscle called the diaphragm which will then refer to the shoulder on the same side. The left shoulder is also affected by heart problems although heart pain is quite particular in nature. Your shoulder and arm pain would be worse when you exert yourself such as climbing the stairs. In some of these cases we can do a few clinical tests to try and track down where the pain is coming from, but in many cases where we suspect an organ problem we need to send you to get further investigations done. Whilst this technically isn’t a shoulder problem, it is very closely related to the shoulder as the neck and shoulder affect each other quite profoundly. The front of your neck consists of many strand-like muscles between which all the nerves, arteries and veins pass which then travel further on to the shoulder and arm. These muscles can compress the blood vessels and cause swelling in your hands - usually worse first thing in the morning. They can also compress the nerves which would lead to tingling, numbness or pain in the shoulder or arm region. Thus if we take this into account, we can’t really treat the neck without the shoulder and vice versa.

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