Shoulder Tendinopathy
Is where the tissue connecting muscle to bone develops some problems. This occurs as a result of the breakdown of collagen in the tendon. It is often associated with an achy type pain and reduction in range of motion. Tendinopathies in the shoulder usually occur in the rotator cuff muscles and are generally a result of over use, such as repeated reaching/throwing/lifting.

It is generally categorised into two sub-categories:
Acute - Exercise and repetitive loads such as throwing.
Chronic - ‘Wear and tear’ of structures over time as well as from degenerative diseases.
They are often diagnosed by an MRI and treated by rest and rehabilitation.

Tendon Tears
Imaging such as an MRI is often used to diagnose tendon tears in the shoulder. These may be partial or complete (where the tendon is removed from the bone). Again, this can occur from both acute and chronic causes and is most commonly seen in the rotator cuff and bicep tendons.

Instability
Shoulder instability occurs when the joint is compromised by either changes to its position or surrounding/supportive structures. This can happen over time or suddenly from an injury.
Shoulder dislocations can be a way in which the shoulder is suddenly injured and its stability compromised. Dislocations can be partial or complete. Partial dislocations, known as subluxations, occur when the ball (head) of the arm bone (humerus) is partially distracted from the socket. Complete dislocations occur when the ball (head) of the arm bone (humerus) completely operates from the socket. During these injuries, surrounding structures which support the shoulder such as muscles, tendons and ligaments can become loose and/or torn. This can place the shoulder at a greater risk for recurrent dislocations, which can further lead to developing arthritis in the joint.

Frozen Shoulder - Adhesive Capsulitis
Is the term used to describe the thickening and tightening of the capsule of one's shoulder joint. When this occurs, there can be less fluid lubricating the joint, further adding to the restriction and limitation of movement. Frozen shoulder is more common in women than in men and in people with certain medical conditions, such as diabetes, high cholesterol, or thyroid disorders. Frozen shoulder can occur after an injury and/or after a period of immobilisation or insidiously. The problem resolves over time but can last an extended period of time (2-3 years in some cases).

Arthritis
Cartilage is smooth tissue which covers the ends of your bones which connect to form joints. Their function is to promote smooth movement, however over time, general ‘wear and tear’ of these structures can result in osteoarthritis, which is the most common type of arthritis. The general ‘wear and tear’ is commonly caused by repetitive use through sport or work. It is known to be degenerative which means it develops slowly then worsens over time. Onset usually occurs during the mid-late stage of life and usually presents as swollen, painful, stiff, inflamed joints. People often tend to avoid movement of the joint to help manage their pain, but this can further exacerbate other symptoms and issues such as increased stiffness and muscle wastage. There are numerous treatments for osteoarthritis, including rest, modifications to activities, anti-inflammatory drugs, corticosteroid injections, and surgery in some cases.

Fractures
The breaking of the shoulder complex is more commonly seen in the clavicle (collar bone), humerus (arm bone), scapula (shoulder blade), rather than the head of the shoulder bone which makes up the joint and sits in the shoulder socket. Fractures can occur from a variety of forces. In the elderly population fractures are usually seen from a fall. While in the younger population they are often caused by a sporting injury. Fractures are often characterised by immediate severe pain and discomfort, swelling, bruising.

Other issues which can cause shoulder complications

• Neck and upper back problems: Problems with the joints and nerves of one's neck and upper back can refer to the shoulder, creating a source of pain.

• Poor posture of the mid-back: Having excessive amount of rounding (kyphosis) of the mid-back (thoracic) region, can place excess stress and cause a dysfunction of the shoulder joint.

• Axillary nerve injury: This nerve can often be damaged by a shoulder dislocation and can result in weakened shoulder muscles and loss of sensation. 

• Thoracic outlet syndrome: Is a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed.

• Muscle imbalances: Dysfunction of the muscles around the shoulder, neck, mid-back can cause shoulder pain.

• Health complications: Problems affecting your heart and lungs can present as referred pain into the shoulder region. If symptoms are sudden and do not coincide with any recent mechanisms of injury it is advised to seek immediate medical intervention.

Rest assured, while seemingly complicated most of these conditions can be well treated with the intervention of a physiotherapist. With an accurate diagnosis and optimal treatment plan, patients often respond well to modalities aimed at removing pain and restoring function. Click below on one of the links to connect with expert physiotherapists at one of our Sydney physiotherapy clinics.

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