“Ouch! My shoulder!”

By Erin Rothenburger – RMT

As a massage therapist, I have seen many people requiring treatment for shoulder pain. Often, the complaint is of the rotator cuff, but this in only one of many problems that can occur in the shoulder. Some of the most common problems can include poor posture, which occurs frequently in those who work in an office environment; the patient’s shoulders are rounded forward from slumping over a desk or steering wheel. Pain can also occur when muscles and joints are overused through repetitive over-lifting; from accumulative, repetitive movements often found most in jobs requiring the same motions over a long period of time, such as manual factory labour or sports practice, or conversely in lack of activity in that area. Impact injuries that can occur in the home (such as a fall), or in sports (such as being checked into the boards during a game) can also affect the shoulder causing pain and discomfort in the muscles and joints there. Many different pain syndromes and dysfunctions can occur involving the shoulder girdle. Direct impact injury, overuse, and strain are most common, but postural and mechanical imbalances may also contribute; even neck and upper thorax problems may refer pain into the shoulder.

The following issues are the most common issues I deal with in my day to day treatments:

Rotator Cuff Strain: The rotator cuff is a group of four muscles that provide stabilization of the very mobile ball and socket joint of the shoulder; they also function to rotate the arm. Most commonly, it is the Supraspinatus muscle that is involved with n injury, but the other muscles can also be injured.

Bursitis:  The Bursa is a small, flat sac of synovial fluid located in the shoulder that is designed to reduce friction irritation with movement and function. This bursa may become irritated with excessive, repetitive overuse or with direct trauma such as sports related injuries like getting checked into the boards during a hockey game. Movement, stretch, or contact pressure (such as with lying on the affected side) can be very painful. The pain is often nagging and constant.

Biceps Tenosynovitis: The biceps long tendon has a synovial sheath that the long tendon glides within. Problems can occur with overused of the tendon itself, or of irritation of the sheath around the tendon. Pain is located at the front of the shoulder and the upper arm.

Impingement Syndrome: The Supraspinatus, biceps long tendon, and/or the bursa can all become impinged under a bony arch in the shoulder causing pain and difficulty when raising the arm up. Pain is at the top and front of the shoulder, varying depending on which structure is involved.

Adhesive Capsulitis: The capsule of the shoulder joint normally allows a wide range of mobility, but if there has been an injury or irritation to structures of the shoulder, the capsule may become inflames, adhered, and significantly restricted. Pain typically occurs at the end of the range of motion, or while lying on the affected side. Mobility will be limited with this issue.

For an image relating to the shoulder and shoulder muscles, click here.

Check with your health care professional for differential assessment and treatment options. A Massage therapist can help determine what the dysfunction is and provide appropriate treatment to relieve pain and improve mobility, helping you to return to activities of daily life, recreation, and work.