The shoulder is a complex joint with many different structures having different functions. In part 1 and 2 of the shoulder series, rotator cuff injuries and arthritis were discussed as common causes of shoulder pain. This article will discuss other causes of shoulder pain, including impingement, bursitis, tendonitis, and labral tears.
Shoulder impingement occurs when one of the tendons of the rotator cuff passes underneath the bony arc on the top of the shoulder and becomes pinched when the arm is raised above shoulder level. There are several factors that may contribute to this pinching. Inflammation of that tendon, or tendonitis, can cause the tendon to be swollen which results in a decrease in the space allowed for that tendon to move. A fluid filled sac, known as a bursa, sits between the tendon and the bone to allow the tendon to glide smoothly. The bursa can also become inflammed, reducing the amount of space for that tendon. This is called bursitis.
One of the most important functions of the rotator cuff is to depress the ball of the shoulder joint so that when you raise your arm overhead, the tendon does not get pinched. A physical therapist can teach you exercises to strengthen the rotator cuff so that the shoulder can move in a normal, pain-free range of motion. PTs will also assist with decreasing the inflammation of the soft tissue that may be causing the impingement by utilizing massage, taping, or modalities, such as electrical stimulation or ultrasound.
The labrum is a cartilage rim along the outside of the socket of the shoulder that assists with keeping the ball in the socket. The labrum can be torn during an injury causing shoulder pain and, at times, a feeling of instability. The size and location of the tear will determine what treatment is necessary to decrease symptoms. An MRI of the shoulder is the primary test used to find a labral tear. A smaller tear can usually be managed with anti-inflammatory medication and a referral to physical therapy. Because the labrum gives the shoulder stability, exercises will be focused on improving the strength of the muscles around the shoulder and shoulder blade. Moderate to large labral tears will likely require surgery.
Advance Physical Therapy offers free screenings! If you are having shoulder pain but not sure what to do for it, gives us a call at 636-528-7333 to set up an appointment.