What is Causing My Shoulder Pain?

Riley Hanagan, LMT

15 September 2019

What is causing my shoulder pain?

There are a multitude of tissues located in the shoulder —a complex web of interconnected muscles, tendons, ligaments, joint capsule tissues, bones, and bone structures. Consequently, pinpointing the exact cause of your shoulder pain can be difficult to diagnose. However, there are some telling signs that will distinguishing what is causing your shoulder pain and how to move forward with your treatment.

Some of the most common shoulder injuries are rotator cuff injuries. Rotator cuff injuries are especially prevalent among athletes or those participating in activities that involve repetitive overhead motions such as swimming, throwing, or climbing.

However, several other shoulder injuries involving the shoulder’s joint capsule or other non-contractile tissues could mimic the symptoms of rotator cuff tears. It is important to determine whether what you are experiencing is an actual rotator cuff injury or something entirely different before you move on with treatment. Working with a skilled clinical massage therapist will help you in this process.

How do I know if my shoulder pain is a rotator cuff injury?

The “rotator cuff” is just a term for a bundle of muscles located around the scapula and shoulder joint. These four muscles function to hold the shoulder in place against resistance (shoulder stabilizers), as well as assist in medial rotation, lateral rotation, adduction, and abduction of the shoulder. The four muscles that make up the rotator cuff include supraspinatus, infraspinatus, teres minor, and subscapularis.

Supraspinatus is the most common muscle to be involved in a rotator cuff injury. This muscle assists in abduction of the arm (bringing the arm out and overhead from the side of the body), and shoulder stabilization. Due to its location across the top of the shoulder joint, the supraspinatus is susceptible to injuries from excessive overuse or sudden loads. It also runs under a bony protuberance of the shoulder blade, called the acromion process, which may pinch down on the muscle when the arm is raised overhead. 

Possible injuries to this muscle include impingement, strains, complete tears, and tendinosis. The pain experienced in a supraspinatus injury is often described as dull, aching, and deep in the shoulder and may be difficult to locate.

Sharp pain may be experienced upon raising the arm overhead, especially under a load. Typically, the pain increases with activity and decreases with rest. The pain may be worse at night.

Injuries to infraspinatus or teres minor are easier to locate than a supraspinatus injury because these muscles are easy to access and sit just below the shoulder blade. Both these muscles assist in lateral shoulder rotation and adduction (bringing the arm back into neutral position fromabduction), as well as stabilizing the shoulder in high strain activities such as throwing a baseball. Pain experienced in these muscles due to a tear or tendinosis is localized in the area and is typically tender to the touch.

Unlike the other three rotator cuff muscles, subscapularis is very unlikely to be injured due to its deep, protected location under the scapula. However, it is vulnerable to injury in the instance of a shoulder separation or dislocation. 

The pain here is difficult to locate, unless palpated by a skilled practitioner, then the muscle may be tender to touch. During medial rotation or when the hand is placed behind the back with a bent elbow, pain may occur.

In order to properly diagnose a shoulder injury, an MRI should be performed. 

Getting circulation and heat to the muscles also aids in pain management and healing. Working with your massage therapist to develop an at home stretching and strengthening routine will also be beneficial to prevent recurring injuries in the future.” 

Image courtesy of Riley Hanagan. Protected by Copyright.

Injuries That Mimic Rotator Cuff Tears

Various other shoulder injuries that do not affect muscle, but rather affect the non-contractile tissues of the shoulder (such as the shoulder joint and ligaments), may cause pain and range of motion limitations that are similar to rotator cuff injuries. Some of the more common conditions include frozen shoulder, adhesive capsulitis, bursitis, or labrum tears. 

In frozen shoulder, the range of motion is typically severely limited, and the limitation usually comes on gradually. Frozen shoulder and adhesive capsulitis look very similar and are often difficult to distinguish, but generally adhesive capsulitis affects only tissues of the joint.

Bursitis is caused by compression and often causes pain deep in the shoulder joint—it may be most painful during a small arc of the range of motion when the arm is raised overhead. 

 Labrum tears and shoulder separation are often characterized by a “clicking” and unstable sensation in the shoulder joint when the joint is moved around. When differentiating between these various conditions, it is important to work with a skilled practitioner who can walk you through a series of range of motion and resistance tests to rule out various conditions.

Massage Treatment for Rotator Cuff Injuries

If you suspect you have a rotator cuff injury, massage is an excellent way to begin to treat the condition. If a complete tear has occurred, be sure to allow adequate time for healing before proceeding with treatment. If the injury involves a partial tear or tendinosis, massage involving deep transverse friction, lengthening, and stretching techniques can help to encourage the muscle to rebuild properly, avoid scar tissue buildup, and increase range of motion in the joint. 

Getting circulation and heat to the muscles also aids in pain management and healing. Working with your massage therapist to develop an at home stretching and strengthening routine will also be beneficial to prevent recurring injuries in the future. 

 If you suspect you have a rotator cuff injury, don’t waste time! Contact one of our massage therapists today to get scheduled for a clinical assessment and develop a treatment plan specific to your needs.

Corrective Exercise for Shoulder Pain

Shoulder pain can stem from movement and posture dysfunctions that over time have work down collegen fibers in the tendons. Additionally, dysfunctional and repetitive movements cause muscle imbalances. A muscle imbalance means that muscles on one side of a joint are over worked and tight whereas muscles on the other side of the joint are weak and not doing their job helping with movement.

Corrective exercise aims to correct compensation patters, treating your pain fro the root cause. Stretches, strengthening exercises and foam rolling are combined in a tailor made program just for you. 

At The Anatomy of Wellness, we offer corrective exercise packages that combine with clinical bodywork to get you better fast.

Kinesio Tape for Shoulder Pain and Injury

RockTape is also an excellent way to alleviate pain in the muscles, assist to stabilize the shoulder (while not limiting range of motion), and encourage proper posture as the muscles heal.

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