What is Causing My Shoulder Pain?
Riley Hanagan, LMT
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 distinguish 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 of identifying what is causing your shoulder pain.
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. There are four muscles in this group, and these four muscles function to hold the shoulder in place against resistance (shoulder stabilizers), as well as assist in internal rotation, external 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 shoulder pain and 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 shoulder 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 external shoulder rotation and adduction (bringing the arm back into neutral position fromabduction), as well as stabilizing the shoulder in high strain/velocity activities such as throwing a baseball. Shoulder 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 and protected location under the scapula. However, it is vulnerable to injury in the instance of a shoulder separation or dislocation.
The source of the shoulder pain here is difficult to locate, unless palpated by a skilled practitioner, then the muscle may be tender to touch. Shoulder pain may occur during internal rotation or when the hand is placed behind the back with a bent elbow.
Manual tests by a qualified healthcare professional can be very helpful in diagnosing the cause of shoulder pain, but the best and most accurate way to diagnose a shoulder injury is by having an MRI scan. If a serious shoulder injury is suspected, or shoulder pain persists after treatment, 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 separations are often characterized by a “clicking” and unstable sensation in the shoulder joint when the joint is moved around. Sometimes, this “clicking” can be associated with an increase in shoulder pain, but that’s not always the case. When trying to differentiate 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 that you have a rotator cuff injury, or if you have shoulder pain that won’t go away, massage therapy 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. And 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 and to decrease shoulder pain.
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 worked down the collegen fibers in the tendons. Additionally, dysfunctional and repetitive movements cause muscle imbalances that can contribute to shoulder pain and in injuries. 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 properly to help with a given movement.
Corrective exercises aim to correct compensated movement patterns and treat your pain at 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
Kinesio Tape (K-Tape) is also an excellent way to alleviate shoulder pain in the muscles, assist in stabilizing the shoulder (while not limiting range of motion) and encourage proper posture as the muscles heal. We have several K-Tape certified practitioners at The Anatomy of Wellness who can help you to learn more about how K-Tape can help you.