Shoulder Pain

The shoulder is a complex joint, and commonly a cause of pain. There are numerous reasons for shoulder pain, which at the Injury Hub we can diagnose via examination and an ultrasound scan. The four most common causes are: 

1. Subacromial bursitis/sub deltoid bursitis. Bursue or bursa are thin fluid filled sacs found throughout the body that help protect, cushion, reduce friction of a tendon as they pass over a bone.  Due to repetitive exercises or poor posture the bursae can become irritated and inflamed leading to a bursitis. In the shoulder joint, when the arm is elevated out to the side between 80-130 degrees, or when performing overhead activities, the bursa that sits on top of the rotator cuff and underneath the arch of the shoulder blade can become compromised leading to a subacromial bursitis. 

Resting the affected bursa and avoiding overhead activities are crucial steps in the first line of treatment. Ice and anti-inflammatory medications can help reduce pain and swelling. Research has shown a tailored physical rehab program to help increase rotator cuff strength along with hands on articulation and traction is key to resolving the problem, compared to just performing shoulder exercises that are non- specific.  Injections of corticosteroids under ultrasound guidance are recommended for more persistent cases.

Despite these treatments, it’s not uncommon for bursitis to recur, especially if the underlying cause—like repetitive stress or poor posture—persists. Adopting preventive measures, such as using proper techniques during physical activities and making ergonomic adjustments, can help reduce the risk of flare-ups.

2. Rotator cuff Tendinopathy / Rotator cuff tears. Rotator cuff tendinopathy, often referred to as rotator cuff tendinitis or tendinosis, involves inflammation or degeneration of the tendons in the rotator cuff, a group of four muscles and their tendons that stabilise the shoulder joint. Tendons lose the ability to withstand the forces passing through them and become swollen and painful. Some tendons of the cuff become torn, which go on to become painful on muscle activation. 

Tendons are amenable to rehab, and can be rejuvenated if the corrective exercises are prescribed. They also respond well to shockwave therapy, fenestration and dry needling. 

3. Osteoarthritis of the shoulder joint or Acromioclavicular joint. The main joint of the glenohumeral joint is the main ball and socket joint of the shoulder. Directly above the shoulder is the collar bone which articulates with the shoulder blade and this is known as the acomioclavicular joint. Both joints are prone to wear and tear and hence can become arthritic. This is a very common issue, many of us live without symptoms, but occasionally after a fall, during sporting activities or just down to constant repetition they can flare up and cause pain and local irritation. 

Note: All of the 3 pathologies above are likely to present when over-head activities are performed. Having worked with many shoulder surgeons they will all tell you it’s impossible to pinpoint anyone of the above tissue just by examination alone. We can definitely narrow it down on examination but trying to diagnose a tear in a rotator cuff tendon and swollen bursa is near on impossible to do. This is why most consultant surgeons will send you for an MRI scan or an ultrasound scan to be absolutely certain of the cause of pain thus making the treatment specific to the individual. This is something we pride ourselves on at the Injury Hub, we can offer affordable point of care ultrasound giving you an exact diagnosis and tailored treatment plan.

4. Frozen shoulder – Adhesive Capsulitis Every single joint in the human body is surrounded by a capsule, think of a tight bag surrounding the joints and inside lives a fluid, a bit like WD40, it’s called synovial fluid and it lubricates our joints every 20 minutes of the day.