Photo: woods wheatcroft photography

Shoulder Pain Can Be Confusing

john singer sargent: Madame X (detail) The shoulder is the only joint in the body where a bone attaches to the trunk via muscles and tendons.  It also has the greatest range of motion of all the joints in the body.   This provides a great deal of flexibility and room for injury.

Common injuries include sprain and strain or over use types of injuries, impingement, frozen shoulder, and rotator cuff tears.  Sprain/strain injuries may occur with weekend warrior types of activities.  So many of us are guilty of trying to physically do at age 50 what we could easily do at age 30.  Unfortunately, we lose 1% of our muscle mass per year after age 35, so unless you are religiously in the gym 3x/wk, none of us are in the same physical condition at 50 as we were at 30 which can lead to injury.

Impingement is a term that describes the pinching of a tendon at the AC joint.  This is the acromial clavicular joint.  It is the bony portion that you can feel on top of your shoulder.  There is a tendon under the top portion or acromion.  Often due to overuse, injury, or muscle imbalance this tendon becomes inflamed and takes up more space than it should.  When you raise your arm in a specific direction you may get a pinch at this joint as the tendon is “impinging”.  Soft tissue mobilization, joint mobilization, taping, or other modalities such as electric stimulation and ultrasound may be helpful for shoulder impingement.

The rotator cuff is a group of 4 muscles that are the primary mover of the arm.  A rotator cuff tear occurs when one or more of these muscles are torn due to injury or overuse.  Although massage and physical therapy may be helpful for recovery in partial muscle tears, frank or complete tears require surgical repair.

Frozen shoulder occurs when you are unable to move your arm above the shoulder level up in front or out to the side.  It can be especially painful.  This may occur after falling directly onto the shoulder, after surgery with extended immobilization of the arm, and is often associated with hormonal changes during menopause.  It occurs more frequently in women.  Treatment is usually difficult, painful, and prolonged.  Some doctors believe that frozen shoulder will resolve after 1 or more years if left untreated.

Mary Boyd, MS, PT is the owner of Mountain View Physical Therapy and a member of the Sandpoint Wellness Council.  She can be reached at 290-5575 for questions regarding shoulder pain or on the web

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