One of the commonest conditions I see in practice is shoulder pain. Patients will report pain on raising their arms above shoulder height, difficulty lying on the affected side in bed and sometimes struggle with every day tasks such as putting on a seat-belt or taking off a jumper. In younger patients, the problem may have started after a sporting injury or DIY but in middle-aged or older people it often comes on gradually for no obvious reason. In practice I have to distinguish by thorough history-taking and examination whether the pain is coming from the structures of the shoulder itself or is referred pain from the neck. Our brain’s ‘map’ of the upper body is not very accurate and the pain can be very difficult to localise to a specific structure.
In most cases shoulder pain originates in the ‘rotator cuff’. This is a hard-working group of tendons that are responsible for shoulder movement. With age, these tendons can become a bit worn out and painful. Swollen tendons can get pinched under your collar bone when you raise your arms, known as “impingement”, or develop small tears or splits. In most cases, rotator cuff pain diminishes with time, manual treatment and an exercise regime but this can take as long as 6-12 months which is very frustrating for patients and osteopaths alike! If conservative treatment fails, there are other options such as steroid injections or occasionally, surgery but this is rarely necessary.
Patients often prefer to avoid using a painful shoulder but this is risky, as lack of use can lead to a “frozen shoulder” which is when the elastic capsule surrounding the joint becomes stuck together, causing profound stiffness and loss of function. The rehabilitation of a frozen shoulder is long and painful so it is much better to avoid it happening by getting your sore shoulder looked at early on and starting on a suitable programme of treatment and exercise. Your osteopath should be able to help you with this and get you back to hanging out the washing!
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