Chronic Shoulder Pain

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: Shoulder Pain

Published: 27 November 2015

Causes of Chronic Shoulder Pain

Why Diagnosis is key.

Believe it or not, chronic shoulder pain is quite common at my back pain clinic. The “Chronic” part refers to a pain or movement problem that has been present for more than six weeks - and I find that this is the most useful definition to start with.

However, there are various degrees of ‘”chronic” associated with shoulder pain. These degrees vary according to the length of time a problem has been active in conjunction with the severity of your symptoms and the constancy of your pain. Let’s have a look at this in more detail.

When I see “Shoulder Pain” become “Chronic Shoulder pain”, it is usually down to one of the following reasons:

1. Failure to remove the underlying cause: For example, if your chronic shoulder pain is coming from a pinched nerve in your neck then treatment must be directed towards your neck pain primarily and not your shoulder.

   Another example: If the cause of your chronic shoulder pain is due to a poor sitting posture, or your work station is incorrect for you - then treatment is required for both posture correction and to modify your work station. Without correcting these underlying causes of shoulder pain, then all the shoulder treatments in the world will not relieve you permanently from your pain.

   These are just two common examples of treatment errors that I see in my clinic.

2. Failure to treat the structural source of your pain: If your shoulder pain is coming from your neck, then treatment must be directed towards your neck. If your shoulder pain is coming from your rotator cuff tendons, then treatment must be directed primarily towards your tendons.

   Quote often the pain you experience in your shoulder is being referred from a nearby part of the body. That is why diagnosis is the key in the long term resolution of your chronic shoulder pain, as failure to identify the root cause may lead to ongoing shoulder pain for you.

1. Structural problems: These can be degenerative or positional problems. Sometimes, due to genetical reasons, your shoulder may be out of alignment. Other times, wear and tear leads to arthritis and extra bony growths in your shoulder joint.

   Both these factors can cause chronic shoulder pain. However, once identified and treated manually (or surgically when required) - relief is possible.

2. Poor posture: I find that this is the underlying cause of many of the above. Over time, poor posture can cause pain in your shoulder, and if it is not corrected early enough - then structural changes can occur in your joint resulting in chronic pain.

   [Correction of your posture] (/category/overview/good-posture “Collection of articles on how to maintain a good posture. “)is the key. Your physiotherapist will use manual techniques to release the tightness in your joint and soft tissues, and provide you with posture exercises to both strengthen your posture and unload your painful shoulder. Results are usually excellent.

Jesse’s Story.

I consider shoulder pain to be chronic if has been present for more than six weeks as stated above. Jesse presented to my clinic 4 months ago with pain in her shoulder on movement of her arm above her head or behind her back.

Over the previous three weeks it had become very stiff also. She could not lie on that shoulder so the pain frequently woke her at night as she turned in her sleep. She was ok during the day as long as she didn’t move her arm into painful positions. Unfortunately, Jesse was self-employed and worked as a curtain maker. Her work involved a lot of overhead activity that she could not avoid. As a result she was straining her shoulder regularly during the working day.

On examination, Jesse reported that she injured her shoulder three months before while attempting to start her stubborn lawnmower! Although she experienced a mild twinge of pain at the time it did not stop her from continuing to mow the lawn.

Two days later her shoulder pain worsened and it gradually got worse over the next few weeks. The stiffness was a more recent complaint and it was especially stiff in the early mornings.

My examination suggested a partial tear of the “infraspinatus muscle” of her shoulder. Because Jesses injury had been left untreated for three months - and the movement of her arm had been greatly restricted - she had developed further complications. The muscles around her neck and shoulder had become imbalanced and this was causing her upper back to be painful also.

Injuries left untreated can cause these muscle imbalances which may then interfere with other bodily movements. This results in further injury and pains. I sent Jesse for a MRI scan to confirm my diagnosis. I was correct. Jesse had a partial tear of her infraspinatus just at the junction between its muscle and tendon.

Initially, I treated Jesses shoulder injury with taping and soft tissue physiotherapy techniques, to which she responded positively. After six weeks Jesse was pain-free and had full range of shoulder movement.

However, if she had attended me for treatment sooner it would probably have only taken 2-3 weeks to achieve this. Early intervention is always the way of choice.

Since then, Jesse is doing a progressive home exercise programme to strengthen her shoulder and neck muscles. Although her strength is improving weekly she still has some way to go to return to her pre-injury condition.

Again, this intensive exercise rehabilitation could have been avoided with earlier treatments.

The lesson for us all here is to seek early physiotherapy/physical therapy intervention if you have shoulder pain lasting longer than three days.

Early detection and intervention is the key in the prevention and management of chronic shoulder pain.