What is Shoulder Bursitis?
Shoulder bursitis is an inflamed shoulder bursa. Your bursa is a synovial fluid-filled sac that helps to reduce tendon-bone and tendon-tendon friction in your shoulder spaces. You have several bursae within your shoulder. Your subacromial bursa is the most commonly inflamed of the shoulder bursa.
There are five main bursae around the shoulder. They include:
- subacromial-subdeltoid (SASD) bursa
- subscapular recess
- subcoracoid bursa
- coracoclavicular bursa
- supra-acromial bursa
Subacromial bursitis is a common cause of shoulder pain related to your shoulder’s bursa’s impingement between your rotator cuff tendons and bone (acromion). Your subdeltoid bursa is a less commonly inflamed shoulder bursa.
Shoulder Bursitis Symptoms
Shoulder bursitis commonly presents with the following symptoms:
- Pain on the outside of your shoulder.
- Pain may spread down your arm towards the elbow or wrist.
- The pain is made worse when lying on your affected shoulder.
- The pain is made worse when using your arm above your head.
- Painful arc of movement – shoulder pain felt between 60 – 90° of the arm moving up and outwards.
- When your arm is by your side, there is minimal pain and above 90° relief of pain.
- Shoulder pain with activities such as washing hair and reaching up to a high shelf in the cupboard.
How to Diagnose Shoulder Bursitis
An ultrasound scan is often the most helpful investigation to confirm subacromial bursitis. MRI scan may also be beneficial.
What Causes Shoulder Bursitis?
Repeated minor trauma such as overuse of the shoulder joint and muscles or a single more significant injury such as a fall commonly causes shoulder bursitis.
When your arm is at your side, the subacromial bursa protrudes laterally. It does not invade unless it is grossly inflamed.
When you elevate your arm further out to the side, the bursa rolls beneath the bone, increasing the impingement.
When you continue to elevate your arm above shoulder height, the bursa rolls clear the impingement zone, and your pain eases. However, further impingement may return at the extreme range when your arm is adjacent to your ear.
How Can You Prevent Shoulder Bursitis?
Eliminating the causes of primary and secondary impingement is the key to preventing shoulder bursitis and rotator cuff problems. Factors such as posture, muscle length, shoulder stability, and rotator cuff strength need to be addressed and optimised with specific exercises prescribed by your physiotherapist.
For more specific advice, please consult your physiotherapist.
What is Calcific Shoulder Bursitis?
If treating shoulder bursitis is neglected, it can become quite chronic and challenging to treat, resulting in a cycle of rotator cuff injury and the shoulder joint’s impingement.
Calcific bursitis (bone growth within the bursa) may occur over time. If physiotherapy rehabilitation is unsuccessful, surgery to excise the bursa may be a treatment option.
What is Chronic Shoulder Bursitis?
In chronic (persistent) shoulder bursitis, a corticosteroid injection, a drug to help reduce inflammation, may be required.
About one-week post-injection, physiotherapy normally recommences. Address the biomechanical, muscles and joint issues that have caused bursitis.
There are some advantages and disadvantages to corticosteroid injection. Please discuss the pros and cons with your doctor. Diabetes and other general health issues can limit its safe use. The best results occur when the needle is ultrasound-guided.
Shoulder Bursitis Treatment
Shoulder bursitis is one of the most common problems we see as physiotherapists. Unfortunately, an injury often recurs if you return to sport or work too quickly, especially if you have an incomplete rehabilitation program.
Your rotator cuff is an essential group of control and stability muscles that maintain the “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This centralisation prevents injuries such as bursitis, impingement, subluxations and dislocations.
We also know that your rotator cuff provides subtle glides and slides off the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.
Did you know that your arm only has one bony joint articulation where your collarbone (clavicle) attaches to the acromion (tip of the shoulder blade)? The rest of your attachments are muscular, highlighting the importance of retraining and strengthening your shoulder muscles.
Shoulder Bursitis Exercises
You’ll most likely be unable to lift your arm or sleep comfortably fully in the early phase. Pain relief is usually a high priority for patients suffering from acute shoulder bursitis.
Researchers have concluded that there are mostly seven stages that need to be covered to effectively relieve your bursitis pain in the short term and prevent your bursitis from returning in the future. These are:
Phase 1 – Early Injury Protection: Pain Relief & Anti-inflammatory Tips
Your first aim is to avoid activities and positions that squeeze or irritate your bursa. In most cases, you should stop doing the action or activity that provoked the shoulder pain in the first place and avoid doing anything that causes suffering within your shoulder. Your physiotherapist will provide you with some active rest suggestions to help you prevent pain-provoking postures and movements.
To relieve pain, you may need to wear a sling or have your shoulder “sling” taped. It may mean that you need to sleep relatively upright or with pillow support in some cases. Your physiotherapist will guide you.
Ice is a simple, natural and effective modality to reduce your pain and swelling. Apply ice for 20 to 30 minutes, each 2 to 4 hours during the initial phase. Or, apply when you notice that your shoulder is warm or hot.
Anti-inflammatory medications (if tolerated) and natural substances, e.g. arnica, may help reduce your pain and swelling. However, due to the bursa being a self-contained entity with minimal blood flow, there is a theory that NSAIDs are less effective than in other inflammatory conditions.
Most patients can tolerate paracetamol as pain-reducing medication. Would you please check with your doctor or pharmacist?
What about Cortisone Injections?
Corticosteroid injections combined with a local anaesthetic (Hydrocortisone + Local anaesthetic = HCLA) may relieve pain and promote healing. The local anaesthetic can provide short-term pain relief. The best results occur with the injection performed under ultrasound guidance. Over the next week or so, the cortisone improves your medium-term pain.
Researchers generally find excellent short-term pain relief from HCLA injection corticosteroids, but some potential long-term side effects may be less desirable. Unfortunately, as with most drugs, side effects exist, and corticosteroids should be cautiously advised, especially with diabetics. Whether you are a suitable candidate for a corticosteroid injection should be discussed with your doctor. Diabetes and other general health issues can limit its safe use.
Some patients report adequate initial relief before a recurrence of symptoms. This reaggravation is due to a resumption of your poor movement patterns/weakness that caused bursitis in the first instance. In these cases, the long-term solution is to have your shoulder and movement patterns thoroughly assessed by your physiotherapist to commence corrective rehabilitation.
Phase 2: Regain Full Range of Motion
IProtectingyour injured rotator cuff structures appropriately will heal the injured tissues and inflammed systems, e.g. (tendonitis and bursitis), which will settle when protected from additional damage.
Symptoms of shoulder bursitis may take several weeks to improve while we await Mother Nature to work her wonders. During this time, it is essential to create an environment that allows you to return to regular use quickly and prevent a recurrence.
Your physiotherapist will utilise a range of pain-relieving techniques, including joint mobilisations, massage, acupuncture or dry needling, to assist you during this painful range-restricted phase. The good news is that researchers have concluded that physiotherapist-assisted treatment will improve your range of motion quicker and, in the long term, improve your functional outcome.
In some cases, you may also have developed short or long-term protective tightness of your shoulder joint capsule (usually posterior) and some compensatory muscles. These structures need stretching to allow normal movement. Your physiotherapist can assess your limitations and prescribe the appropriate treatment.
Signs that have full soft tissue extensibility include moving your shoulder through a full range of motion. As you improve, you will be able to do this under your muscle power. This may need to be done passively (by someone else) in the early stage, e.g. your physiotherapist.
Phase 3: Restore Scapular Control
Your shoulder blade (scapula) is the base of your shoulder and arm movements.
Normal shoulder blade-shoulder movement – known as scapulohumeral rhythm – is required for a pain-free and powerful shoulder function. Alteration of this movement pattern results in impingement and subsequent injury.
Your physiotherapist is an expert in assessing and correcting your scapulohumeral rhythm.
Researchers have identified poor scapulohumeral rhythm as a major cause of rotator cuff impingement. Any deficiencies will be an essential component of your rehabilitation.
Plus, they have identified scapular stabilisation exercises as a critical ingredient for successful rehabilitation.
Your physiotherapist will be able to guide you through the appropriate exercises for your shoulder blade.
Phase 4: Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
In most cases, especially chronic shoulders, some treatment directed at your neck or upper back will ease your pain, improve your shoulder movement and stop pain or injury from returning.
Your neck and upper back (thoracic spine) are significant in treating shoulder pain and injury. Neck or spine dysfunction can not only refer directly to your shoulder, but it can affect a nerve’s electrical energy supplying your muscles, causing weakness and altered movement patterns. Painful spinal structures caused by poor posture or injury don’t provide your shoulder or scapular muscles with the required solid pain-free base.
For specific advice, whether your neck or upper back is related to your shoulder pain, please consult your physiotherapist for individualised assessment and treatment as required.
Phase 5: Restore Rotator Cuff Strength
It may seem odd that you don’t attempt to restore your rotator cuff’s strength until a later rehabilitation stage. However, if a structure is injured, we need to provide nature with an opportunity to undertake primary healing before loading the architecture with anti-gravity and resistance exercises.
Researchers have discovered the importance of strengthening the rotator cuff muscles in a successful rehabilitation program. These exercises need both load and position progression to accommodate any damaged rotator cuff tendons and whether you have a secondary condition such as bursitis.
Your physiotherapist will happily prescribe the most appropriate program for you.
Phase 6: Restore High Speed, Power, Proprioception & Agility
If your sport has caused your shoulder injury, it is usually during high-speed activities, which place enormous forces on your body (contractile and non-contractile) or repetitive actions.
To prevent a recurrence as you return to sport, your physiotherapist will guide you through exercises to address these essential rehabilitation components to prevent a recurrence and improve your sporting performance.
Depending on your sport or lifestyle, a customised speed, agility, proprioception and power program will prepare you for light sport-specific training.
Phase 7: Return to Sport or Work
Depending on the demands of your chosen sport or your job, you will require specific sport-specific or work-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport or employment.
Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport or work.
Work-related injuries will often require a discussion between your doctor, rehabilitation counsellor or employer.
The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.
There is no specific time frame for when to progress from each stage to the next. Many factors will determine your injury rehabilitation status during your physiotherapist’s clinical assessment.
In most cases, you’ll find that your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improve.
It is also crucial to carefully monitor your progression since attempting to progress too soon to the next level can lead to re-injury and frustration.
For more specific advice about your bursitis or rotator cuff injury, please contact your PhysioWorks physiotherapist.
Common Shoulder Pain & Injury Conditions
- Rotator Cuff Syndrome
- Shoulder Tendinopathy
- Rotator Cuff Calcific Tendinopathy
- Rotator Cuff Tear
- Bicep Tendinopathy
- Shoulder Impingement
- Swimmer's Shoulder
- Subacromial Decompression
- Shoulder Arthroscopy
- Rotator Cuff Repair
- SLAP Repair
- Biceps Tenodesis
- Biceps Tenotomy
- Total Shoulder Replacement
Researchers have discovered that managing your shoulder injury with physiotherapy is usually successful. Typically, you have two options: a non-operative or a surgical approach. Your condition will dictate which option is best for you at this time. Non-operative care is conservative rehabilitation.
If shoulder surgery is required, then your physiotherapist may undertake:
Pre-operative rehabilitation - either trial a non-operative/conservative treatment approach or condition and prepare your shoulder and body for a surgical procedure.
Post-operative physiotherapy will safely regain your normal range of movement, strength and function.
PhysioWorks physiotherapists have a particular interest and an excellent working relationship with leading shoulder surgeons. Our physiotherapy team provide you with both conservative and post-operative shoulder rehabilitation options. We aim for you to attain the best possible outcome for your shoulder injury.
For specific information regarding your shoulder, please consult your trusted shoulder physiotherapist.
Shoulder Pain FAQs
- When Should You Worry About Shoulder Pain?
- 6 Common Shoulder Injuries?
- What Causes Shoulder Pain?
- What is Your Scapulohumeral Rhythm?
- What is Your Rotator Cuff?
- How Can You Tell If You Have Torn Your Rotator Cuff?
- Can You Diagnose A Torn Rotator Cuff Without An MRI?
- Can You Lift Your Arm With A Rotator Cuff Tear?
- Will Your Shoulder Blade Hurt With A Torn Rotator Cuff?
- Will A Cortisone Injection Help A Torn Rotator Cuff?
- How Can You Make Your Rotator Cuff Heal Faster?
Common Shoulder Pain Causes
Shoulder pain can commence after a traumatic injury or present gradually.
Traumatic shoulder injuries include:
- Shoulder fractures (broken bones),
- Shoulder dislocation (out of position),
- AC joint injury (torn ligaments),
- Shoulder tendinopathy (tendon injuries) or
- Rotator cuff or muscular injuries.
The most common cause of traumatic shoulder injuries would be sports injuries or lifting injuries.
Gradual onset shoulder injuries include:
- Previous injuries that are inadequately treated (e.g. old joint or ligament sprains)
- Shoulder impingement or shoulder bursitis from poor muscular control, soft tissue tightness or joint position issues (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition), e.g. frozen shoulder
- Joints laxity (excessive sloppiness causes joint or tendon damage through poor control)
- Shoulder Arthritis
Your shoulder physiotherapist will be able to assist with your diagnosis and treatment plan. Please consult with them regarding your shoulder condition.
Shoulder Impingement Syndrome
Your Shoulder Impingement Zone is where your shoulder tendons and bursa are most likely to impinge against the (acromion) top of the shoulder blade during overhead or shoulder height movement. The shoulder impingement zone is the most likely area when injuries to your rotator cuff or shoulder bursa occur due to the narrowing of the sub-acromial (space below the acromion) during this shoulder position.
Postures that significantly narrow the sub-acromial space are:
- Rounded shoulder postures.
- Your arm is working at or near shoulder height.
- Your arm is high overhead.
- Poor scapulohumeral rhythm.
Who Suffers Shoulder Impingement Syndrome?
Shoulder Impingement Syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, water polo, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height are also at risk of rotator cuff impingement.
What are the Symptoms of Shoulder Rotator Cuff Impingement?
Commonly rotator cuff impingement has the following symptoms:
- An arc of shoulder pain occurs approximately when your arm is at shoulder height or when your arm is overhead.
- Shoulder pain can extend from the top of the shoulder to the elbow.
- Pain when lying on the sore shoulder.
- Shoulder pain at rest as your condition deteriorates.
- Muscle weakness or pain when attempting to reach or lift.
- Pain when putting your hand behind your back or head.
- Pain reaching for the seatbelt.
How is Shoulder Impingement Syndrome Diagnosed?
A thorough clinical examination will identify a rotator cuff impingement in most cases. Your physiotherapist will ask about your shoulder pain and its behaviour and examine your shoulder with specific tests that identify impingement signs.
A problem with your neck joints can commonly cause shoulder pain. Your physiotherapist will examine this area to rule out this cause or include its treatment in your care plan.
For specific shoulder impingement advice, please consult your shoulder physiotherapist.
More info: Shoulder Injuries
Rotator Cuff Muscles
Your rotator cuff muscles hold your arm (humerus) onto your shoulder blade (scapula). Most of the rotator cuff tendons hide under the bony point of your shoulder (acromion), which, as well as protecting your rotator cuff, can also impinge on your rotator cuff structures.
The shoulder joint is a relatively unstable ball and socket joint. It is often likened to a golf ball on a tee. Your subscapularis, supraspinatus, infraspinatus and teres minor are small muscles that stabilise and control your shoulder movement. Collectively, these four muscles are known as the rotator cuff.
What is your Rotator Cuff?
Rotator cuff syndrome is a prevalent shoulder injury. Your shoulder joint is a relatively unstable ball, and the socket joint is moved and controlled by a small group of four muscles known as the rotator cuff.
As the name suggests, the rotator cuff muscles are responsible for shoulder rotation and form a cuff around the humerus's head (shoulder ball). The subscapularis, supraspinatus, infraspinatus and teres minor are your rotator cuff muscles. These muscles stabilise and control your shoulder movement on your shoulder blade (scapula).
Rotator Cuff Injury
Your rotator cuff muscles and tendons are vulnerable to rotator cuff tears, rotator cuff tendonitis, rotator cuff impingement, and related rotator cuff injuries.
Rotator cuff injuries vary. Medium severity injuries include acute or subacute rotator cuff tendon damage (rotator cuff tendinopathy). The lesser end is mild soft tissue pinching and catching (shoulder impingement), an inflamed subacromial bursa (shoulder bursitis). The more significant injury end of the spectrum is more longstanding tendon damage (calcific tendinopathy), a rotator cuff tear, or complete tendon rupture.
Rotator Cuff Treatment
Fortunately, most rotator cuff injuries respond to physiotherapy treatment that addresses how your shoulder moves, e.g. avoid clicking impingement positions. This treatment approach helps with short-term pain and long-term damage such as rotator cuff tears or repeat bursitis.
More significant injuries include partial and full-thickness rotator cuff tears, which may require rotator cuff surgery.
Some shoulder rotator cuff injuries are more common than others.
Article by John Ferguson
What is Shoulder Bursitis?
Shoulder bursitis is a common complaint among people of all ages. Shoulder bursitis can occur following acute shoulder trauma, but it is more consistently due to overuse and suboptimal biomechanics. Bursa is a fluid-filled sac-like structure that rests wherever there may be friction between soft tissue and bone. The subacromial bursa, which rests between the humerus and the ceiling of the shoulder joint, can become irritated when tight or weak rotator cuff muscles cause the humerus's head to infringe on it during arm movements. Known as an impingement, this pattern, coupled with repeated overhead arm movement, can cause the subacromial bursa to become inflamed and painful.
Once irritated, shoulder bursitis can result in considerable pain and restriction, which can be felt down the arm and traditionally aggravated by overhead activities.
Positively, despite the pain and disability associated with shoulder bursitis, often it does not coincide with the need for surgical management. Indeed, research suggests that most people respond well to a simple home exercise program and rest from aggravating activities.
More info: Shoulder Bursitis
What Causes Rotator Cuff Impingement?
Rotator cuff impingement and bursitis causes have primary (structural) and secondary (posture & movement related) causes.
Primary Rotator Cuff Impingement – Structural Narrowing
Some of us are born with a smaller sub-acromial space. Conditions such as osteoarthritis can also cause the growth of sub-acromial bony spurs, which further narrows the space.
Because of this structural narrowing, you are more likely to squash, impinge and irritate the soft tissues in the sub-acromial space, which results in bursitis or rotator cuff tendonitis.
Secondary Rotator Cuff Impingement – Dynamic Instability
Impingement can occur if you have a dynamically unstable shoulder.
Dynamic shoulder instability means excessive joint movement, ligament laxity and muscular weakness around the shoulder joint.
This impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity.
In an unstable shoulder, the rotator cuff has to work harder, which can cause injury.
An overworking rotator cuff fatigues and eventually becomes inflamed and weakens due to pain inhibition or tendon tears.
Typically, when your rotator cuff fails, it cannot prevent the head of the humerus (upper arm) from riding up into the sub-acromial space, squashing your bursa or rotator cuff tendons.
Failure to properly treat this instability causes the injury to recur. Poor technique or bad training habits such as training too hard is a common cause of overuse injuries, such as bursitis or tendinopathy.
Article by Zoe Russell
How Can You Tell If You Tore Your Rotator Cuff?
So you have hurt your shoulder - and it is painful. It is interrupting your sleep, and you are lying awake at night, and you wonder - have I torn my rotator cuff?
How Can You Tell?
There are two types of Rotator Cuff Tears.
- Traumatic Tears
- Atraumatic Tears
A traumatic tear occurs when you sustain trauma to your shoulder. This trauma could be a fall where you reach out and land on your arm or even a shoulder dislocation. In essence, something specific, memorable and traumatic happens to your shoulder.
You may experience intense pain, it interrupts your sleep, and you may be unable to move your arm, especially with lifting and rotating your arm away from your body.
An atraumatic tear is when your symptoms occur without recollection of a significant force. These atraumatic tears often result from microtraumas. Essentially, the effect of multiple low threshold forces beyond the capacity of your shoulder. A small force, or something that you do every day causes a tear to your shoulder. Often the symptoms of an atraumatic tear are the same as a traumatic tear, where you have pain, and interrupted sleep due to this pain. Commonly, with the inability to lay on your shoulder at night and an inability to move your arm. In these cases, the rotator cuff tendons often display changes to the tendon preceding this trauma.
How we manage these tears is often dictated by the size of the tear, the nature of the precipitating event, and your shoulder's function. If you have any of these symptoms:
- Constant pain, that interrupts your sleep
- Inability to move your arm
You may have sustained a tear to your rotator cuff.
Please seek physiotherapy support early, as some tears may require referral to a shoulder specialist. With same-day appointments available - your local PhysioWorks is well equipped with experienced physiotherapists to help you on the path to recovery.
More info: Rotator Cuff Tears
Can You Diagnose A Torn Rotator Cuff Without An MRI?
Yes. In most cases, a skilled shoulder physiotherapist or doctor will diagnose a rotator cuff tear without an MRI. In a clinical setting, a doctor or physiotherapist can use the information on how your symptoms developed, the symptoms you are experiencing, and a series of physical tests to determine whether you have experienced an injury to the rotator cuff. If this is suspected, either high-resolution diagnostic ultrasound or MRI may be considered. The research evidence identifies ultrasound as the more specific, sensitive and cheaper diagnostic test of the two options. Your imaging results can help determine whether your condition is more likely to benefit from surgical or non-surgical management. X-rays do not help decide whether or not you have a rotator cuff tear but can assist in ruling out other possible causes of your symptoms.
More info: Shoulder Injuries
Can You Lift Your Arm With A Rotator Cuff Tear?
Whilst it is possible to lift your arm following a rotator cuff tear, several factors can influence how well you can do this. The first key consideration is the severity of the injury. Acute rotator cuff injuries are typically divided into partial or complete thickness tears. In the event of a partial tear, you may experience pain lifting your arm, though the movement remains possible. However, full-thickness tears are associated with more difficulty lifting the arm. The second consideration is the change in your function. Your disability will depend upon which section of the rotator cuff has been affected.
Given that the rotator cuff comprises four different muscles and their tendons and the different movements they are responsible for, the change in your function will be specific to each of them. The final consideration is the amount of pain you are suffering. Unsurprisingly, a high intensity of pain is likely to discourage you from wanting to move and your muscles from making you potentially move in ways that aggravate your condition.
For specific shoulder impingement advice, please consult your shoulder physiotherapist.
More info: Shoulder Injuries
How Can You Make Your Rotator Cuff Heal Faster?
Rotator cuff injuries are common. Around 732,000 people seek medical advice for rotator cuff injuries in Australia (Naunton et al., 2020). The majority of these will not need surgery. Does time heal all wounds? Or, is some motion your lotion?
The answer is predictably measured and will involve a little of both. Here are the dot points on how to get your recovery right;
Finding Your Appropriate Load Level
Most rotator cuff injuries are from repetitive overuse. Continuing to load these muscles at the same rate will delay healing. But, complete rest isn't going to work. The damage that has been done requires an appropriate load to stimulate tissue remodelling.
The same can be said of acute rotator cuff injuries, with caveats. A short period of complete rest is usually appropriate before gentle exercise is required to prevent scar tissue buildup.
Providing an appropriate load level at the proper time for your type of cuff injury is tricky. Identifying causative factors and respecting pain are good places to start, but seeking the guidance of a health professional, such as your shoulder physiotherapist, is recommended to ensure you're ticking all the boxes.
Avoid Sleeping On Your Affected Side
Thankfully this one shouldn't require an appointment to get right. Just don't sleep on it.
The reason is that tendons hate compression. And the rotator cuff is very susceptible to compression due to its anatomy.
The cuff muscles originate on the shoulder blade and work to hold the head of the arm bone in place. This naturally leads to them adopting an L shape. When the arm is by the side, the long part of the L is stretched (in the case of the top muscle pictured) and compresses the tendon (the corner of the L) against the arm bone.
Sleeping on the affected side adds another compression element, and now your tendon is being squished from both sides.
Using this new knowledge, you can reason that it is preferable to avoid sleeping on the affected side and with your arm away from your side a slight amount.
It is also best to avoid any rotation, which tensions the other cuff muscles. The most common mistake is sleeping on the unaffected side but letting your hand fall onto your belly.
Changing your sleep position is sometimes difficult. It can be helpful to start thinking about this before you're staring at the ceiling by taking pain relief or icing before it's time for bed.
Usually, ice is used to reduce inflammation, but in tendon overuse conditions, its function involves preventing the abnormal formation of new blood vessels in the tendon (Khan et al., 2000). Studies have shown that shoulder tendons with neovessels present are 6.5 times more likely to experience shoulder pain than those without (Skazalski et al., 2021). It's a complicated reason for a simple intervention; 20 minutes, multiple times a day, with at least 45 minutes between exposures.
Rotator cuff injuries are common, and most don't need surgery. Minimising compression to the area by adjusting your sleep positioning, icing regularly and loading the right amount at the right time will ensure your rotator cuff heals as fast as possible.
For more specific advice, please seek the guidance of your trusted shoulder physiotherapist or doctor.
More info: Shoulder Injuries
ReferencesNaunton J, Harrison C, Britt H, Haines T, Malliaras P (2020) General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care. PLOS ONE 15(1): e0227688. https://doi.org/10.1371/journal.pone.0227688 Skazalski, C, Bahr, R, Whiteley, R. Shoulder complaints more likely in volleyball players with a thickened bursa or supraspinatus tendon neovessels. Scand. J. Med. Sci. Sports. 2021; 31: 480– 488. https://doi.org/10.1111/sms.13831 Khan, K. M., Cook, J. L., Taunton, J. E., & Bonar, F. Overuse Tendinosis, Not Tendinitis. The Physician and Sportsmedicine, 28(5), 38–48. doi:10.3810/psm.2000.05.890
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.
Will A Cortisone Injection Help A Torn Rotator Cuff?
Your rotator cuff comprises four muscles and tendons surrounding the shoulder joint. They provide strength to lift the arm in all directions and provide stability to the shoulder to firmly hold the ball of the shoulder (head of the humerus) in the socket (glenoid).
Management for Rotator Cuff Tears
Tears of the rotator cuff can occur acutely through several mechanisms or can result from gradual changes over time and, in some cases, can cause shoulder pain and reduced function. Good quality research has suggested that physiotherapy and exercise rehab is effective and should be the first-line treatment for many types of rotator cuff injuries. However, in some particularly stubborn cases, other additional options may need to be considered.
A cortisone injection, also known as an HCLA (hydrocortisone + local anaesthetic) injection, is an injection that can help to reduce inflammation and provide pain relief. With the guidance of your physiotherapist and medical team, a cortisone injection may be considered for people with:
- Persistent high pain levels despite medication and relative rest.
- Night pain
- Where pain has restricted the progression of exercise rehab.
Pros and Cons of Injections
A cortisone injection can effectively reduce pain and inflammation in conditions such as bursitis in the right circumstances. However, injections do also have some potential adverse side effects.
Recent studies show that repeat injections or injections involving large tendon tears can weaken the tendon structure and inhibit the cells that help repair damaged tissue. This is why healthcare professionals, such as your physiotherapist, will try to avoid unnecessary steroid injections and persist with rehab for at least 4-6 weeks before considering them.
Rehab Following Injection
Research shows that people experience significantly greater improvements in shoulder pain and function when completing a specific exercise rehab program following a cortisone injection (Holmgren et al., 2012). Following a successful cortisone injection, your physiotherapist can use this reduced pain “window” to allow the more effective exercise of the muscles in the area. Typically, relative rest is recommended for 1-2 weeks following the injection before commencing exercise rehab.
Consulting with one of our PhysioWorks physiotherapists can ensure that your shoulder injury is accurately diagnosed and treated accordingly. Book an appointment, or feel free to call us, and one of our physiotherapists will be happy to help.
More info: Rotator Cuff Syndrome
What is Scapulohumeral Rhythm?
Your shoulder-scapula joint motion has a regular functional motion pattern known as scapulohumeral rhythm - to provide you with pain-free and powerful shoulder function. When elevating your shoulder overhead, roughly one-third of your shoulder motion occurs at your scapulothoracic joint. Two-thirds of movement occurs at the glenohumeral joint, or 'true" shoulder joint. However, the timing and coordination of your shoulder muscles and how they control your scapulohumeral rhythm are essential factors.
View it on Youtube here: http://www.youtube.com/watch?v=_Ia0VvT81xc
Alteration of this regular scapulohumeral movement pattern results in shoulder injuries, pain and impingement.
When your scapulohumeral rhythm becomes abnormal -due to pain, weakness or muscle incoordination - you are more likely to suffer shoulder clicking, pain or rotator cuff injury.
Shoulder Joint Anatomy
Your shoulder motion occurs via a complex group of joints that dynamically controls the movement of three bones (scapula, humerus and clavicle) upon your ribcage. Your shoulder blade (scapula) is the centralised triangular base for your shoulder and arm movements. Your scapular muscles guide your scapula as it articulates around your rib cage. This motion is known as scapulothoracic motion.
Your clavicle or collarbone is the only skeletal attachment of your arm. It attaches to your upper sternum and the lateral edge of your scapula at the acromioclavicular (AC) joint. Your shoulder ball and socket joint is the glenohumeral joint where your upper arm bone (humerus) articulates on the glenoid fossa of your scapula.
What are the Symptoms of Abnormal Scapulohumeral Rhythm?
Poor shoulder blade stability results in abnormal tipping and rotation of your scapular, which causes your acromion (bone) to pinch down into the subacromial structures (e.g. bursa and tendons), causing impingement leading to swelling or tears. Typically signs of abnormal scapulohumeral rhythm include shoulder pain, instability and clicking. Researchers have identified abnormal scapulohumeral rhythm as a major cause of rotator cuff impingement.
Your shoulder physiotherapist is an expert in the assessment of scapulohumeral rhythm. They will observe your shoulder motion and perform strength and control tests to assist their diagnosis. X-rays, MRIs, ultrasound scans and CT scans cannot determine scapulohumeral rhythm dysfunction.
Why is Scapulohumeral Rhythm Important?
Poor scapula stability usually results in tipping and downward rotation of your scapula. The downward posture causes your shoulder (tip of acromion) to pinch down on the subacromial structures. Rotator cuff impingement, shoulder bursitis or rotator cuff tears result from subacromial impingement.
Normal shoulder blade-shoulder movement - (scapulohumeral rhythm) - is required for a pain-free and powerful shoulder function. Luckily, abnormal scapulohumeral rhythm can be retrained by an experienced shoulder physiotherapist.
Scapulohumeral Rhythm Correction
Your skilled physiotherapist can assess and correct your scapulohumeral rhythm. Any deficiencies will be an essential component of your rehabilitation. Among other treatment options, teaching you how to control your shoulder blade via scapular stabilisation muscles is crucial for a successful recovery.
Your physiotherapist will be able to guide you in the appropriate exercises for your shoulder.
Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
You may find it challenging to comprehend that your neck and upper back (thoracic spine) are essential in treating shoulder pain and injury. Neck or spine dysfunction can not only refer to pain directly to your shoulder but can affect a nerve's electrical energy supply to your muscles, causing weakness.
Plus, painful spinal structures from poor posture or injury don't provide your shoulder, or scapular muscles, with a solid pain-free base. In most cases, especially chronic shoulders, some treatment directed at your neck or upper back may ease your pain, improve your shoulder movement and stop pain or injury from returning.
For more information, please consult your shoulder physiotherapist.
Kinesiology tape has a comprehensive array of therapeutic benefits. Because kinesiology taping can usually be left on for several days or up to a week, these therapeutic benefits are available to the injured area 24 hours a day, significantly accelerating the healing process from trauma, injuries and inflammatory conditions.
Benefits of Kinesiology Taping
Pain Relief via Structural Support for Weak or Injured Body Parts
Kinesiology tape is a flexible elastic tape that moves with your body. The supple elasticity provides supports to your body parts without the tape slipping.
By supporting your body part, kinesiology tape can provide you with pain relief and muscular support to help control body parts affected by muscle inhibition.
Kinesiology tape potentially assists your muscle strength via physical assistance. It also provides tactile feedback through the skin, e.g. proprioception boost. This phenomenon may help both the non-disabled athlete to enhance their performance and hypotonic, e.g. children with low muscle tone.
Kinesiology provides a passive lift to your skin via its elastic properties. This vacuum effect allows your lymphatic and venous drainage systems to drain and swollen or bruised tissue quicker than without the kinesiology tape.
It is also thought that this same principle can assist the removal of exercise byproducts like lactic acid that may contribute to post-exercise soreness, e.g. delayed onset muscle soreness (DOMS).
More info: Strapping & Supportive Taping
What is Dry Needling?
Dry needling is an effective and efficient technique for the treatment of muscular pain and myofascial dysfunction. Dry needling or intramuscular stimulation (IMS) is a technique that Dr Chan Gunn developed. Dry needling is a beneficial method to relax overactive muscles.
In simple terms, the treatment involves the needling of a muscle's trigger points without injecting any substance. Western anatomical and neurophysiological principles are the basis of dry needling. It should not be confused with the Traditional Chinese Medicine (TCM) technique of acupuncture. However, since both dry needling and acupuncture utilise the same filament needles, the confusion is understandable.
In his IMS approach, Dr Chan Gunn and Dr Fischer, in his segmental approach to Dry Needling, strongly advocate the importance of clearing trigger points in both peripheral and spinal areas.
Dry needling trained health practitioners use dry needling daily for the treatment of muscular pain and dysfunction.
What Conditions Could Acupuncture or Dry Needling Help?
Acupuncture or dry needling may be considered by your healthcare professional after their thorough assessment in the following conditions:
Private Health Fund Rebates
Most private health funds offer rebates on acupuncture or dry needling treatments as a component of your physiotherapy or acupuncture consultation.
Why is Post-Operative Physiotherapy Beneficial?
The success of your surgery doesn't finish the moment you leave the operating theatre. A famous quote: "The only place 'success' comes before 'work' is in the dictionary." Vidal Sassoon.
Your surgeon will have skillfully performed a surgical procedure that is the initial step towards your successful outcome. However, you'll have to do some work in the form of exercises to optimise your results.
Your physiotherapist will provide you with simple exercises to minimise chest infection or DVT complications when in the hospital. They may prescribe some early strengthening or range of motion exercises. Once discharged, you'll usually require re-assessment and checking of your progress.
Post-orthopaedic surgery, you'll almost certainly require exercise progression to regain your strength, flexibility, and function fully. Optimise your prompt return to life by consulting an experienced physiotherapist. Based on their assessment, they'll prescribe the most appropriate exercise for you and discuss your post-operative treatment.
At PhysioWorks, we'll happily assist you in your post-operative care. We are familiar with the treatment protocols prescribed by most Orthopaedic Surgeons. We'll happily liaise with your surgeon to determine any specific requirements based on your surgery.
Common Surgeries Requiring Post-Operative Care
Wrist & Hand
Carpal Tunnel Release, Fracture, Tendon Repairs
Achilles Tendon Repairs, Fasciotomy
Ankle & Foot
Ankle Reconstruction, Ligament Repairs, Arthroscope, Fracture, Spur Removal, Bunionectomy
Spine (Neck & Back)
Discectomy, Micro-discectomy, Laminectomy, Spinal Fusion/Stabilisation
Individualised Post-Operative Physiotherapy
At PhysioWorks, we'll work with you to develop a tailor-made rehabilitation program to ensure you make the best possible recovery in the quickest time. Whatever your needs, we'll get you back to your work, sport or day to day activities ASAP.
If you have been a surgical patient, it is always beneficial to inform your surgeon that you would like to return for post-operative care at PhysioWorks.
You can make an appointment with PhysioWorks at any stage. Seek their advice if you believe you are not making satisfactory progress in your recovery or if your mobility is compromised.
When Should You Commence Physiotherapy?
In severe cases, it is best to commence physiotherapy as soon as possible. However, it does vary from case to case. Your physiotherapist has some nifty tricks to improve your pain straight away.
If you are not sure what to do, please call us for advice. We’ll happily guide you in your time of need. Often a bit of reassurance is all that you will need.
How Much Treatment Will You Need?
After assessing your injury, your physiotherapist will discuss the injury severity with you and estimate the number of treatments needed. No two injuries are ever the same.
Your treatment will include techniques and exercises to regain your:
- joint, ligament and soft tissue mobility
- muscle strength, power and speed
- balance and proprioception
- prevention tips
- performance improvement.
What If You Delay Treatment?
Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve. This can lead to nastier conditions. The sooner you get on top of your symptoms the better your outcome.
All injuries are different and little variations can make a big improvement to your recovery rate. Stiff joints or muscles may need some range of movement exercises. Other injuries may require massage or very specific strengthening exercises.
Seek professional guidance promptly for your best outcome.