Shoulder Pain.
What is causing your shoulder pain?
The shoulder is complex with many structures that stabilise and allow movement at the joint. Shoulder pain is the third most common musculoskeletal complaint in adults, with the leading cause coming from the rotator cuff muscles. Like knee and back pain, shoulder pain is a symptom rather than a diagnosis — and identifying the specific structure and mechanism involved is essential, because the treatment for a frozen shoulder is quite different from that for a rotator cuff tear, which differs again from shoulder instability or an AC joint injury.
Common causes of shoulder pain
Referred pain from the cervical spine — cervical radiculopathy from C5 nerve root compression and cervical facet joint syndrome at C3-4 and C4-5 both refer pain into the shoulder region. A shoulder that doesn't respond to standard local treatment should always prompt assessment of the cervical spine.
How is shoulder pain diagnosed?
A physiotherapy assessment evaluates the likely pain source through specific provocation and stability tests, strength and movement assessment, and functional analysis. Ultrasound is the most accessible and informative imaging for rotator cuff pathology, bursitis and calcific tendinitis. MRI provides more comprehensive information for labral pathology and complex presentations.
How can physiotherapy help?
The rehabilitation approach is specific to the diagnosis. Rotator cuff and scapular muscle retraining is central to most shoulder presentations — the lower trapezius, serratus anterior and rotator cuff external rotators are the primary targets. Thoracic mobility and posture work addresses the postural contributors to subacromial compression and scapular dyskinesis. Manual therapy improves glenohumeral and acromioclavicular joint mobility and reduces pain through neurophysiological mechanisms.
Real time ultrasound assists in retraining deep rotator cuff activation where pain and inhibition have disrupted normal muscle recruitment. Clinical Pilates provides a controlled environment for progressive shoulder and scapular loading with precise progression. Dry needling assists with pain management and muscle guarding in the periscapular and rotator cuff region.
For patients whose shoulder condition arose from a workplace or motor vehicle injury, WorkCover and CTP funded physiotherapy is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in shoulder conditions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
The shoulder is complex with many structures that stabilise and allow movement at the joint. Shoulder pain is the third most common musculoskeletal complaint in adults, with the leading cause coming from the rotator cuff muscles. Like knee and back pain, shoulder pain is a symptom rather than a diagnosis — and identifying the specific structure and mechanism involved is essential, because the treatment for a frozen shoulder is quite different from that for a rotator cuff tear, which differs again from shoulder instability or an AC joint injury.
Common causes of shoulder pain
- Rotator cuff injuries — the most common cause of shoulder pain — range from tendinopathy and partial tears to full-thickness ruptures. Injury to the rotator cuff can occur from repetitive use, sports activities, or a fall, causing pain, weakness and limited range of motion. Many rotator cuff tears — including full-thickness tears — respond well to structured physiotherapy without surgery, and the evidence supporting conservative management for degenerative cuff tears has strengthened considerably in recent years.
- Shoulder impingement (subacromial pain syndrome) — where the rotator cuff tendons and bursa are compressed in the subacromial space during arm elevation — produces the characteristic painful arc with overhead movements and night pain. This condition can occur due to repetitive overhead movements, poor posture, or aging. Structured physiotherapy addressing rotator cuff and scapular muscle function is as effective as surgery for the majority of presentations.
- Frozen shoulder (adhesive capsulitis) — progressive fibrosis and contracture of the glenohumeral joint capsule — produces a characteristic pattern of increasing pain and stiffness across all directions of movement. It is more common in individuals aged 40 to 60 and in those with diabetes or thyroid disorders, and its rehabilitation is stage-specific — the approach in the freezing phase differs considerably from the frozen and thawing stages.
- Glenohumeral joint instability — where the shoulder slips, subluxes or dislocates from inadequate passive or dynamic stabilisation — ranges from traumatic anterior instability following dislocation to atraumatic multidirectional instability in hypermobile athletes. Management depends critically on the type and direction of instability.
- AC joint injuries — sprains or separations of the acromioclavicular joint from falls onto the shoulder — are common in contact sport and cycling. Grade 1 and 2 injuries are managed conservatively; higher-grade injuries may require surgical reconstruction.
- Calcific tendinitis — calcium crystal deposits within the rotator cuff tendon — produces acute, severe shoulder pain in the inflammatory phase and chronic dull aching in the formative phase. Both presentations respond to physiotherapy, with ultrasound-guided needle aspiration available for refractory acute cases.
- SLAP lesion and labral tears — tears of the superior labrum or shoulder socket rim — produce pain, clicking and instability particularly in overhead athletes and following dislocation.
- Shoulder bursitis — inflammation of the subacromial bursa — is frequently associated with rotator cuff pathology and responds to load management, manual therapy and targeted strengthening.
- Post-surgical shoulder conditions — following rotator cuff repair, labral repair, AC joint reconstruction, SLAP repair or subacromial decompression — require structured post-surgical rehabilitation that respects the specific healing timelines and precautions of each procedure.
Referred pain from the cervical spine — cervical radiculopathy from C5 nerve root compression and cervical facet joint syndrome at C3-4 and C4-5 both refer pain into the shoulder region. A shoulder that doesn't respond to standard local treatment should always prompt assessment of the cervical spine.
How is shoulder pain diagnosed?
A physiotherapy assessment evaluates the likely pain source through specific provocation and stability tests, strength and movement assessment, and functional analysis. Ultrasound is the most accessible and informative imaging for rotator cuff pathology, bursitis and calcific tendinitis. MRI provides more comprehensive information for labral pathology and complex presentations.
How can physiotherapy help?
The rehabilitation approach is specific to the diagnosis. Rotator cuff and scapular muscle retraining is central to most shoulder presentations — the lower trapezius, serratus anterior and rotator cuff external rotators are the primary targets. Thoracic mobility and posture work addresses the postural contributors to subacromial compression and scapular dyskinesis. Manual therapy improves glenohumeral and acromioclavicular joint mobility and reduces pain through neurophysiological mechanisms.
Real time ultrasound assists in retraining deep rotator cuff activation where pain and inhibition have disrupted normal muscle recruitment. Clinical Pilates provides a controlled environment for progressive shoulder and scapular loading with precise progression. Dry needling assists with pain management and muscle guarding in the periscapular and rotator cuff region.
For patients whose shoulder condition arose from a workplace or motor vehicle injury, WorkCover and CTP funded physiotherapy is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have experience in shoulder conditions and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
