Crisis Plan Series
Acute shoulder pain
Acute shoulder pain could be very painful and debilitating. Pain is often felt locally at the shoulder joint area but could also very commonly radiate down to the upper and mid arm by the deltoid muscle insertion (attachment) area. If excluding the very likely cervical (neck) and thoracic (upper back) spine as the source (origin) of pain, the rotator cuff tendons (tendinitis) at the subacromial space (at the tip of the shoulder) are the most common sources of injury. It is common to have a painful arc in shoulder flexion (forward elevation) and abduction (sideward elevation) but all movements could be restricted to nil in very acute severe cases. The subacromial area is often swollen and tender especially anteriorly (in the front). The common causes are a sudden exertion of the shoulder, such as heavy lifting, or chronic (long-standing) impingement of the subacromial structures such as a habit of resting with the hands behind the head or repetitive activities involving the shoulder at or above 90 degrees such as swimmers and throwers. The patient must clearly understand the source and cause of the condition so as to promote recovery and prevent future aggravations. Other than the much required medications, the Crisis plan for such shoulder injury includes immediate rest from all painful activities and gentle mobilizations to increase the subacromial space to prevent further impingement. Patients with severe pain may feel more comfortable hunching over and holding the shoulder stiff, but this could only provide short-term relief. It actually causes further stiffening and pain. The patient should be advised to straighten up as much as possible. Gentle postural and mobility exercises touching the edge of the pain should be encouraged:
scapular retraction (shoulder blades backward movement) and rotation (rolling),
neck side-bending away from the painful shoulder,
Pendulum exercise (arm swinging) in possible directions,
Shoulder extension (backward stretch) if possible.
Ice may also help to reduce inflammation and muscle spasms and should be encouraged. I will continue the progressive treatment on the shoulder in my next newsletter.
scapular retraction (shoulder blades backward movement) and rotation (rolling),
neck side-bending away from the painful shoulder,
Pendulum exercise (arm swinging) in possible directions,
Shoulder extension (backward stretch) if possible.
Ice may also help to reduce inflammation and muscle spasms and should be encouraged. I will continue the progressive treatment on the shoulder in my next newsletter.
Luck LI
Musculoskeletal Physiotherapist
Musculoskeletal Physiotherapist