What’s causing your shoulder pain? [2022]

Shoulder pain diagnosis

If you have shoulder pain and have had a scan its not uncommon to find you have been given the diagnosis of one of the following conditions:

  • Rotator cuff tear
  • Calcification
  • Bursitis
  • Frozen shoulder or capsulitis

In this blog we will take a look at what these common diagnosis are and what this really means for you and your recovery.

Rotator cuff tears

These are very common finding on imaging and can be divided into partial thickness tears  or full thickness tears. The good news is that you can have a tear and no pain.  The most common tendon in the cuff to tear is the supraspinatus tendon.

The rotator cuff is a group of 4 muscles that surround the shoulder and are important in the control and stabilisation of the joint. The muscles are:

  • Supraspinatus
  • Infraspinatus
  • Teres Minor
  • Subscapularis.

Rotator cuff tears  are divided into full thickness and partial thickness tears and  generally respond very well to exercise based rehabilitation.

We go into more depth about rotator cuff tears here


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Shoulder calcification and the rotator cuff tendon.

These are small focal areas in the tendon that are probably the tendon just trying to repair itself… badly! They are a fairly common finding on imaging and generally are a result of underlying impairments in the cuff.

The deposits reduce the space between the acromion and the rotator cuff leading to impingement (pinching of the tendons). Calcific tendonitis most commonly affects people over the age of 40.

There are two different types of calcific tendonitis of the shoulder: degenerative calcification and reactive calcification.


Degenerative Calcification

As part of the aging process, blood flow to the tendons of the rotator cuff decreases this weakens the tendon and affects the healing process . Instead of collagen being laid down to repair the tendon calcium is  deposited in the  tendons as a part of the healing process.

Reactive calcification

Why it occurs is not clear. It does not seem to be related to degeneration, though it is more likely to cause shoulder pain than degenerative calcification. Doctors think of reactive calcification in four stages.

  • Pre-calcific stage:  the tendon repair process is disrupted resulting in calcium deposits more likely to form  rather than collagen .
  • Calcific stage:  the calcium crystals are deposited into the tendon.
  • Resting phase : the calcium deposits become encapsulated in fibrocartilage shell.
  • Resorptive  stage :The deposits become more like toothpaste  and begin to be absorbed by the body and disappear.

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Shoulder bursitis.

The bursa is a fluid filled sac in the shoulder that helps your joint move freely. When the bursa gets inflamed it’s called bursitis and creates pain, some would argue considerable pain.

The good news is that  all these shoulder conditions share a common feature that is critical in their recovery. That means there’s a long-lasting solution that doesn’t require surgery or injections as well.

But what does your shoulder pain diagnosis mean for you ?

Its best and most useful to simplify shoulder pain into 3 categories rather than looking at a specific structure that is to blame. It is very rare that we are able to pinpoint one exact cause of shoulder pain due to it being such a mobile joint, so we tend to focus on the limitations:

  • Painful and weak shoulders : this is the most common group and related to the rotator cuff and associated structures.
  • Painful and stiff shoulders: often referred to as  frozen shoulders
  • Painful and unstable shoulders: often after dislocations/subluxations

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Rotator cuff tears,  bursitis and calcifications

These disorders generally fall into the PAINFUL AND WEAK  category. This results in the shoulder having the following issues;

  • Poor or altered movements that irritate the structures around the cuff including the bursa or tendon.
  • Lack of strength endurance in the cuff that affects the ability to perform repetitive movements or tolerate repetitive work.

So the best approach to take ,and the one that has shown results equal or better than surgery in some cases, is a progressive exercise program that;

  1. Improves the quality of movement of the shoulder, make it a smooth operator so to speak.
  2. Increase the strength of not only the rotator cuff but also the muscles at the shoulder blade, elbow and grip.
  3. Strengthen up the specific movement patterns that you struggle with.
  4. Calcification in the rotator cuff has been shown to respond well to shockwave therapy to break down he deposits.

Now you have a better understanding of what your shoulder pain diagnosis means , we will take a look at some of the exercises and strategies we use in treating this condition in this blog.

If you need help with a painful shoulder you can book into see one of the team here.

Thanks for reading


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