Shoulder Pain

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An AC joint separation or AC joint sprain is an injury to the ligament that holds the acromioclavicular joint together at the top of the shoulder. It is usually caused by fall onto an outstretched arm.

AC joint sprains range from very mild (grade 1) to a severe (grade 6) injury. Early treatment and support through taping is important to avoid long term problems or shoulder deformity.


The most common way of injuring the AC joint is by landing on the shoulder, elbow, or onto an outstretched hand. When you fall and automatically places your hand out to break the fall. The forces are then transmitted up the wrist and arm to the shoulder joint.

Signs & Symptoms

Symptoms of include pain right at the end of the collar bone on the top of the shoulder. The pain may be widespread throughout the shoulder initially but later on more localized to a bony point on the top of the shoulder.

Pain will be worse when trying to move the arm overhead and there is often swelling and depending on the extent of the injury a deformity may be seen in the form of an obvious lump on top of the shoulder joint. Acromioclavicular joint separations are graded one to six with grade one being mild with only minor ligament damage and no separation of the bones whilst grade 6 is a severe injury with complete ruptures of the ligaments and visible deformity.



Frozen shoulder is a condition that leads to pain and stiffness of the shoulder. It’s also known as adhesive capsulitis or shoulder contracture.


Frozen shoulder occurs when the sleeve that surrounds the shoulder joint, known as the capsule, becomes swollen and thickened. It’s unclear why this happens. The shoulder is a ball and socket joint. The end of your upper arm bone (humerus) sits in contact with the socket of your shoulder blade (scapula). The shoulder capsule is fully stretched when you raise your arm above your head, and hangs down as a small pouch when your arm is lowered. In frozen shoulder, bands of scar tissue form inside the shoulder capsule, causing it to thicken, swell and tighten. This means there’s less space for your upper arm bone in the joint, which limits movements.

Frozen shoulder can sometimes develop alongside other shoulder conditions, such as:

  • calcific tendonitis – where small amounts of calcium are deposited in the tendons of the shoulder
  • rotator cuff tear – the rotator cuff is a group of muscles that control shoulder movements

Signs & Symptoms

Pain and persistent stiffness in the shoulder joint are the two main symptoms of a frozen shoulder. This makes it painful and difficult to carry out the full range of normal shoulder movements. You may find it difficult to perform everyday tasks, such as:

  • bathing
  • dressing
  • driving
  • sleeping comfortably

Symptoms vary from mild, with little difference to daily activities, to severe, where it may not be possible to move your shoulder at all.



A rotator cuff strain is a tear to any of the four rotator cuff muscles in the shoulder and is common in throwing and racket sports. They are so called because their job is to rotate the arm at the shoulder and provide a supportive cuff around the joint. Rotator cuff tears can range from mild to severe.

Treatment consists of reducing pain and inflammation followed by a full rehabilitation program consisting of mobility, strengthening and sports specific exercises.


A rotator cuff tear is usually caused by over stretching or a rapid twisting of the joint. There are four rotator cuff muscles in the shoulder which work together to provide the joint with dynamic stability, helping to control it as it rotates. Because the shoulder joint has a large range of motion and often needs to move at very high speeds such as in throwing sports there is a higher risk of injury to the muscles or tendons (which join muscle to bone).

Signs & Symptoms

Torn rotator cuff symptoms will consist of sudden pain in the shoulder sometimes accompanied by a tearing feeling. Symptoms may radiate down into the arm. The patient will often be unable to sleep on the injured shoulder and there may be signs of shoulder impingement where the tendon pinches between the ball and socket of the shoulder joint when moving the arm out over head height.



Shoulder impingement syndrome, which is sometimes called swimmer’s shoulder or thrower’s shoulder, is caused by the tendons of the rotator cuff muscles becoming impinged as they pass through a narrow bony space called the subacromial space. The subacromial space is so called because it is under the arch of the acromion. With repetitive pinching, the tendons become irritated and inflamed.


It is thought shoulder impingement syndrome begins as an over use injury of the supraspinatus tendon which runs along the top of the shoulder blade. Pain then causes dysfunction of the rotator cuff muscles which causes the upper arm bone to shift slightly and possibly also result in inflammation of the bursa or small sack of fluid (subacromial bursitis).

Over time the pain causes more dysfunction and impingement in a vicious circle which may eventually lead to bony spurs growing and causing injury to the rotator cuff tendons and so on. So it is vitally important that impingement syndrome is rested and treated as soon as possible to avoid longer term damage.

Signs & Symptoms

Symptoms of shoulder impingement syndrome include pain on the top / outside of the shoulder as well as raising the arm up out to the side and above the head.

in particular pain when moving the arm out to the side at a 60 degree arc. Pain in the shoulder can be coming from a number of structures and to help determine the cause of pain, a therapist will perform an assessment.



Tendons are the tough fibers that connect muscle to bone. For example, the Achilles tendon connects the calf muscle to the heel bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

Doctors may use different terms to describe a tendon injury. You may hear:

  • Tendinitis. This means “inflammation of the tendon.”
  • Tendinosis. This refers to tiny tears in the tissue in and around the tendon caused by overuse.

Most experts now use the term tendinopathy to include both inflammation and microtears. But for many years most tendon problems were called “tendinitis.” Many doctors still use this familiar word to describe a tendon injury.


Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury. But people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.

Signs & Symptoms

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.