What’s mechanical shoulder pain?

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Have you ever felt shoulder pain that is hard to pin down – sometimes it feels sore and stiff and other times seems to move much more easily? Or you notice the pain can change locations? You may be experiencing mechanical shoulder pain.

It’s actually a common cause of shoulder pain and makes up about 30-40% of all ‘non-traumatic’ shoulder complaints. The word ‘mechanical’ refers to the fact that movement directly influences the symptoms and function of the shoulder. There’s no structural damage but the symptoms are related to the joint being ‘stuck’ or not moving properly.

Characteristics

Here’s some things you should know about mechanical shoulder pain:

  • It’s associated with a rapid recovery – you shoulder get better quickly and have no lasting deficits – nothing is damaged in the shoulder.
  • Movement is often restricted in one of more directions (eg. you feel stiff or blocked when lifting you arm above head or behind your back)
  • Symptoms are usually variable (you have good and bad days – or an activity that’s sore to do one day isn’t the next)
  • Certain specific movements will make the shoulder feel much better (moving your shoulder in one direction results in less pain and better movement – sometimes moving it in the opposite direction can stiffen it up and increase the symptoms.)

Diagnosis

Diagnosing mechanical shoulder pain involves a few steps (within a physio assessment)

  1. Rule out serious causes of shoulder pain (this can be done accurately through the physio assessment)
  2. Establish some baselines (these are things that are restricted or painful to do)
  3. Test the neck to rule out referred pain presentations (this involves simple movements of the neck to test for effects on the shoulder symptoms and baselines in step 2)
  4. Repeated movement testing exam (this involves repeatedly moving the shoulder in a variety of directions to assess the effect on shoulder symptoms and baselines)

Mechanical shoulder pain will respond with a pattern to repeated movement testing exam. Specific movements when done repeatedly (for example repeatedly stretching your arm behind your back) will result in a rapid change in pain and function. And other movements may cause the opposite to occur (rapidly stiffen the shoulder up or increase the symptoms). These changes are reversible and generally follow a clear pattern.

Treatment

Treatment primarily involves exercises that focus on moving the shoulder in the direction that improves symptoms and function. This can involve as little as one exercise to completely restore the shoulder function but sometimes requires a few different directions to get complete resolution.

The good thing about managing this presentation is that you can typically control the the symptoms independently with movement alone. The trick is working out the right movement for your presentation – they don’t all behave the same way.

Maintenance and prevention of recurrence is achieved through ensuring full resolution of the shoulder motion and strength (usually some simple movements you can use ongoing to check and maintain your shoulder function).

Winston Hills Physio | McKenzie Method | Physiotherapy

Tim Cathers

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