Active Seniors

How long do injuries take to heal? Part 4; Shoulder injuries

Shoulder pain is extremely common. It is estimated that up to 70% of people will experience at least one episode of shoulder pain throughout their lifespan. In this article we consider the typical time frame to recover from an acute onset of pain, factors that influence and prolong this recovery time and we finish by discussing frozen shoulder.

The exact cause of shoulder pain can be difficult to diagnose. The patterns of pain are often not consistent among different causes which can lead to variations in presentation for the same issue. The area underneath the tip of the shoulder blade, called the subacromial space, is a common area to experience pain. This area houses one of the rotator cuff tendons, the bicep tendon and also a fluid filled sac called a bursa which reduces friction between the bones and these rope like tendons.

An acute onset of pain around the top of the shoulder area, or radiating down the “badge position” of the upper arm, due to irritation in this subacromial space will usually resolve within 12 weeks provided there is an appropriate rehabilitation strategy. This strategy involves a gradual loading program to improve the strength and coordination of muscles in the area. As with most injuries, finding the balance between enough load and avoiding aggravating the area with too much load or inappropriate load can be a difficult balance to achieve. Where this is challenging, the recovery time frame will be extended.

In some situations, the shoulder becomes grumbly over time with fluctuations in pain and repeated episodes of pain over a longer course of time. In these situations where the pain has persisted for some time, the recovery time frame can be doubled to 24 weeks. This is also the case if the shoulder pain occurs alongside neck pain or where there is a history of neck problems. If the pain has been present for over a year, and there are Xray or MRI results indicating that the structures of the shoulder have undergone degenerative changes, this time frame extends out again to 6 months before symptoms substantially improve or resolve.

So why can shoulders take so much time to settle? The shoulder has a very large amount of movement and is a complex of the combined movement of four different joints. This movement is created and supported by the coordinated effort of many muscles around the local area and around the neck. In situations where there is an imbalance in these muscles, there can be abnormal stress on certain structures. Retraining this balance and finding the “sweet” spot where loading strengthens irritated structures and doesn’t cause further aggravation takes perseverance and can require some trial and error. A thorough assessment can reveal if the shoulder needs a slight reduction in load, if certain muscles need activating during movement and if the focus should be predominantly on the rotator cuff muscles or on the muscles that move the shoulder blade.

A unique shoulder condition that responds very differently to what is described above is frozen shoulder. This condition is challenging to diagnose as it can present similarly to other shoulder problems in the early stages. One of the major differences is that as well as pain, there is a progressive stiffness of the shoulder – especially in rotation. Reaching behind the back to un-do a bra or to brush hair becomes more difficult due to this stiffness. Unfortunately there are still many unknown questions around what causes frozen shoulder and who is more susceptible to experiencing it.

What is known however is the gradual time frame for recovery which is typically around the 18 month mark. This follows a pattern of 3 distinct phases. During the first phase, the shoulder is painful and becomes progressively stiff. During the second phase, the shoulder pain reduces substantially but the stiffness reaches its peak – often limiting movement at or above shoulder height. In the final phase, the shoulder gradually regains its mobility.

When managing frozen shoulder, there is no great gain from forced stretching and painful mobilization of the shoulder. The main goal of exercise is to comfortably retain the strength of as many shoulder muscles as possible. With an extended recovery time compared to the other conditions, stopping exercise altogether would cause significant weakness of the muscles around the shoulder, potentially lengthening out the recovery time and increasing the risk of future injury.

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