02 September 2020

Shoulder and Elbow Pain

Shoulder and Elbow Pain

There are too many things that can cause pain in the shoulder and elbow to list here! If you’re suffering but don’t relate to anything here, get in contact to see how we can help you.

Bones and joints of the shoulder and elbow

Rotator cuff tear or strain

The rotator cuff is a collection of four muscles around the shoulder that control rotation. They can be injured in sports or other trauma such as falls.

Common signs of a rotator cuff injury include:

  • Pain and weakness on rotation of the shoulder
  • Tender points around the shoulder blade

Major tears are best managed with surgery, but most can heal with relatively conservative management. It is important not to excessively immobilise the shoulder as it tries to heal: muscles heal more effectively when they have to move as it helps their fibres knit back together in an effective way. Prolonged immobilisation during this phase encourages more fibrous scar tissue to build up, which may make the risk of re-injury more likely.

Immobilisation is also linked with an increased risk of developing frozen shoulder.

Osteoarthritis of the shoulder

The ball and socket joint of the shoulder, like most joints in the body, is not immune to osteoarthritis. However, that’s not to say nothing can be done about it.

Arthritis may be more likely to develop in joints that are either over- or underused. The cartilage in the joint becomes uncomfortable or unhealthy and as a result you lose movement. When your movement is limited, it gets harder for nutrients to enter the cartilage and for waste products to be flushed away. This all means that returning movement to the joint improves health long term.

It is difficult to start moving properly again when you’re in pain, and your osteopath can help you here. During treatment sessions we can ease off the muscles that are trying to protect the joint, and work through shoulder movement to remind the brain that the movement is safe. Between treatments, we can build on the improvement already made by giving you simple exercises designed to push the limits with minimal pain.

AC (shoulder) sprain

The joint at the outer edge of the collarbone is the acromioclavicular (AC) joint. It is not a very big joint but it can still be sprained. This is almost always as a result of trauma, such as a car accident or a fall. It’s not the same as a shoulder dislocation which affects the ball and socket joint.

There are two major ligaments at this joint, and in a mild sprain, only one will be injured. However the symptoms might be felt generally around the shoulder and into the neck. Often the true cause of the pain is further disguised by muscle spasms around the area.

For minor sprains, osteopathy can help to speed up recovery and reduce pain in the area in treatment and in advice. But if you have a traumatic shoulder injury that has caused significant visual change to the shoulder, you should seek urgent care.

Thoracic Outlet Syndrome

The nerves that run through the arm have to pass through a small opening at the front of the shoulder, and sometimes they get compressed on their way. This opening is known as the thoracic outlet, and if compression causes symptoms it is known as Thoracic Outlet Syndrome (TOS).

Thoracic Outlet Syndrome: a condition of the shoulder area causing symptoms in the arm.

One common cause of this compression is tightness through the pectoral muscles of the chest. They can become tight in response to prolonged hunching, for example being stuck at a desk all day. Prevention is better than cure, so keep moving throughout the day.

This chest tightness often goes hand in hand with mild weakness through the upper back. Strengthening these muscles around the shoulder blades can help act against the hunched desk position and make it harder for the muscles to compress the contents of the thoracic outlet.

Rehab after shoulder surgery

After shoulder surgery you should be offered rehabilitation or advised to seek your own. Although the hospital may say you need physio, osteopaths can provide rehab too!

Some consultants provide guidelines for when they expect certain movements to be incorporated into everyday life, but even with a guide this can be hard to follow on your own. Even the best intentions can be hindered if you’re not sure how much pain is allowed.

Your osteopath can work hands on to calm down any muscles that may be reacting to trauma or other changes, and work through shoulder movements as appropriate. Exercises are an important part of rehabilitation after surgery, and your osteopath is able to prescribe and monitor these. As your shoulder heals, the exercises will become stronger and cover a larger range.

Neglecting rehab increases likelihood of developing frozen shoulder so make sure you rehabilitate properly.

Olecranon bursitis

This mouthful is also known as “student’s elbow”. Bursitis is inflammation of a bursa, which is a fat pad that sits between bones and soft tissue to reduce friction. Bursae are all over the body, including around the elbow. The olecranon is the point of the elbow, and the olecranon bursa sits on top of it.

Repeated irritation of the bursa causes it to become inflamed. An example of this irritation, as the name “student’s elbow” suggests, is prolonged leaning on the elbow.

It often looks worse than it feels, with pain generally not being a major symptom. However, the tip of the elbow can become visibly swollen, and maybe warm and red. Movement may be reduced or there may just be some general stiffness.

Your osteopath may want to work around the whole arm to take any unnecessary pressure off the elbow. They may also give you advice for managing bursitis at home.


The medical name for tennis elbow is lateral epicondylitis, referring to the inflammation at the point where the muscles join the elbow. The similar condition, golfer’s elbow, is known as medial epicondylitis.

Medial and lateral epicondylitis (tennis and golfers elbow)

In both of these, the muscles that act on the wrist are irritated and eventually cause a problem further up the arm. Often the cause of this irritation is overuse or repetitive injury. This may or may not be related to sport, and can often be nipped in the bud at this point. Stretching before and after activities that strain the forearm is always a good idea.

If you develop epicondylitis, you might notice increased tenderness around the elbow, along with some heat, redness, or swelling. Movements that ask for strength from these muscles will become more uncomfortable and eventually you might notice some stiffness on elbow movement. Your osteopath can give advice and treatment to help you get back to normal.

Elbow sprain

The most commonly sprained ligament of the elbow is on the inner edge of the joint. A single trauma or repetitive strain on the elbow can cause a sprain. Commonly this trauma may be a fall onto an outstretched hand, or one that over-extends the elbow.

As with any sprain, it is important not to over rest. Doing so will not help the ligament fibres to heal well. Your osteopath can work through the joint during treatment sessions to stress the ligament in a productive way, and provide you with graded exercises as you heal to further strengthen the area. In the early stages they may advise you to rest and work on calming down the whole area.

At Ilminster Osteopathy we specialise in treating disorders of the neck, shoulder, and arm. Book your appointment today.

Learn more

At Ilminster Osteopathy my goal is to help people achieve their goals whatever they may be. Watch our video to find out more.