Shoulder pain and discomfort is prevalent within our community – and something we treat a lot at Sport & Spinal Physiotherapy in Gungahlin Canberra.
Research shows that:
- 1 in 3 people will experience shoulder pain at some stage in their life – with the incidence increasing with age
- 1-2% of the population attends the GP because of shoulder pain each year.
- The prevalence of work related upper limb disorders exceeded that of low back pain for the first time in the UK in 2011-2012.
However a problem within this is that a lot of shoulder pain is related to chronic underuse of the shoulder tendons, because physiologically the human body hasn’t changed a lot in the last 20,000 years, but human lifestyle definitely has.
We have evolved to manipulate objects within our visual field -ie between hip and shoulder height – however many of our everyday tasks take us outside of this range, and with underused, weak shoulder tendons this can become problematic.
So along with these ergonomic (working/lifestyle) considerations, it needs to be communicated to the wider community that with shoulders there is a poor correlation between structural failure (i.e. shoulder injury seen on MRI scan) and musculoskeletal symptoms (i.e. pain). Recent studies have shown that in a population of people without shoulder pain, 28% of those aged 40-60 showed some degree of structural failure, with this increasing to 54% in those aged greater than 60 years! These people had no discomfort!
Since the presence of structural failure does not match up with symptoms shown, shoulder pain can be hard to accurately diagnose.
So with so many people out there around with structural shoulder failure, but experiencing no pain or dysfunction, how should the medical world be treating those who present with shoulder pain, when we currently cannot accurately predict or tell what is causing the pain?!
Recent studies have tried to shed some light on this: one study showed that there was no significant difference in the outcomes between those that underwent surgery for a particular shoulder condition, and those that undertook structured physiotherapy instructed exercise. It concluded that the surgery was not cost-effective and that the structured exercise appeared to be the treatment of choice for this particular shoulder syndrome.
A further study completed this year also showed that surgery was not superior to exercise in the treatment of a different shoulder condition AND discussed that surgery definitely is more expensive and associated with more time off work, and that exercise costs less, has more generalized benefits, and has a lower risk of adverse events.
I recently attended a shoulder course in Newcastle where it was noted that the incidence of a certain type of shoulder surgery in the UK had increased 746% over a 10-year period from 2001 to 2010, and that another type of surgery went from 58000 performed procedures in 2006 to 272,148 procedures in 2006! At an estimate of $5000 per surgery, this accounts to approx. $136 million. Unfortunately this new research I discussed above showed that a lot of this money spent on surgery possibly could have been saved through the correct use of conservative treatment such as physiotherapy.
Although there definitely are instances where people presenting with shoulder pain should be referred directly to a surgeon or other medical specialist there is new research and evidence being published that shows that for a lot of common shoulder conditions where surgery has been promoted in the past, a structured program of physiotherapy – joint mobilisations and manual therapy and prescriptive exercises are in the long-term much more beneficial/ cost-worthy and has the same if not better outcomes as undergoing the dreaded surgical knife!
Parsons S et al. 2007. The influence of patients’ and primary care practitioners’ beliefs and expectations about chronic musculoskeletal pain on the process of care: a systematic review of qualitative studies. Clin J Pain, 23, 91-8.
Lewis et al. 2001. Subacromial impingement syndrome: Has evolution failed us? Physiotherapy, 87, 191-198.
Sher et al. 1995. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am, 77, 10-5.
Judge et al. 2014. Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England. JBJS, 96-B, 70-4.
Toliopoulous et al. 2014. Efficacy of surgery for RC tendinopathy: a systematic review. Clin Rheum, 33 (10), 1373-83.
Lewis J, 2014. The Shoulder: Theory and Practice (9th ed). (Newcastle course)