Shoulder pain and restrictive movement behind lower back

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Pain and restriction when attempting to place your hand behind your lower back may indicate a partial tear to the Subscapularis tendon of the shoulder.

Pain and restriction when attempting to place your hand behind your lower back may indicate a partial tear to the Subscapularis tendon of the shoulder.

The Subscapularis tendon is one of four Rotator Cuff muscles that stabilise and move the shoulder joint.

It is located on the front of the shoulder at head of the humeral bone or upper arm bone. It is responsible for stabilsing the front of the shoulder joint and for allowing the arm to be placed behind the lower back. In addition it also assists in the movement of the arm across the body such as when sweeping a floor or dusting down a work-top.

The Subscapularis tendon can be torn when the arm is forcibly pushed into external rotation or when the arm is suddenly forced backwards. However it is more often torn when elevating the arm overhead causes the humerous bone (upper arm bone) to rub against the overlying coracoid bone. Overhead work such as painting or using a clothes line can bring about this wearing of the subscapularis tendon leading to partial tearing overtime.

Indeed Subscapularis tears are common in tennis players and racquet sports that require overhead swinging.

Signs and symptoms:

- Achy pain at the front of shoulder

- Pain and restriction when attempting to move your hand behind your back such as when tucking a shirt in the back of your trousers

- Tenderness felt on the front tip of the Shoulder when direct pressure is applied

- Pain is aggravated also when bringing forearm towards your midline against resistance such as when cleaning a worktop with a cloth or when swinging a hurley or racquet at hip level

- Feeling of a lack of power in the arm and shoulder

- Affects older and younger patients

Management and treatment:

- When treating patients with a tear to subscapular tendon it is important to diagnose the level of tear that is present in the tendon. This is identified through the severity of the patient’s symptoms. A high grade tear may be referred to an orthopedic surgeon. With mild to moderate tears which are more common, it is important that the dysfunctional compression between the head of the humerus and the overlying coracoids bone is addressed through treating scapula dyskinesis that may be present.

- Overhead activity should be avoided for the initial weeks, followed by graded strengthening of the subscapularis tendon under the guidance of a Physical therapist.

Tomás Ryan is based in Clonmel & Thurles. Contact him on: 0504 26672 or email your queries to: info@tipp-phyiscaltherapy.ie