Pain in the upper arm when raising the arm, physical therapy: Focus Fizikal✓

The shoulder joint (glenohumeral joint) is the most mobile joint in the human body, but due to this high mobility, it is naturally less stable. The main role in its active stabilization and movement is played by the rotator cuff—a group of four muscles and their tendons (m. supraspinatus, m. infraspinatus, m. teres minor, and m. subscapularis). Above these tendons lies the bony roof of the shoulder (the acromion), and between them is a protective bursa that reduces friction. When the arm is raised, the space beneath the acromion narrows. If the tendons are inflamed or thickened, painful impingement occurs, and the pain, following nerve pathways, is referred down the upper arm, often reaching the elbow.

At the Focus Physical Therapy Center, we approach upper arm pain during arm elevation through a detailed biomechanical and functional assessment of the shoulder girdle. A very common misconception among patients is that the problem is located in the upper arm muscles themselves (deltoid or biceps), which is why inappropriate treatment of the arm alone often does not produce results. Our primary goal is to use specific clinical provocation tests (such as the Neer and Hawkins-Kennedy tests) to precisely determine which rotator cuff tendon is affected and whether bursitis is present, in order to design an effective and safe treatment protocol.

Proper rehabilitation of this syndrome at our center focuses on restoring the subacromial space and normal shoulder biomechanics. Through individualized programs at the Focus Physical Therapy Center, we successfully combine modern physical therapy modalities that deeply reduce inflammation with specialized manual techniques. Our ultimate goal is to eliminate the so-called “painful arc” (pain occurring between 60 and 120 degrees of arm elevation), recenter the head of the humerus within the joint socket, and restore full, pain-free arm function.

Treatment and physical therapy of the shoulder and upper arm require patience and a combination of different methods, as symptoms do not resolve overnight. The first step in therapy is the temporary avoidance of activities that provoke sharp pain, namely, movements involving lifting the arm above shoulder level and carrying heavy loads. During the acute phase, accompanied by severe, radiating pain, cryotherapy (ice application) to the front and outer part of the shoulder is recommended several times a day for 10–15 minutes to reduce inflammation, along with strict avoidance of sleeping on the affected arm.

At the Focus Physical Therapy Center, treatment of this painful syndrome is carried out through strictly individualized protocols designed to safely eliminate inflammation and permanently restore the biomechanics of the entire shoulder girdle:

• Functional diagnostics and range of motion assessment: Detailed evaluation of passive and active shoulder mobility, strength testing of individual rotator cuff muscles, and palpation of tendon insertions prior to starting therapy.
• TECAR therapy for the shoulder: Application of high-efficiency radiofrequency energy. TECAR therapy deeply heats the internal structures of the shoulder joint, increases local circulation, immediately relaxes painful secondary muscle spasm, and stimulates the resorption of inflammatory edema.
• HILT laser therapy (High-Intensity Laser Therapy): Penetrates deeply through the deltoid muscle directly into the subacromial space and affected tendons. It has a strong anti-inflammatory effect, rapidly reduces pain and swelling, and stimulates fast cellular regeneration of tendon tissue.
• Electrotherapy (IFS, TENS, diadynamic currents): Application of targeted electrical currents that block pain transmission to the brain, have a muscle-relaxing effect, and locally reduce inflammation in the soft tissues of the shoulder and upper arm.
• Manual therapy and joint mobilization: Specific manual techniques in which the physiotherapist performs gentle traction and mobilization of the glenohumeral joint and scapula. This mechanically increases the subacromial space and releases pressure on the compressed tendon.
• Kinesiotherapy and corrective exercises: A key phase of recovery that begins with safe pendulum (relaxation) exercises and progressively advances to specific eccentric strengthening exercises for the rotator cuff and scapular stabilizers (m. serratus anterior, m. trapezius).
• Kinesiology taping of the shoulder and upper arm: Application of special elastic tapes that gently lift the skin, reduce pressure on the subacromial bursa, support the supraspinatus muscle, and maintain proper shoulder positioning between therapy sessions.

The combination of these advanced modalities and expert manual therapy at the Focus Physical Therapy Center ensures rapid pain relief, eliminates shoulder impingement during arm elevation, and restores full freedom of movement, strength, and the ability to perform all daily and sports activities without limitation.