The painful shoulder

The anatomy

The shoulder is not simply a ball and socket joint. It is the site where the upper limb attaches to the skeleton via its direct connections to the shoulder blade and collarbone. It is a complicated region comprised of multiple joints including the glenohumeral (ball and socket), acromioclavicular “AC” and the sternoclavicular joints. These joints are stabilised by many ligaments and muscles including the rotator cuff, other stabilising muscles and their attaching tendons. The shoulder is also the site where veins, arteries, nerves, lymphatic vessels and glands are located, which are vital to the function of the whole arm.

Shoulder treatment

Injuries to the shoulder

The shoulder is a highly mobile joint – with optimal function of the glenohumeral joint at 180 degrees rotation in three different planes. While its great to have a lot of movement, this also makes it more vulnerable to injury than other, more stable joints. Common injuries to the shoulder include:

Rotator cuff strain

This is a muscle tear/s to the main dynamic stabilising muscles including supraspinatus, infraspinatus, teres minor, and subscapularis. This can occur following a single violent blow to the shoulder, a FOOSH injury (fall on outstretched hand), from lifting or pulling, following prolonged or repetitive actions like overhand throwing, or from pre-existing impingement syndrome.

Tendinopathy

Inflammation of the muscle tendons can result from similar causes as rotator cuff strains. Ongoing tendinopathies can be a chronic source of pain and lead to degeneration of the muscle’s tendon.

Labral tear

A tear of the glenoid labrum is a tear of the fibrous connective tissue within the glenohumeral joint. Characterised by pain with overhead or cross body activities, this injury can often occur in conjunction with other shoulder injuries.

Shoulder instability

The causes of shoulder instability are vast including traumatic dislocation or labral tear, congenital or acquired ligament laxity, muscle imbalances or joint malformation.

Frozen shoulder

Also called adhesive capsulitis, this condition is characterised by marked reduction in shoulder range of motion. It is often difficult to diagnose until later in its progression.

AC joint sprain

There are 6 grades of severity for this injury resulting in shoulder separation. Contact sports, motor vehicle accidents and falls are often responsible for this injury and result in a visibly lowered shoulder and may require immediate surgical referral.

Referred pain

Pain can be referred to the shoulder from a number of areas. Spinal facet sprains from the neck or upper back can refer to the shoulder. Similarly, disc herniation can cause compression onto the nerve roots that descend toward the arm. Pathology of the heart commonly refers to the left shoulder as in a heart attack or angina. While digestive complaints such as gall bladder pathology can refer to the right shoulder.

Many other postural influences may affect the biomechanics of the shoulder, predisposing the soft tissues to some of the injuries listed earlier.

How your osteopath can help

It is important to see your osteopath for diagnosis of your shoulder pain. A session with an osteopath will include taking a thorough history and examination before arriving at a diagnosis. The formation of an action plan will follow and include the determination of further investigation and conservative manual treatment.

***

Jess Round

This post was written by Dr Jessica Davies.

You can find out more about Jess here or book an appointment with her here.

Alternatively, you can call the clinic on 9908 2844.

 

References

  • Brukner, P., Bahr, Blair, Cook, Crossley, McConnell, McCory, Noakes, Khan. (Eds.). (2012). Brukner & Khan’s Clinical Sports Medicine (4th). NSW, Australia, McGraw-Hill Education (Australia) Pty Ltd.
  • Carnes, M., Vizniak, N. A. (2012). Quick reference evidence-based conditions manual (3rd). Canada, Professional Health Systems Inc.
  • Murtagh, J., Rosenblatt, J. (2015). John Murtagh’s General Practice (6th). NSW, Australia, McGraw-Hill Education (Australia) Pty Ltd.