Shoulder Pain and Injury

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MORE ABOUT SHOULDER PAIN AND INJURIES

Shoulder Anatomy

The shoulder (glenohumeral joint) is a very shallow ball and socket joint.  This allows for greater mobility in the joint but because of this, the joint is very unstable.  To provide that stability, the joint is layered with muscles that help to secure it in place. It is the surrounding muscles that provide the joint stability so clearly lacking in the bony skeleton.  And as such, they are prone to injuries.

It is a complicated region comprised of multiple joints including the glenohumeral joint (mentioned above), the 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 Injuries

The shoulder is a highly mobile joint and allows for 180 degrees rotation in three different planes. While it’s 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 or tears to the main stabilising muscles that surround the shoulder.  These include supraspinatus, infraspinatus, teres minor, and subscapularis. Injuries can occur following a single violent blow to the shoulder, a fall, 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 tendon injuries 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 wrapping that helps gives stability to the very shallow joint.  Characterised by pain with overhead or cross body activities, this injury can often occur in conjunction with other shoulder injuries.

• 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 many ranges of shoulder movement. Almost every movement is limited and painful.

• 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 in severe cases.

• Referred Pain 

Pain can be referred to the shoulder from a number of areas. 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. Organs such as 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.  

Osteopathic treatment will aim at improving the function and movement of the shoulder and decrease any tension in the associated muscles.  We may use a combination of soft tissue massage, stretching, muscle energy techniques, joint mobilisation and possibly joint manipulation.

Your osteopath will also want to address any strain through the low back, pelvis and thorax which may be causing altered muscle tension in the shoulder or poor posture.

To complement the treatment, we may also provide some stretching and rehabilitative exercise as well as offer advice on how to improve your posture and lifestyle habits. 

At the end of the initial consultation we always provide a management plan that has your individual goals in mind, so we know where we are headed.  It details the diagnosis, timeframes that you can expect for recovery, how many appointments you will require and any exercises or stretches that may help.

We are also highly trained to detect if specialist referral is needed, for example if rheumatoid arthritis was suspected.  In this case, we may refer you to your GP for further investigations or other tests to help in management.