In today’s blog post we are going to be taking a deep dive into shoulder pain.
First before we can diagnose what is going on within our shoulder we need to understand the structures of which our shoulder is made up of. The shoulder actually consists of four different joints they are named the glenohumeral joint (the ball and socket of the shoulder), the acromioclavicular joint (pointy part of the shoulder), the sternoclavicular joint (where the collar bone meets the sternum) and the scapulothoracic joint which is a floating joint between the shoulder blade and the ribs in your upper back.
All of these joints form something called the shoulder girdle which means the shoulder is an incredibly complex joint.
The shoulder is similar to the hip in that it is a ball and socket joint however unlike the hip the glenohumeral joint prioritises movement over stability hence why the socket is not as deep compared to its counterpart in the hip. This means the shoulder girdle has a lot more muscles crossing it in order to provide stability.
With the amount of muscles which help to move the shoulder in conjunction with the lack of bony and ligament structures surrounding it compared to the hip, the shoulder is an easily injured and a very commonly injured area of the body.
The shoulder is unique in the fact that it has a structure called the rotator cuff which helps to provide active stability meaning it holds the ball of the humerus in the socket of the shoulder joint using muscle contraction in conjunction with ligaments also.
The Rotator Cuff
The rotator cuff is a group of four muscles which originate from the shoulder blade and attack in the humerus. It’s role is to provide stability and help with the mobility of the ball and socket of the socket.
The rotator cuff muscles are called supraspinatus, infraspinatus, subscapularis and teres minor.
The all help with stability in the shoulder. They all with exception of subscapularis help with external rotation of the shoulder and abduction.
Ligaments
Here is a picture of the ligaments of the shoulder, they attach from bone to bone and help with stability in the shoulder along with the rotator cuff.
Common Injuries
There are a lot of common injuries that anyone can have with shoulder pain. These are in no particular order. We can have:
Tendonitis: where the tendons in the shoulder are overloaded and are unable to tolerate what is being asked of them giving stiffness and pain.
Muscle tears/strains: where the muscle is overloaded instead of the tendon and there is a small tear, or a big one. This can cause mild pain to major pain and this depends on what the injury severity is.
Dislocations: due to the lack of bony surface in the ball and socket of the shoulder it is relatively easy to dislocate. This is a common injury from falling onto the shoulder or having it overstretched into positions it does not like. This needs to be firstly treated by an appropriate professional in order to get the shoulder back into the joint and then rehabilitated by physios.
Bursitis: due to the number of muscles within the shoulder there is a need for bursa which are fluid filled sacs which help to reduce friction within the shoulder. Sometimes these can become inflamed and cause pain.
Frozen Shoulder: this is often characterised as the reduction in movement in the shoulder often coming with severe pain and stiffness. There is no full consensus as to why this happens but physiotherapy is rated as the best way of helping with the pain and lack of movement in the shoulder.
Fractures: This is fairly straight forward a fracture is usually caused by trauma, either falling onto the shoulder or having it overstretched into positions it should not be in. This is often rehabilitated by physios and is a common injury to the shoulder.
There are many more types of injury to the shoulder however these are the most common ones.
Rehabilitation Considerations
There are many things which a physiotherapist has to consider when it comes to rehabbing shoulder pain. We first need to consider where the pain is and what your symptoms are in order to establish whether or not the shoulder is the joint affected and it is not coming from nerve pain on the neck or other internal organs which can refer pain to the shoulder such as the heart and the gall bladder.
We need to consider the movement of the neck, the upper back, the shoulder girdle itself as well.
We need to consider the strength around these areas as well as any weaknesses will determine which direction we take when it comes to rehabbing the shoulder.
We need to test the different structures of the shoulder to see what the cause of the pain is and with knowing where the muscle weaknesses are we can find the root cause of the pain.
At All Out Physiotherapy we under go extensive training and keep up to date with the latest evidence base in order to properly rehabilitate the shoulder. With finding the true cause using the All Out Method and rehabilitation using the same methods we can treat the whole body to fix your shoulder aches, pains and injuries.
If you would like to book in and see how we can help you with your shoulder then here is the link to book in below.
https://my.powerdiary.com/clientportal/takecontrolofyourhealth
Or alternatively you can call or email us as well to discuss what the best way forward for your shoulder is.
We at All Out Physiotherapy want to help you take control of your health.
