|
Shoulder pain is very common, making up 14% of the injuries I see.
The shoulder is a complex joint. There are articulations between three bones:
The main shoulder joint is a ball-and-socket where the arm attaches to the shoulder blade. The arm moves on the shoulder blade, as well as the shoulder blade moving on your back. The shoulder blade is attached to the collarbone, which connects to the sternum (breast bone), so it’s essentially the collarbone that connects your arm to your body. The bones are held together by ligaments. |
Your hip is also a ball-and-socket joint. At the hip joint, the ball is deep in the socket, which means it’s nice and stable – it’s not easy to dislocate a hip – but it sacrifices mobility for the sake of stability. Whereas the socket at the shoulder is very shallow, which allows a lot of movement – we can get our hands essentially anywhere in space – subsequently sacrificing stability. It’s much easier to dislocate the shoulder compared to the hip.
The deltoid muscle is the big main muscle that moves the shoulder. "Delta" in the Greek alphabet is a triangle, and a well developed deltoid muscle looks a bit like an upside-down triangle. The deltoid muscle is the main big muscle that does a “shoulder press” and a “lateral raise”. Underneath the deltoid are a few smaller muscles that form a “sleeve” or “cuff” for the upper arm. They do the rotation movements, so are called “rotator cuff” muscles.
More importantly, the rotator cuff muscles wrap around the ball-and-socket joint to help stabilise it. The rotator cuff muscles contract and relax, constantly adjusting as we move our arms, to keep the ball centered in the socket. The shoulder relies on this “dynamic” stability of the rotator cuff muscles, more than the “passive” stability of the depth of the socket like the hip.
So it’s a complicated joint with lots of moving parts that need to work in synchrony.
When we examine a painful shoulder there are lots of special tests to examine specific structures.
Common traumatic shoulder injuries:
Gradual onset shoulder pain:
Shoulder pain is generally aggravated with use. Dressing, reaching, driving, carrying, overhead, and hand-behind-back positions are painful. Shoulders can be painful to lie on. Lateral shoulder pain often radiates down the arm. Shoulder pain is often described as “sharp” and “pinching” or “dull” and “aching”.
An accurate diagnosis is essential. Thorough assessment identifies measurable deficits that we can work on with treatment. This may include stretching to restore normal range of movement, exercise to restore normal strength, and postural control for normal patterns of movement and control.
Shoulder pain can be relieved reasonably quickly with hands-on treatment, massage, heat, ice, taping, medication, or postural correction.
Have you had a shoulder injury? What was your experience?...
The deltoid muscle is the big main muscle that moves the shoulder. "Delta" in the Greek alphabet is a triangle, and a well developed deltoid muscle looks a bit like an upside-down triangle. The deltoid muscle is the main big muscle that does a “shoulder press” and a “lateral raise”. Underneath the deltoid are a few smaller muscles that form a “sleeve” or “cuff” for the upper arm. They do the rotation movements, so are called “rotator cuff” muscles.
More importantly, the rotator cuff muscles wrap around the ball-and-socket joint to help stabilise it. The rotator cuff muscles contract and relax, constantly adjusting as we move our arms, to keep the ball centered in the socket. The shoulder relies on this “dynamic” stability of the rotator cuff muscles, more than the “passive” stability of the depth of the socket like the hip.
So it’s a complicated joint with lots of moving parts that need to work in synchrony.
When we examine a painful shoulder there are lots of special tests to examine specific structures.
- Joints
- Ligaments
- Muscles
- Tendons
- Nerves
- Posture
- Control
- Stability
Common traumatic shoulder injuries:
- AC joint sprain (acromio-clavicular joint)
- SC joint sprain (sterno-clavicular joint)
- Shoulder subluxation / dislocation (gleno-humeral joint)
- Muscle strain injury
- Muscle contusion (cork)
- Fractures
- Rotator cuff tears
Gradual onset shoulder pain:
- Rotator cuff irritation
- Bursa
- Pinching / impingement
- Postural issues
Shoulder pain is generally aggravated with use. Dressing, reaching, driving, carrying, overhead, and hand-behind-back positions are painful. Shoulders can be painful to lie on. Lateral shoulder pain often radiates down the arm. Shoulder pain is often described as “sharp” and “pinching” or “dull” and “aching”.
An accurate diagnosis is essential. Thorough assessment identifies measurable deficits that we can work on with treatment. This may include stretching to restore normal range of movement, exercise to restore normal strength, and postural control for normal patterns of movement and control.
Shoulder pain can be relieved reasonably quickly with hands-on treatment, massage, heat, ice, taping, medication, or postural correction.
Have you had a shoulder injury? What was your experience?...
