Shoulder Pain

Anatomy of the shoulder

The shoulder is designed to allow large movements in all directions (ball and socket joint), this is great functionally as we can manipulate objects with our hands in lots of various positions. Unfortunately there is a strong correlation between large range of motion and instability, as such it is important to understand what mechanisms provide stability to the shoulder.

There are a number of structures used to stabilise the shoulder:

• Glenoid Labrum: Deepens the surface area the humeral head sits in.
• Shoulder capsule: Holds the shoulder in place
• Ligaments: restricts end of range movements
• Scapular: A direct barrier to prevent movement
• Muscles: create and prevent movement at the shoulder.

Shoulder pain from trauma

Following a collision or fall it is very common to sustain a shoulder injury. Any of the above structures can be damaged depending on the direction of force. Depending on how your injury presents will determine whether a scan in necessary and surgical intervention is needed. As the shoulder has a large range of movement available the brain will restrict movement to structures that are damaged to prevent pain and aid healing. However other structures will move excessively and create abnormal movement patterns. After the original structure has healed secondary problems will result if correct movement patterns aren't restored to normal.

Shoulder pain referred from the neck

The most common type of shoulder pain is commonly received from the neck region. Nerves exiting the neck (Cervical Spine) provide sensory and motor innovation to the shoulder, the muscles attached from the neck to the shoulder can also tighten causing secondary issues,  therefore any dysfunction in the neck will effect the shoulder in one way or another. Neck mobility or stability issues need to addressed to fix 95% of shoulder issues.

Poor shoulder biomechanics

Optimal shoulder mechanics involve smooth rhythmic control between the arm (Humerus) and shoulder blade (Scapulae). Muscles around the shoulder and neck contract and relax in correct sequence to ensure the Humerus doesn't impinge on the Scapulae. Any imbalance will result in compensatory or abnormal movements that will eventually lead to pain. This condition is very common in gym goers, especially those who focus on bench press and other related chest exercises.

Postural related pain

For those who find themselves sitting at a desk all day and have a slouched (flexed) posture will most likely find they have postural related pain. If you are finding that you are unable to stand up straight (lacking thoracic extension) you will find this places huge stress on the shoulders. This is exacerbated   when attempting to do anything at or above shoulder height. Office workers that attend boxing classes are a classic example of this.

Miscellaneous

• Frozen shoulder (Adhesive capsulitis): synovial folds stick together limiting movement in all directions, (insidious onset).
• Polymyalgia Rheumatica: inflammatory condition effecting multiple joints
• Osteoarthritis: degenerative bone condition
• Thoracic Outlet Syndrome: Condition where the nerves travelling between the collar bone and first rib get compressed.