Explaining shoulder pain

Shoulder Conditions

Author: Luke Langley

Injuries to the shoulder are common and represent a high percentage of patients presenting to physiotherapy practices. An understanding of the anatomy of the shoulder is important in identifying the cause of symptoms and providing specific rehabilitation to allow a successful outcome.

Given that the shoulder relies highly on muscular support, many shoulder conditions will see a complete resolution with exercise-based rehabilitation and manual therapy.

In terms of anatomy of the shoulder, the head of the humerus (top of your arm bone) sits within the glenoid fossa (a socket within your shoulder blade). The positioning of the head of the humerus is important and errors in this position are the basis for many shoulder conditions. The two main factors influencing the head of the humerus are shoulder blade position and rotator cuff strength. If the shoulder blade is too forward (protracted) or too tilted (downwardly rotated) the humeral head may sit forward and rub on structures in the shoulder causing irritation with movement. The rotator cuff is a group of muscles which connect to the head of the humerus and help hold it in position. Injury or weakness in the rotator cuff can cause poor humeral head position. Physiotherapists can identify errors in shoulder blade position and/or rotator cuff strength and provided specific exercises to correct this which will help with pain and function.

Some patients are born with larger shoulder sockets causing increased movement of the shoulder. The technical term for this is multidirectional instability. The best management for these patients is targeted rehabilitation to strengthen the muscular support around the shoulder.

In some cases, heavy trauma to the shoulder such as a fall or sudden knock to the shoulder while playing sport can cause tears to the rotator cuff or injuries to the cartilage rim surrounding the shoulder. While many of these injuries can be successfully rehabilitated with physiotherapy, if a large traumatic rotator cuff tear occurs in a young patient, this may be best managed with surgery. Similarly, complicated tears to the cartilage rim (labrum) may also require surgery. Physiotherapists are highly trained in identifying large traumatic or labral tears and can refer to medical professionals for imaging and referral for surgical opinions.

Over the course of life, errors in shoulder mechanics or working overhead jobs such a painter, plasterer or professional swimmer can cause osteoarthritis of the shoulder joint. As muscles act as shock absorbers to help support the joint, specific exercise based rehabilitation can be very helpful in decreasing pain and improving function of the shoulder joint in patients with osteoarthritis.

Most of the time, pain in the shoulder is caused by structures in the shoulder. However, referral from the neck, or occasionally the middle of the back can also cause strong pain into the shoulder. In some patients the neck and structures in the shoulder are both causing pain. In these cases additional treatment of the neck can help resolve shoulder pain.

In summary, many shoulder conditions can see a complete resolution with exercise based rehabilitation. Consultation with your physiotherapist will provide you with an assessment of what is causing the pain, what to do about it including specific rehabilitation exercises and manual techniques. They may also recommend a short break of a few weeks from aggravating activities and in some cases of heavy trauma, appropriate referral to the medical system for imaging or a surgical opinion.