Understanding the shoulder joint
The shoulder is one of the most complex parts of the body. It is made up of four joints with overlapping layers of ligaments, tendons and muscles. Over half of the muscles that control the shoulder are also attached to the spine at multiple levels.
The four joints are:
- Glenohumeral joint – this is the main ball and socket joint of the shoulder. This socket is very shallow making the joint unstable by nature.
- Acromioclavicular joint – this is a small but important joint found at the end of your collar bone, connecting the collar bone to the shoulder blade. It helps suspend the shoulder on the thorax and enables tilting of the shoulder blade through arm movements.
- Sterno-clavicular joint – This is the small where the breast bone meets the collar bone.
- Scapulo-thoracic joint – This is where the shoulder blade meets the ribcage at the back.
What causes shoulder pain
As one of the most mobile parts of the body, the shoulder is susceptible to multiple injuries. In extreme cases such as contact sports or a bad fall, the joint is susceptible to dislocation or fracture. More commonly, the shoulder muscles and tendons are prone to getting painful particularly if the main joints become stiff or unstable due to weakness. The most common group of tendons to become irritated are attached to the rotator cuff muscles. The four rotator cuff muscles live above and below the shoulder blade and are important for both stability and mobility of the shoulder. The muscles around the shoulder are also prone to getting tense and painful owing to the way we under-use them.
Diagnosis of your shoulder pain
With a good understanding of the cause and structure involved in your shoulder pain, you can then get the right treatment and management plan for your condition.
Shoulder pain can be diagnosed by taking a thorough history of your recent activity and lifestyle, a review of your medical history, and a thorough physical examination.
Imaging can sometimes be useful to rule out any structural damage following injury or serious pathology. It can also be useful if your symptoms are not responding to conservative management. Examples of imaging are Ultra-sound, x-ray or MRI.
How to manage your shoulder pain
If you have acutely hurt your shoulder or it has suddenly become painful, sometimes short-term relief is needed such as pain medication, topical non-steroidal gels, ice or heat treatment or modification of your activity levels. If the pain persists, then seeking input from a Physiotherapist is advised.
How can Physiotherapy help shoulder pain?
A Physiotherapist will take a detailed case history to understand the cause and contributing factors to your Shoulder pain.
Often the physio will assess your back to ensure it is not involved in your shoulder pain picture. A passive assessment of the shoulder joints combined with a movement screen to identify any biomechanical factors contributing to your symptoms. This may involve a combination of simple shoulder movements or looking at the functional tasks you are struggling with, i.e. dressing.
The Physiotherapist will then explain what they see and advise on the diagnosis and factors contributing to your pain picture.
Depending on your presentation and expectations of the appointment, the Physiotherapist will advise on any relevant short-term relief options such as optimising pain relief medication, manual therapy techniques i.e. soft tissue release, joint mobilisations or taping. These hands-on techniques provide short-term relief and can sometimes help to dampen down the secondary responses to pain such as muscle tightness.
The Physio will also suggest self-management advice i.e. how to modify your activities, simple movement strategies, or an exercise program to address any movement deficits. In some cases, the Physiotherapist may feel onward referral is necessary i.e. back to GP or a specialist. This will always be a shared decision-making process and often there is a lot you can be doing in the meantime.
