Shoulder pain is the third most commonly reported musculoskeletal condition in adults in the UK. 70% of people will experience at least one episode of shoulder pain in their lifetime.
The glenohumeral joint (shoulder joint) is a ball and socket joint consisting of the glenoid which arises from the scapula (shoulder blade) and the head of the humerus (upper arm bone). The end of the clavicle (collarbone), a bony protuberance called the acromion and the top of the scapula form the acromioclavicular joint. The ends of these bones which articulate to form the joints are covered in hyaline cartilage which creates a smooth, low friction surface to allow the bones to move over one another. The nature of the glenohumeral joint allows for a large range of movement into multiple different directions.
Stability to the joint is enhanced by a fibrocartilage ring called the labrum, a capsule and surrounding ligaments, whilst a synovial membrane lubricates the joint, keeping it moving smoothly. Further stability is provided by the muscles, most significantly the rotator cuff group.
Rotator Cuff Tendinopathy
Tendinopathies of the rotator cuff often occur due to overload or degenerative changes. Overloading occurs when an unusual activity is carried out that the muscles and/or tendons have not been conditioned for, leading to acute irritation and micro trauma of the tendon resulting in pain and inflammation. Joint degeneration can occur over time causing the tendons to become less resilient. Gradual micro trauma often related to a particular injury or activity can lead to a gradual onset of pain and loss of function.
Impingement occurs when soft tissue, most commonly the supraspinatus tendon or the bursa (fluid filled sac to reduce friction) is pinched during movement of the shoulder. This can result from poor posture leading to a muscular imbalance. There can also be anatomical causes, where structures become irritated and inflamed which further reduces space and can worsen symptoms if not treated.
Adhesive Capsulitis (Frozen Shoulder)
Adhesive capsulitis occurs when the joint capsule becomes thickened and shrinks around the joint. The cause is unclear but risk factors include being over 40 years old, female, undergoing recent surgery or injury and being diabetic.
This condition passes through 3 stages over the duration of up to 2 years:
- Freezing: painful stage with a gradual loss in range of movement (particularly abduction and rotation), pain often affects sleep.
- Frozen: pain tends to reduce a little but marked stiffness and loss of function remains.
- Thawing: movement and function gradually return.
Osteoarthritis can occur at both the glenohumeral and acromioclavicular joints. This is an age related processes which leads to the thinning of the hyaline cartilage, synovial changes and bony irregularities. Symptoms include pain, stiffness and loss of function which in turn leads to weakness and tightening of the surrounding musculature. Pain will often come on gradually and be felt as a deep ache, with morning stiffness and clicking/grinding sensations.
We have discussed some of the most common shoulder complaints but this blog is not exhaustive and there are many other conditions. Our physiotherapists can carry out clinical assessments and formulate treatment plans to incorporate hands on treatment as well as exercise therapy to address issues such as posture, stiffness, tightness and muscular weakness in order to promote healing of the damaged structures causing pain. If you are suffering from should pain and would like to see one of our specialists, book here today.