I thought I would focus todays blog on shoulder pain. I had a patient this week who has been experiencing shoulder discomfort rather than actual pain. The shoulder felt unstable and like it would pop out when loaded with activities such as throwing. I examined the shoulder and the joint itself was normal. There was a normal range of movement and no trauma that could have caused any acute damage. So what could be causing the discomfort and instability???
The Glenohumeral Joint or ‘shoulder joint’ is a ball and socket joint but unlike the hip the socket isn’t well formed or very deep. This allows for a greater range of movement but means it isn’t quite as tough as the hip joint. The joint is made up from articulations between the humerus, scapula and clavicle.
Connective tissue, ligaments and muscles keep the head of the humerus held firmly within the joint. For the shoulder joint to function well, the movement of the scapula is paramount. The scapula moves to allow for the head of the humerus to remain centered within the socket. If the scapula doesn’t move well then the head of the humerus can cause compression to the soft tissue within the joint space. This can lead to pain within the joint.
The rotator cuff muscles are a set of muscles that work together to maintain the head of the humerus within the joint and their tendons attach into the shoulder joint and the soft tissue that support the joint.
The tendon of the biceps also pass into the shoulder joint and are susceptible to compression if the mechanics of the shoulder aren’t quite right.
Patients often present in clinic with pain inside the shoulder joint, they may be slightly round shouldered, have desk jobs or exercise a lot with their anterior shoulder muscles. It may be repetition that is a cause, so hours spent trimming a hedge or digging. There is often a noticeable difference when you observe the movement of the shoulder blades (scapula) and the symptomatic side may be further round the rib cage or pop out slightly as the arm is lowered from above the head.
The term ‘frozen shoulder’ is often used by GPs but Adhesive Capsulitis (to give it its posh name) is very rare (only about 3% of the population get it). The main cause for shoulder problems is a simple imbalance in the muscles that support and move the shoulder. History taking and a full assessment will highlight these imbalances so you can then work on a rehab programme to address the patients specific needs.
When I first assess a patient suffering with shoulder pain I spend some time educating them about the shoulder joint and how it moves. I will nearly always get them to think about their posture for the next week as poor posture can lead to rounding of the shoulders. Often the first few exercises I give a patient are very simple and I like to check to make sure they can perform them adequately before progressing the exercises to include weights.
If you are experiencing pain in the shoulder my top tips are
1- stop doing exercises that aggravate the symptoms
2- lay down and perform range of movement exercises by taking your arm up and over your head; you may need to use the other arm to assist if pain is an issue. You can also take your arm out to the side and make and angel movement with it.
3- take plenty of regular breaks from your desk
4- regularly perform shoulder shrugs – lift you shoulders up and let them drop down, shoulder blade squeezes – squeeze the bottom of your shoulder blades together and hold for 3 secs
5- come and get it checked- I often see shoulder patients just for reassurance and guidance. Once they understand what is causing their pain its generally up to them to make the changes with some guidance from me.
If you are experiencing shoulder pain and would like some more advice on useful exercise you can do at home please take a look on my FB page for further details
The patient I saw this week with shoulder instability ultimately has too much movement in his shoulder so we have set out a programme to build some strength and stiffness into the rotator cuff muscles and the shoulder blade stabilisers. I’ll keep you posted as to progress