The shoulder region is a complex but fascinating area of the body. Pain in the shoulder is also a common reason people come to clinic. It is made up of the upper arm bone (humerus) and socket which it sits in, known as the glenohumeral joint. It differs from other ball and socket joints in the body in that it has a shallow socket. This allows for a greater range of movement than most joints. The downside of this, is that it means it is less stable and therefore at a higher risk of dislocation.
As physiotherapists we also need to consider the shoulder blade (scapula) and collar bone (clavicle) and where they attach together known as the AC joint (see picture above). The AC joint is commonly injured when falling onto that point of the shoulder, so cyclists in particular are prone to injuries here. The shoulder blade is important as your rotator cuff muscles attach to it. There are four rotator cuff muscles; supraspinatus, infraspinatus, teres minor and subscapularis (you don’t need to remember the names, just remember they are important). Their main purpose is to stabilise the shoulder joint and keep the shoulder in a good position, so that movement is pain free.
If there is no trauma to the shoulder, then the most likely cause of pain in the shoulder is the rotator cuff tendons. Commonly patients will report pain with dressing or lifting their arm out to the side, which is known as a painful arc. This occurs because there is an imbalance in the rotator cuff muscles and therefore the ball doesn’t move smoothly in the socket. This often leads to a catching pain between 70 and 120 degrees.
The solution, based on research is to strengthen up the rotator cuff muscles. If you look at the picture below, you can see above the humerus bone are the supraspinatus tendon, subacromial bursa and the deltoid muscle. If the rotator muscles are weak the deltoid becomes dominant. This in turns pull the humerus upwards, closing the space where the tendon and bursa sit. When we lift our arm it compresses these structures and causes us pain. This is also why patients often report pain lying on their side, because they are also compressing the already irritated area.
If however the rotator cuff muscles are stronger, then the humerus will be not compress the tendon or bursa and we can move our shoulder pain free.
It is really important to ensure that exercises for your shoulder are pain free as pain tends to switch off the rotator cuff muscles and therefore makes the shoulder more vulnerable.
So if you are struggling with shoulder pain, then see a physiotherapist, because we can guide you to which exercises, in combination with local treatments to the shoulder, are best to help your shoulder pain settle down.
If you would like to book a consultation then either call 01276 37670 or click the button below to book online. Alternatiely if you would like to have a free telephone consultation with one of our Physiotherapists click here
Warm regards
Jonathan Smith
Director of Thorpes Physiotherapy Ltd