Shoulder Pain

When a person has an issue with their shoulder it's necessary to work out when and why the condition started. It's important examine the shoulder joint, scapula, neck and upper back. Look at the range of movement, where pain is experienced and check for any weakness.

Shoulder pain can arise from many of the muscles in the upper back and around the shoulder. The neck and thoracic spine are often involved in shoulder pain.


Anatomy.
A shoulder is made up of the shoulder blade (scapula), upper arm bone (humerus) and the Collar bone (clavicle). The actual shoulder joint is called the glenohumeral joint, this is a ball and socket joint. This joint normally has a great range of movement.

The shoulder joint relies on a group of muscles called the rotator cuff for stability, these muscles keep the ball centred in the socket.

The shoulder blade relies on various muscles for its stability and movement. These muscles run from the neck and thoracic spine on the back of the body and from the chest at the front. When the arm moves the shoulder blade also moves and helps stabilise the arms movements.

There are a number of conditions that affect the shoulder. The vast majority of these shoulder conditions are uncomplicated and respond quickly to treatment. The most recent research shows that the majority of shoulder conditions do not need surgery.


Neck and Upper Back.
Pain can be referred from the neck and upper back to the shoulder area. The nerves that supply the shoulder come from this area. Shoulder issues are frequently related to the neck. From the cervical spine the C5 and C6 nerves supply the motor and sensory components, and the T4 area in the upper back supplies the autonomic component. When these areas of the spine are causing problems the shoulder muscles will often be weak and painful.


Shoulder Dislocation.
After a shoulder dislocation the rotator cuff muscles often develop trigger points and an ache around the shoulder can persist for ages. Treating the rotator cuff muscle will often alleviate this condition.


Posture.
Bad posture frequently causes shoulder pain. Day in - Day out, looking down for prolonged periods at computers, tablets and mobile phones the muscles at the front of the body shorten and the muscles at the back of the body lengthen. The head is very heavy when not in a neutral position. Many muscles are used to support the weight of the head, and they will start to object when they are overloaded. The result is usually an imprecise, but nasty pain around the shoulder blade, upper back, neck, shoulder and arm.

Bursitis.
A bursa is like a small polythene bag filled with oil. A bursa allows tendons and muscles to move over each other almost frictionlessly. Occasionally, with overuse, a bursa may become irritated and inflamed. In the shoulder joint subacromial bursitis can occur with minor joint instability.

Tendonitis.
A tendon connects a muscle to a joint. Tendons are small, very tough chord like structures. With overuse, they can become frayed and inflamed. They can often be the source of ongoing shoulder pain.

Tendon Tears.
Tendon Tears can be result of trauma or severe overuse. A partial tear will cause pain with movement while a complete tear will cause pain and loss of movement. With a complete tear the tendon will separate from the bone. This will require surgery.

SLAP Lesions.
The Shoulder socket - glenoid - has a cartilage rim around it, which helps to locate the ball part of the joint. This cartilage rim can occasionally develop a tear, which occasionally is the cause of shoulder pain. There are no definitive tests for this injury and an MRI scan is required for diagnosis.

Arthritis.
The shoulder joint is rarely affected by arthritis.

Acromio-clavicular Joint.
The acromio-clavicular joint, the bony bit at the end of the collar bone, is often displaced in folk who play rugby or lift heavy weights. It is a painful injury and severe cases this joint may need surgery. It usually settles down on its own in time.