The shoulder is a highly mobile joint, which gives us the ability to move it through a large range of movement. This is very useful in many activities of daily living, especially those which require our arms to be raised above our head.

Because of its high level of mobility, the shoulder has heavy reliance on the muscles around the shoulder to act as dynamic stabilisers during movement of the arm. Dysfunction of the stabilising mechanics, either at the shoulder joint itself or around the shoulder blade, combined with or without abnormalities in the anatomical arrangement of the structures around the joint, or biomechanical faults make the shoulder particularly prone to pain and injury.

Common Causes of Pain and Dysfunction of the Shoulder

Shoulder pain can have various different causes; each will present with slightly different signs and symptoms and need to be differentiated if quick and effective recovery is to be made. Some of the conditions producing shoulder pain are:

• rotator cuff strains/tears
• rotator cuff tendinitis
• glenohumeral (shoulder joint) instability
• glenohumeral dislocation/subluxation
• acromioclavicular joint injury
• fractures of the clavicle (collar bone), or scapula (shoulder blade)
• adhesive capsulitis (frozen shoulder)
• biceps tendinitis
• referred pain from the cervical or thoracic spine
• referred pain from soft tissues
• nerve entrapments (eg suprascapular, long thoracic) or brachial plexus injury
• levator scapula syndrome

Instability and tendinitis are often implicated in shoulder impingement. Impingement occurs when the structures in the subacromial arch are squased because they themselves are swollen (as in tendinitis), or because the humerus is displaced superiorly, reducing the room in the subacromial space.

Diagnosis and Treatment of Shoulder Problems

Diagnosis of shoulder injuries involves obtaining a detailed history, assessment of movements, strength and muscle length around the shoulder and scapula, looking at biomechanics/technique/scapulo-humeral rhythm, and clearing the cervical and thoracic spine for any contribution. Investigations such as x-ray or ultrasound may sometimes be performed for confirmation, exclusion, or diagnostic purposes.

Treatment will depend on the diagnosis and clinical signs and symptoms.

Other sources of information related to shoulder pain.