Painful shoulder?

A problem in the shoulder

Many patients will attend the clinic with shoulder pain as their main presentation. A number of problems can occur in the shoulder as it is a complex joint that we can put a lot of stress on.

Having ruled out the pain the patient has as definitely coming from the shoulder, and not referred from anywhere else such as the neck, we start to examine the different tissues and discover the source of the pain. 

 

 

As you can see from the picture there is a lot going on in the shoulder joint!

 

A very common problem is damage to part of your rotator cuff mechanism and that's what we will concentrate on in this blog.

 

Because the shoulder is such a mobile joint we have the normal supporting structures such as the ligaments and bony structure but there is a special set of muscles called the rotator cuff.  This cuff is made from four muscles that form a cuff around the shoulder joint therefore increasing its stability. 

 

Damage to these muscles can occur suddenly through an injury such as forcing your arm out to the side for example slipping on the stairs whilst holding onto the banisters. More often through these muscles become damaged slowly over time as part of the natural degenerative process.  Because the muscle on the top of the shoulder blade, the supraspinatus, has quite a poor blood supply this process tends to affect this muscle more so.  See the below image.

 

 

 

 

Treatment can help depending on the severity of the damage.  Often night pain is common and patients describe a throbbing pain that keeps them awake.

 

A lot of the rehabilitation with shoulder problems comes down to the same word again...posture!

 

If these muscles are under stress because of something you do then the damage will not get better.  Often sleeping position can be the culprit where people place their hands under the pillow or over the head.  

 

Rehabilitation often consists of graded exercises to strengthen the muscle to allow return to function once again.