The Shoulder Joint

During March and April, we will be looking at the shoulder joint. For those of you who have recently wondered, ‘where that click in your shoulder’ or ‘pain when reaching for something in the cupboard’ has come from, these are the months you want to stay tuned in for.

What does the shoulder consist of?

The shoulder joint is a highly mobile ball-and-socket synovial joint. The shoulder girdle consists of the upper arm (humerus) which articulates with the collarbone (clavicle) and the shoulder blade (scapula) to form the ‘glenohumeral joint’ or as we commonly know it as ‘the shoulder joint’.
The shoulder joint is supported by a number of structures, these include the rotator cuff muscles (Supraspinatus, Infraspinatus, Teres Minor and Subscapularis), that stabilise the joint capsule, ligaments, and tendons. A small number of fluid-filled sacs known as bursae surround the capsule and aid in mobility in multiple directions.

Causes of shoulder pain:

Recent studies have shown that 18-26% of adults are affected by shoulder pain at sometime during their life. Symptoms are usually persistent and disabling with regards to an individual’s ability to complete their activities of daily living.
There are a number of reasons why the shoulder joint is prone to injury. The high range of motion of the shoulder comes at the expense of decreased stability of the joint, making it prone to dislocation and injury. The shoulder is also supported by a high number of soft tissue structures which are prone to injury. These structures can become impinged between bones or can be strained during sudden forceful movements of the shoulder joint.
A number of studies have found that overhead athletes in sports like cricket and javelin as well as contact sports are major risk factors for shoulder problems. Certain occupations are also risk factors for shoulder injuries, for example people who work overhead for long hours.

Common shoulder injuries and treatment:

Rotator Cuff Injuries

Majority of shoulder pain injuries stem from rotator cuff tears, which can arise due to trauma, overuse, or age-related degeneration. These tears may manifest as either asymptomatic or with significant pain and reduced range of motion. Risk factors for rotator cuff tears include smoking, elevated cholesterol levels, and a family history of such injuries.
Rotator cuff tendonitis or impingement typically manifests as pain during overhead activities, often resulting from the compression of the supraspinatus tendon by the acromion, leading to inflammation in the surrounding tendon and bursae.
Symptoms to look out for are persistent pain, particularly during specific activities, discomfort that hinders sleeping on the affected side, audible grating or cracking sensations during arm movements, restricted range of motion in the arm and muscle weakness.

Shoulder Dislocations

The price of being the most mobile joint in the body is that the shoulder joint lacks stability and is subject to dislocation.
Dislocations in the front of the shoulder are the most common as they make up 97% of all dislocations. The typical cause is a blow to the arm when it is out to the side, and externally rotated (outward). This type of dislocation may result in nerve damage, causing paralysis of some shoulder muscles and decreased sensation over the shoulder, as well as ligament tears and fractures.
Dislocations at the back of the shoulder are less frequent however there is more risk of rotator cuff and ligament tears with these dislocations.
General symptoms may include swelling, limited joint mobility and feeling of the shoulder slipping in and out of its socket.

Frozen Shoulder

Adhesive capsulitis, commonly known as frozen shoulder, affects approximately 2 to 5% of the population, predominantly females aged 55 and over. Although many shoulder diseases involve pain and loss of motion, frozen shoulder is most often caused by inflammation (swelling, pain and irritation) of the tissues surrounding the joint, resulting in restricted range of motion across all planes.
The condition is more prevalent among individuals with diabetes or those who have kept their arm immobilized for an extended duration. Symptoms may develop gradually and typically subside within one to two years. Rehabilitation includes stretching exercises and strengthening the joint and structures around it.
Symptoms of frozen shoulder typically include shoulder pain without any notable trauma, along with a gradual decrease in shoulder joint mobility, making tasks like showering and dressing progressively more challenging.

Treatment

Treatment of shoulder injuries can be conservative, with most cases resolving through exercise intervention to restore strength, range of motion and stability deficits. These deficits are restored within pain limits of the injury. Surgical intervention is reserved for more severe cases and involves complex procedures performed by surgical specialists.
Biokineticists are exercise specialists who can provide you with the latest research based conservative rehabilitation protocols to treat your shoulder problem, not only do we treat the injury, but we strive to provide rehabilitation tailored to your individual needs, as not one person is the same as another.
For more information with regards to exercises keep an eye on our various social media platforms and visit a biokineticist for their professional opinion.
References:
Miniato, M.A., Anand, P. & Varacallo, M. (2023). Anatomy, Shoulder and Upper Limb, Shoulder. National Library of Medicine.
Maruvada, S., Madrazo-Ibarra, A. & Varacallo, M. (2023). Anatomy, Rotator Cuff. National Library of Medicine.
Linaker, C.H., Walker Bone, K. (2015). Shoulder Disorders and Occupation. National Library of Medicine. 29(3), 405-423
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