30 Nov Shoulder Clinical Perspective

The Shoulder

There are many causes and structures such as muscles, tendons, ligaments and joints that may be involved or in fact contributing to shoulder issues e.g. weakness, pain and immobility.  Therefore, for ease we are going to subcategorize these in to 6 areas but it must be considered that the large majority of shoulder pain for example is diffuse i.e. the exact location cannot even be identified by the sufferer.

1. Rotator Cuff Issues
2. Shoulder ‘Stiffness’
3. Referred Pain
4. Acromioclavicular Joint Pathology
5. Labral Injury
6. Shoulder Instability

1. Rotator Cuff

Injuries to the rotator cuff are easily differentiable into acute, chronic or acute on chronic. Acute injuries are usually muscle or tendon strains or partial or complete tears to the tissues. The structures can also suffer with ‘overuse’ injuries e.g., tendinopathies that may result from work, exercise or sport. An acute on chronic injury could be a tear of a previously degenerative tendon or muscle as well as an acute flare up of a long-term managed rotator cuff issue. Overhead activities are primarily limited here.

2. Stiffness

Shoulder stiffness or reduced range of motion (hypomobility) can be caused by many factors for example but not limited to trauma, surgery or damage to the cervical nerve roots. Adhesive capsulitis or ‘Frozen Shoulder’ is a term for a spontaneous occurring stiffness of the shoulder capsule but must be properly diagnosed and treated as it has become an over diagnosed balloon term for diffuse shoulder stiffness.

3. Referred Pain

Pain can refer to the shoulder from:

1. Cervical Spine
2. Upper Thoracic Spine
3. Associated Soft Tissues

Therefore, it is important to get a comprehensive subjective history, perform a thorough objective examination and listen intently to the person describe a complete injury history.

4. AC Joint Pathology

Pain coming from the AC joint and usually involves trauma and can involve the acromion, clavicle and ligament for obvious reasons.

5. Labral Injury

The glenoid labrum again can be termed acute or overuse.  Instability, which will follow, is often obvious in clinic and may be a recurring issue i.e. dislocation or subluxation.

6. Shoulder Instability

Pain from this may come from the superior, posterior or anterior labrum and capsule and scapular muscles. It is often associated with poor strength or motor control or trauma to active and passive structures such as the labrum, capsule or ligament.

Next up is Shoulder history and examination.