What is typically called the shoulder is in fact several joints that combine with tendons and muscles to allow a wide range of motion in the arm. This mobility, however, comes with a cost. Whereas the hip is a very secure stable ball and socket joint with a decent amount of range of movement (unless you train for flexibility like dance, gymnastics or martial arts), the shoulder has compromised stability in order to achieve its function which is range of motion. This increased range of motion leads to problems with stability or pinching of soft tissue structures which can result in pain. This pain may be experienced only with movement or it can be all the time. It may be temporary or it may persist and thus require medical diagnosis and some form of treatment.
The shoulder is actually held onto the the body by one joint. This is the one at the end of your collar bone, near your throat. It is called the sternoclavicular joint. The rest of the structure is held together on by 25 muscles as well as ligaments but within in this are other joints. At the other end of the collar bone is the acromioclavicular joint where the collar bone attaches to the shoulder blade (scapula). Below this joint is a very shallow rounded ‘socket’ to which the top of the arm (head of the humerus) is attached via ligaments and 4 muscles collectively known as the rotator cuff.
The shoulder blade is attached to the body via muscles on the front and back of the chest and the its movement is known as the scapulothoracic rhythm.
Shoulder pain can come from a number of different causes:
Trauma (a fall with to without a break for example)
Repetitive strain
Neck problems
Degenerative changes (osteoarthritis)
Inflammation (of tendons and bursa)
Frozen Shoulder (Adhesive Capsulitis)
Inflammatory Arthritis and other systemic causes
Post surgery restricted range of movement
The osteopathic approach to shoulder pain is first to establish a detailed history of the onset and subsequent course of the problem. This guides the practitioner towards the likely structures involved.
Because the shoulder is so reliant on good quality muscular strength and coordination, if muscles become weak or tired through over use, the movement at the various joints can change and this may lead to pain. An assessment of the shoulder movements by the osteopath will help to ascertain if and where these have been compromised. The thing about the shoulder is that the pain felt may not be the area where the actual issue has occurred; thesis called referred pain.
Trauma can cause local inflammation and muscle-guarding and thus there may be two sources to the discomfort.
Degenerative changes cause an alteration in the range and quality of movement which may lead to soft tissue structures being pinched or irritated in other ways.
Neck problems can cause nerve related issues which will change the ability of the shoulder to move correctly, again cause soft tissue disruption.
Rounded shoulders alter the position of the arm in the socket and the shoulder blade on the rib cage. This change in position means that normal movement of the shoulder is altered leading to overuse of certain muscles and irritation of other soft tissue structures.
Frozen Shoulder is a condition where the capsule that envelopes the joint between the top of the arm and the shoulder blade becomes inflamed and part of this capsule sticks together (hence the medical name adhesive capsulitis). This can last up to 2 years as a condition but work can be done in the early phase which may help to maintain some range of movement. Medical intervention is a possibility where a saline solution is injected into the capsule to separate the stuck surfaces but a GP needs to be consulted for this to happen.
Systemic causes can include rheumatoid arthritis, septic arthritis, referral from the liver and cancer. The presenting condition is usually abnormal enough for the osteopath to recognise that this needs an immediate referral.
The treatment approach to shoulder pain by an osteopath is management of the tight musculature and a retraining of the movements in the shoulder as no movement for a period of time, particularly after dislocation of surgery can leave the joint very stiff and the muscles underused and thus weakened. There are also various techniques to mobilise the joints of the shoulder complex to help restore and retrain normal active movements. In addition treatment would also be directed to the upper back and neck as these areas are also influential in optimal functioning of the shoulder complex.