The Shoulder & What It Is All About - Intro to 5 part series by Cameron Allshorn

To round out 2018 I will be uploading a 5 part series based around the common shoulder presentation we see as Osteopaths.

Speaking broadly, pain in the shoulder is a common presentation within clinical life; this can range from intermittent and diffuse nagging pain to outright debilitating pain and varying degrees of functional restriction. It is a complex and often multifaceted presentation. 

The complexity of the shoulder comes from the anatomical structure it forms. It is - in my opinion - the most fascinating structures of the human body. At its heart is the ball-in-socket glenohumeral joint (GH), the formation of a ball-in-socket joint between the humeral head and the glenoid fossa of the scapular. Beyond this we must also consider the Acromioclavicular joint (AC) as well as the distal extensions of these joints - The sternoclavicular (SC) and the elbow.

Due to the level of mobility required through the shoulder the GH requires a level of flexibility not seen in other ball-in-socket joints of the human body. This mobility requirement means that a lot of the structural support falls on the ligaments of the region (fig1.2). Injury to these ligaments can lead to a loss of function and mobility but also cause hypermobility of the GH leading to persistent reoccurrence of shoulder pain and an increased risk of dislocation.

An important point to remember is not every dysfunctional shoulder will cause pain. A 2011 study into shoulder pain noted that prevalence of asymptomatic full thickness rotator cuff tears was doubled after age 50 (1) while asymptomatic (meaning non pain producing) AC joint arthritis was apparent in 93% of x-ray images for people over 30 (1). That is to say that shoulder dysfunction and pain are not synonymous nor is it a lifelong sentence.

There is much to consider in relation to the shoulder that gives us the mobility we require, this also incorporates the lower back and elbow. At a muscular level the rotator cuff is a critical driver of shoulder function. More detail on this in part 1 when we take a look at how a rotator cuff injury can impact your ability to have an awesome high five.   

Function of the shoulder muscles is controlled via nerve structures exiting from the spinal cord at the neck (cervical region). This forms a complex web that is known as the brachial plexus, which we will touch on in more detail in parts 2 & 3. Injury or restriction to the neck or shoulder can impact the brachial plexus and present as shoulder pain but also contribute to neck, elbow, wrist and hand pain.

As Osteopaths, we tend to see shoulder presentations two to six months into their presenting history. This can align with the nature of a shoulder complaint in that they are often developed over a period of time through a repetitive action (throwing, writing or lifting for example) or from a habitual postural consideration (sleeping position, poor desk/workplace set up etc).

Shoulder pain is not picky and anyone has the potential to unknowingly fall into its path. However we do know that certain conditions have distinct precursors the increase your risks of developing shoulder pain. These include poor posture, previous history of injury (dislocation, tears or fractures), overuse or repetitive use. Early treatment and management of a shoulder presentation can quickly stop the progression and get you feeling great again. 

Osteopathic treatment may vary between patients and between presentations however following thorough assessment of the shoulder and the surrounding region osteopathic treatment will aim to restore any lost mobility and function with the shoulder using mobilisation, articulation and muscle energy techniques. Treatment may also include joint manipulation of the shoulder, cervical and or the thoracic region should your osteopathic assessment deem that it is necessary. To compliment treatment your osteopath may provide you with some exercises to complete between consultations to assist with recovery.

Keep an eye out for Part 1 of our shoulder series next week!

Works Cited

Cadogan A, Coates M, Hing W, Laslett M, McNair P. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskeletal Disorders. 2011 May; 12(119).

Moore K, Dalley A, Agur A. Clinically Oriented Anatomy. 6th ed.: Lippincott Williams & Wilkins; 2010.