With all the structures of the shoulder so woven together and interconnected, it's often impossible to tell where the pain is coming from. Often, the only thing that's important is simple shoulder physiotherapy exercises to give the arm in the socket more room to move. These exercises aim to stretch tight structures, relieve chafing, allow the muscles to work at better angles and in a more synchronised manner. And as harmony resumes, shoulder pain subsides.
Shoulder pain is very common but isolating the exact structure inflamed is difficult - if not impossible. The orthopaedic world is littered with florid explanations to account for pain - bony spurs, rotator cuff tears, supraspinatus tendonitis, glenoid labrum injuries, slap lesions, bursitis and frozen shoulder. In reality, a bad neck is often the root cause of a shoulder problem through causing discord in the shoulder muscles. Neck problems can also refer pain to the shoulder.
Outgrowths of bone are common to all joints. They are Nature's response to degenerative change, with their purpose to stabilise the joint and reduce excessive movement. Bony spurs should never be removed simply because they are there. They are usually the reaction to the loss of cartilage covering the bony surfaces which introduces joint laxity. In effect, bony outgrowths - also called osteophytes or bony exostoses - safeguard the joint. Removal of bony spurs almost never reduces shoulder, or arm, pain.
Rotator Cuff Lesions
Almost everybody over the age 40 exhibits wear and tear of the shoulders. The most typical of these is fraying of the plait of muscles - the rotator cuff - that helps hold the ball into the socket of the joint. When there is deficiency in motor control of the arm - caused at its simplest by poor postural habits and at it's more complex, by neck problems affecting the nerve supply to the arm - the rotator cuff is abraded by the head of the humerus bumping up under the ledge of bone at the tip of the shoulder (acromium). Partial and full thickness tears are extremely common - but they contribute little to dysfunction and pain. The shoulder is really quite amazing how it copes so effortlessly with this common affliction; it is the main benefit of all the soft tissue structures being so intimately woven together.
The tendon on top of the shoulder with the job of holding the head of humerus down in the socket - so it doesn't ride up when the arm is lifted - belongs to the supraspinatus muscle. With excessive overhead work, or poor lifting techniques this tendon is directly impinged through its own inefficiency in keeping the humeral head down. The defining feature of this syndrome is a 'painful arc' when taking the arm out from the side, as the inflamed part of the tendon threads under the bony overhanging ledge of the shoulder.
Glenoid Labrum Injuries
Another consequence of a poorly stabilised shoulder is the bony trauma caused by the round humeral head of the upper arm knocking against the cartilage ring (glenoid labrum) attached to the rim of the shoulder socket (the glenoid fossa). The role of the bony ring is to make the socket deeper but if the muscles are weak and the arm poorly controlled the ring gets damaged. So-called 'slap' tears are more likely to have a traumatic origin, although neither condition is definitively helped by surgery. Again, the solution to the problem involves shoulder physiotherapy exercises to help stabilise the scapula, the mobile base of the arm, so that arm movement is better controlled.
Bursitis of The Shoulder
A bursa is a small sack of fluid. There are bursae throughout the skeleton in the areas of tight fit, where friction and rubbing would otherwise cause tendons to wear through and cartilage to erode. Bursae can also naturally evolve to counter friction, such as we used to see with 'board bumps' on surfboard riders' legs from kneeling on their boards, or housemaid's knee. Bursae are accustomed to friction and for this reason inflammation of a bursa (bursitis) is an extremely uncommon cause of pain. The same applies to shoulders.
This painful condition of extreme stiffness and inability to lift the arm also has its origins in poor stabilisation of the shoulder base (the scapula) leading to poor motor control of the arm at the shoulder. As with all the above conditions, improved scapula control and exercises that mobilise the arm-to-scapula union help reverse this condition. Frozen shoulders never recover quickly and the shoulder physiotherapy exercises shown below in the video are not suitable in the early stages. The book below features the best exercises for the early, or acute stage frozen shoulder.
Sarah's book explains how shoulders and necks are often either end of the same problem
Surgery for shoulder problems often involves simplistic notions of 'repair'. For example, re-attaching the ring of cartilage to the rim of the shoulder socket is rather like using needle and thread to join up broken fingernail. Similarly, repair of rotator cuff tears can being compared to sewing together two shaving brushes. For this reason, surgery may not be the answer to your shoulder pain.
The fact of the matter is that shoulders - just like other joints of the human skeleton - are frequently not in pristine condition when scanned by ultrasound or MRI. Most people over the age of 60 have partial or complete rotator cuff tears of the shoulder and know nothing about it. Similarly, and just like knees say, there can be excess bone growth in some places, lack of joint space and cartilage deficit in others but this does not necessarily indicate a need for surgery.
Known in yoga as 'mountain pose' holding your arms up like this is best for scapular stabilisaion
Shoulder Blade Stabilisation
When lifting the long willowy arm the shoulder muscles work at a distinct mechanical disadvantage. To help them lift things and position the hand, the shoulder blade (the scapula) must be in the right position and stable - and for this you must have good posture and good scapular anchorage. Believe it or not, the best shoulder physiotherapy exercise here is lifting the arms above your head without allowing the shoulders to hunch up; in other words, keeping your neck long. Doing this a couple of times a day for a few moments only makes all the difference. Improving the posture of your upper back is also important in dealing with problem shoulders. See the page Exercises To Improve Upper Back Posture
Shoulder Joint Mobilisation
For fine, painless manoeuvrability of the hand you also need an arm that is free in the shoulder socket, with all available freedoms in all directions. The shoulder physiotherapy exercises shown in the video below show you exactly how to regain multi-directional joint freedom at your shoulder.
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