Shoulder Dysfunction: A Real Pain in the Neck
Shoulder pain or dysfunction is a common disorder that affects many Australians of all ages. When most people talk about the shoulder joint, they are referring to the glenohumeral joint which is the main ball and socket joint that moves your arm around to position your hand in space. This only makes up 1 part of a wider complex which is made up of 4 bones, 4 joints and over 15 muscles. While the glenohumeral joint is incredibly important and vital to good shoulder health, it often bears a lot of blame for trouble it may not be the root cause of.
Most people have heard of their rotator cuff (or rotary cup to some…), which are 4 main stabilising muscles of the glenohumeral joint. When damage or imbalances occur, they can wreak havoc on the shoulder, causing issues such as shoulder impingement, bursitis, tendinopathy and instability. These muscles originate on your shoulder blade (scapula) and attach into the ball section of your upper arm, wrapping around like a spider’s web and integrating into the joint capsule. They provide dynamic control and stability at the joint.
The scapula is a flat, wide bony structure that serves multiple purposes for the body. Rather than being fixed to the axial skeleton via ligaments or bony attachments, the scapula is a floating joint that relies on multiple muscles working in synergy to maintain control and stability through movements. It increases protection to the chest cavity, and also allows for multiple important muscles to anchor to provide 6 key movement patterns at the scapulothoracic joint. Just as you wouldn’t build your house on a weak foundation, neglecting to address any scapulothoracic issues when dealing with shoulder pain will be your ultimate undoing and a large contributor as to why you will struggle to get the last 10-20% of the desired outcome.
Scapulothoracic movements include:
- Upward rotation
- Downward rotation
These foundational movements allow the scapula to move to positions along the chest wall, optimising glenohumeral joint movement and allowing effective and efficient function. Dysfunction through the cervical and thoracic spine, however, will not facilitate this efficiency of movement – leading to further imbalances or deficits which will increase the likelihood of shoulder pain or dysfunction.
Common cervical and thoracic spine issues that impact shoulder dysfunction include: hypomobility/stiffness, osteoarthritis, facet sprains, strains and tears of surrounding musculature, nerve root irritation and whiplash or concussion. These conditions present clinically with central spinal dysfunction, but commonly will have radiation of symptoms through the shoulder complex itself. This can be a straight-forward referral of pain from neural structures, but most commonly presents via any of the aforementioned secondary conditions stated previously (impingement etc.).
At Inspire Health Services we have a forensic approach to our assessment which includes the mantra of ‘always checking centrally’ to ensure that we look at the person, not the injury. Using a holistic approach to assessment/treatment techniques reduces the chances of anything being missed – getting quicker and better client outcomes, whether that be returning to sport, work or just life. If you, or anyone you know, is dealing with shoulder pain or dysfunction, please feel free to get in touch – we’d love to help!
Ruedi Steuri, Martin Sattelmayer, Simone Elsig, Chloé Kolly, Amir Tal, Jan Taeymans, Roger Hilfiker (2017). Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. British Journal of Sports Medicine 51: 1340-1347
Thiele De Cassia, Libardoni, Susan Armijo-Olivio, Debora Bevilagua, Anamari Sirianide Oliveira (2020). Relationship between intensity of neck pain and disability and shoulder pain and disability in individuals with subacromial impingement symptoms: a cross sectional study. Journal of Manipulative and Physiological Therapeutics 43