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Anatomy of Shoulder

Shoulder pain is an extremely common symptom for people presenting to a chiropractor. Shoulder pain affects around 3 in 10 adults at some time during their lives. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause.

Shoulder pain is the third most common cause of musculoskeletal consultation in primary care. 1% of adults with new shoulder pain consult their GP each year. The self-reported prevalence of shoulder pain is between 16% and 26%.

Shoulder pain isn’t always directly caused by a problem in the shoulder joint. Problems in the neck can cause pain that is felt over the shoulder blade or in the upper outer arm (this is known as referred pain). If shoulder pain is accompanied by a tingling sensation, this is also more likely to be caused by a problem in the neck.

Anatomy of the Shoulder

Shoulder AnatomyThe two main bones of the shoulder are the humerus and the scapula (shoulder blade).

The joint cavity is cushioned by articular cartilage covering the head of the humerus and face of the glenoid. The scapula extends up and around the shoulder joint at the rear to form a roof called the acromion, and around the shoulder joint at the front to form the coracoid process.

The end of the scapula, called the glenoid, meets the head of the humerus to form a glenohumeral cavity that acts as a flexible ball-and-socket joint. The joint is stabilised by a ring of fibrous cartilage surrounding the glenoid called the labrum.

Ligaments connect the bones of the shoulder, and tendons join the bones to surrounding muscles. The biceps tendon attaches the biceps muscle to the shoulder and helps to stabilise the joint.

Rotator Cuff AnatomyThe rotator cuff is made up of four muscles. These individual muscles combine at the Rotator Cuff Anatomyshoulder to form a thick “cuff” over this joint. The rotator cuff has the important job of stabilising the shoulder as well as elevating and rotating the arm. Each muscle originates on the shoulder blade, or scapula, and inserts on the arm bone, or humerus.
The four muscles that form the rotator cuff are the supraspinatus, infraspinatus, teres minor, and subscapularis.

Supraspinatus

The supraspinatus muscle originates above the spine of the scapula and inserts on the greater tuberosity of the humerus. The supraspinatus abducts, or elevates, the shoulder joint. It also works with the other rotator cuff muscles to stabilise the head of the humerus in the glenohumeral joint, or shoulder joint.

Infraspinatus

The infraspinatus muscle originates below the spine of the scapula, in the infraspinatus fossa, and inserts on the posterior aspect of the greater tuberosity of the humerus. The infraspinatus externally rotates the shoulder joint. It also works with the other rotator cuff muscles to stabilise the head of the humerus in the glenohumeral joint, or shoulder joint.

Teres Minor

The teres minor muscle originates on the lateral scapula border and inserts on the inferior aspect of the greater tuberosity of the humerus. The teres minor muscle externally rotates the shoulder joint. It also works with the other rotator cuff muscles to stabilize the head of the humerus in the glenohumeral joint, or shoulder joint.

Subscapularis

The subscapularis muscle originates on the anterior surface of the scapula, sitting directly over the ribs, and inserts on the lesser tuberosity of the humerus. The subscapularis muscle works to depress the head of the humerus allowing it to move freely in the glenohumeral joint during elevation of the arm. It also works with the other rotator cuff muscles to stabilise the head of the humerus in the glenohumeral joint, or shoulder joint.

Symptoms of Shoulder Injury

The location and severity of shoulder pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany shoulder pain include:

  • Pain
  • Swelling and stiffness
  • Redness and warmth to the touch
  • Weakness or instability
  • Popping or crunching noises
  • Inability to fully move the shoulder

For patients suffering from shoulder pain, the first step to recovery is to receive a proper diagnosis so the cause of the symptoms can be determined.

If you feel you have a potential dislocation of the shoulder or a fracture, urgent medical attention should be sought.

Causes of Shoulder Pain

Shoulder pain can stem from one or more of the following causes:

  • Strains from overexertion
  • Tendonitis from overuse (RSI or repetitive strain injury)
  • Calcific Tendonitis
  • Shoulder joint instability
  • Dislocation
  • Collar or upper-arm bone fractures
  • Frozen shoulder
  • Rotator cuff tear
  • Trapped nerves (also called radiculopathy)
  • Referred Pain
  • Arthritis
Investigation for Shoulder Pain and Injury

Like every joint evaluation, the start to a diagnosis is a consultation followed by a physical examination. Your specialist will inspect your shoulder for swelling, pain, tenderness, warmth and visible bruising. A visual assessment is followed by evaluation of the movement and specific orthopaedic tests to determine integrity.

After a provisional diagnosis is made by your specialist, it may be suggested you have the joint imaged by:

  • X-ray
  • MRI Scan
  • CT Scan
  • Ultrasound

If your specialist suspects an infection or arthritis you may be recommended a series of have blood tests .

On rare occasions your specialist may request a nerve conduction study to look for nerve injury and compression.

Treatments for Shoulder Pain

Throughout your diagnosis, treatment, and rehabilitation, dedicated team members will continue to work hard to ensure you can get back to enjoying life with the most comfort, mobility, and functionality possible.

Healthplus Clinics has assembled a group of Shoulder Pain Specialists to provide complete surgical and non-surgical treatments. Our team of Shoulder Specialists includes: Shoulder Surgeons, Pain Specialists, Podiatrists, and specially trained Shoulder Physiotherapists.

Non-Surgical Shoulder Treatments and Procedures

  • Specialist Shoulder Physiotherapy
  • Shockwave Therapy
  • Shoulder Acupuncture
  • Electrotherapy

Shoulder Pain Management Procedures

  • Suprascapular nerve pulsed radiofrequency
  • Triple compartment shoulder injection

Surgical Shoulder Treatments and Procedures

  • Arthroscopic  Debridement
  • Arthroscopic bankart procedure (labral repair)/ shoulder stabilization
  • Rotator cuff repair
  • Shoulder replacement:
  • Hemi-replacement
  • Total replacement
  • Reverse shoulder replacement
  • ACJ reconstruction
  • Arthroscopic frozen shoulder
  • Pectoralis Major tendon repair
  • Sub-acromial decompression
  • Scapulothoracic fusion
  • Capsular shrinkage
  • SLAP repair
  • Arthroscopic stabilisation
  • Arthroscopic sub scapularis repair
  • Fracture Fixation
  • Sub-acromial bursitis drainage
Complications of Shoulder Pain and Injury

Chronic pain

Once your ligaments, tendons and muscles are stretched, or torn, they need about eight weeks to 12 weeks to be fully healed and are pain free. Delaying treatment of these other conditions leads to continued pain, weakness and disruption of your normal daily activities.

Instability of the Shoulder Joint and Recurrent Dislocation

A dislocation to the shoulder can heal incorrectly, leaving your ligaments permanently stretched. This causes your shoulder to be weak and unstable, frequently resulting in abnormal movement. If this happens, you will are likely to recurrently dislocation causing swelling and pain.

Stiffness

Stiffness usually happens because of severe inflammation swelling at the site of the injury and scar tissue. Stiffness most often results in pain and even Frozen Shoulder.

Swelling

When the shoulder does not heal properly, localized swelling occurs causing a limited range of motion and an inability to participate in your usual routine.

Early onset arthritis in the Shoulder Joint

When a joint functions incorrectly following injury there is a possibility that over a period of time premature arthritis can occur.

Most patients will not encounter problems after orthopaedic surgery. As with any surgery, however, there are potential risks, including: reaction to anesthesia, bleeding, infection, blood clots, nerve damage, lack of full range of motion, development of arthritis, scar formation, or re-injury of the joint or soft tissue.

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