To treat a shoulder injury we firstly need to be able to diagnose the underlying causes, which can be difficult to do because the shoulder joint is so complex. Problems arising from the joint generally fall into one of the three categories below.
Neurogenic pain or referred pain
Pain in the shoulder can sometimes be referred from the nerves in the neck. This can be challenge to diagnose especially if there is an absence of neck symptoms.
Treatment: Initially this can be managed conservatively with medication from your GP and physiotherapy. Should symptoms not respond the next step involves scans and diagnostic imaging to determine whether there is a mechanical reason for the pain that may require surgical intervention e.g. a cervical disc bulge. If no underlying cause is found further physiotherapy will be provided to help restore the normal movements of the joints and muscles.
Myogenic pain or muscular pain
The shoulder joint has a huge range of movement and relies on a group of muscles called the rotator cuff to keep the joint stable and allow your shoulder to move normally.
Treatment: Sprains and strains of the rotator cuff are quite common and usually they will heal with time and physiotherapy. However, If the tear is too big the muscle won`t be able repair itself and the movements of the shoulder will become restricted. In these cases surgery is required to repair the injured muscle. This is known as a rotator cuff repair
Our ability to lift our arm hand above our head is due to the amazing biomechanics of the shoulder, but sadly sometimes this can go wrong. The muscles and soft tissues running between your shoulder and the top of your shoulder blade (Subacromial space) can become pinched.
Treatment: Often the problem can be resolved with postural advice and physiotherapy that restores the normal biomechanics to the joint by retraining the muscles. If there is a mechanical reason for the change in mechanics such as joint space narrowing due to osteoarthritis then surgical input may be required.