Shoulder pain: an overview
Shoulder pain can have a real impact on your day-to-day activities. So we've explained the potential causes, the way shoulder pain is diagnosed, and the specific treatments required for effective pain relief.
We use our shoulders surprisingly often in our everyday lives, so any pain or discomfort we feel can have a real impact on our quality of life. In this short guide, we explain the anatomy of the shoulder, highlight potential causes of shoulder pain, and discuss a range of different treatment methods.
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How does the shoulder work?
Unique to the shoulder is that it needs to function efficiently for an extremely wide variety of different tasks. These tasks include needing a large range of motion in to many planes of movement. Examples include reaching above the head or behind the back.
As well as this large range of motion the shoulder complex also requires significant strength for tasks such as weight bearing, pushing, and pulling. Lastly, the shoulder is also required to balance a large range of motion while maintaining strength and stability. The best examples of this are throwing and tackling during sports. To enable all of these tasks, the anatomy of the shoulder complex is built in a very unique way.
Firstly, the shoulder is in fact a complex of several different joints which allow significant rotational movement as well as the large degree of motion above head height which a single joint would not allow.
- Sternoclavicular joint between the breastbone (sternum) and the collar bone (clavicle)
- Acromioclavicular joint (AC) between the collar bone (clavicle) and the top of the shoulder blade (scapula)
- Scapulothoracic joint (SC) between the shoulder blade (scapular) and the rib cage
- Glenohumeral joint between the shoulder socket (glenoid) and upper arm bone (humerus)
Secondly, the shoulder socket itself is a unique joint with a small contact area between a very flat socket. This too allows a high degree of movement in to differing planes of motion. However, this small, flat socket is inherently unstable and as such the third unique part of the shoulder anatomy is the complex of muscles known as the rotator cuff. The rotator cuff muscles and tendons envelope the shoulder socket and when functioning normally, centre the upper arm bone in the shoulder socket. These tendons also contribute strength in to shoulder rotation which is so important for many shoulder movements.
Due to the shoulders anatomy, shoulder injuries are a common problem after trauma as well as repetitive shoulder tasks and are seen in sedentary individuals as well as high level athletes.
Major traumatic injuries include fractures, dislocations as well as muscle and tendon tears. Shoulder pain related to repetitive shoulder tasks, are often related to subtle movement faults due to stiffness of one or more of the shoulder complex joints or poorly functioning muscles which move the scapula or rotator cuff.
Where is shoulder pain felt?
The exact location of shoulder pain is often related to the underlying cause of the symptoms and may also vary with how severe the problem is. The actual shoulder joint, known as the glenohumeral joint, lies at the very top of the arm bone as a small vertical socket. As such, pain arising from the shoulder joint itself is often primarily felt in the front and outer aspect of the upper arm.
Pain related to the structures that lie in or around the subacromial space, just below the top of your shoulder, including the subacromial bursa and the rotator cuff tendons is also felt as a pain towards the front and outer aspect of the shoulder.
When glenohumeral pain or sub acromial pain has become severe or has been persistent, individuals may suffer with the pain radiating down the arm towards the thumb.
In cases where the AC joint is responsible for the pain, this is often felt as a very localised pain directly on top of the AC joint. AC joint pain may also radiate through the large upper trapezius muscle towards the neck.
Pain related to the SC joint is very well localised to the joint itself and sometimes radiates pain to the collar bone on the affected side. Pain related to the scapular may be felt in various locations including over the scapular itself but also radiating to the wider rib area on the affected side and in some cases towards the large upper trapezius muscle and the neck.
Can shoulder pain cause arm weakness?
The most common cause for arm weakness is a significant tear to the rotator cuff muscles and tendons of the shoulder. However, in rare circumstances, compression to a cervical spine nerve root may result in shoulder pain. In severe cases, the function of the nerve may deteriorate to a point where it cannot innervate certain muscles of the arm adequately leading to partial weakness.Shoulder pain diagnosis