Shoulder pain
Due to its predominantly muscular stabilization, the shoulder joint allows for a considerable degree of mobility. However, this mobility also makes the shoulder more susceptible to injury. A well-balanced, functional musculature in the shoulder girdle is therefore particularly important to prevent problems in the long term. Because of long hours spent at a desk and the fact that most movements in our daily lives take place in front of the body, and the shoulder is rarely used within its intended range of motion, the incidence of shoulder problems has been increasing for several years. As a result, chronic use of painkillers and ultimately surgery are common. To better understand the issue, the structure and function of our shoulder joint will be examined in more detail below.
Shoulder joints
Movements in our shoulder joint are primarily made possible by three joints:
The ball-and-socket joint (glenohumeral joint) is formed by the head of the humerus (caput humeri) and the corresponding socket on the shoulder blade (scapula).
The acromioclavicular joint connects the acromion (the roof of the shoulder) to the clavicle (the collarbone).
The only bony contact with the rib cage (thorax) is made through the sternoclavicular joint.
The small contact area between the humeral head and the scapula allows for a large range of motion in the joint. The area between the two articulating surfaces is lined with cartilage and enclosed by a joint capsule.
Parts of the brachial plexus, the network of nerves that runs from the cervical and thoracic spine over the shoulder into the arm, run in the immediate vicinity of the acromioclavicular joint and below the clavicle.
The shoulder blade does not connect to the rib cage via bony structures, but rather through gliding on bursae and muscles. Above the ball-and-socket joint of the shoulder blade is the acromion, to which numerous tendons and muscles attach, enabling flexible arm movements in all directions.
Muscles, tendons and ligaments
The aforementioned, predominantly muscular joint control allows for a wide range of motion. This enables both abduction and adduction of the arms, as well as external and internal rotation movements.
Numerous muscles originate from different points on the shoulder blade. There, they run into tendons that almost completely encircle the head of the humerus. The joint is therefore enclosed by a kind of tendon cap, which is why it's called the "rotator cuff." The supraspinatus tendon is particularly relevant to the development of pain, as it runs through the narrow space between the humeral head and the acromion and is separated from the acromion only by a fluid-filled bursa.
Incorrect posture, trauma, etc. can lead to displacements within the shoulder joint, which can cause permanent irritation of the bursa, tendons, or shoulder capsule.
In addition to the rotator cuff, the deltoid muscle, as well as the pectoral muscles, the trapezius muscle and the upper arm muscles contribute to further stabilization coming from the acromion.
Types of shoulder pain – Common diagnoses
Impingement
The most frequent cause that brings patients with shoulder pain to our practice is impingement syndrome. Due to chronic repetitive strain or poor posture, the position of the humeral head relative to the acromion (the "roof" of the shoulder) can shift. This causes the humeral head to collide with the acromion during lifting or external rotation movements. The resulting entrapment of the structures lying in between can lead to inflammation of the bursa and tendon attachments, sometimes causing severe pain.
Shoulder Tendon Tears (Rotator Cuff Tears)
A tendon rupture can occur as a consequence of impingement syndrome. While any of the tendon ends in the rotator cuff can be affected, the supraspinatus tendon is again the most common site of injury. If a tendon is already irritated, only minimal strain is required to trigger a partial or complete tear. This can happen during everyday movements, such as bracing oneself with the affected arm or lifting a heavy weight.
Osteoarthritis (Arthrosis)
Since we rarely bear our body weight on our hands, osteoarthritis occurs less frequently in the shoulder joint than in the knee or hip joints. However, if poor posture or improper loading does lead to shoulder arthritis, the acromioclavicular (AC) joint is most commonly affected. Occasionally, cartilage tissue in the main shoulder joint also degrades (omarthrosis), which primarily leads to problems in the front area of the shoulder and can become painful during or after exertion. The pain is triggered by the rubbing of the two bones (humeral head and glenoid cavity); however, in our view, this is not solely responsible for the pain. If fascial-muscular balance is restored in the shoulder joint and maintained through proper training, pain-free function can be regained.
Fractures and Trauma
Naturally, typical shoulder pain can also result from accidents or trauma. Notable examples include clavicle (collarbone) fractures from falls while skiing or cycling, dislocated shoulder joints from sports collisions, or AC joint separations. In the case of an AC joint separation, the joint capsule is injured, and ligaments near the joint may be partially or completely torn.
causes
Shoulder and neck pain has become almost an epidemic due to our modern lifestyle. Many hours spent at a desk, on the sofa, or sitting in the car place strain on our bodies for which they are not designed. Due to a lack of compensatory movements, the shoulder is no longer used to its full range of motion, which its anatomy allows and is intended to accommodate. For example, when sitting, the shoulder usually remains in a forward and internally rotated position, which in the long run leads to the atrophy of all the fascial and muscular structures responsible for abduction and external rotation in the shoulder joint. The muscles and fascia responsible for this permanently maintained position (forward shoulder movement and internal rotation) shorten over time, resulting in a fascial pull of the shoulder forward. The pectoralis minor and the subscapularis are the most frequently shortened structures. The anterior fascial pull leads to a displacement of the humeral head in its glenoid cavity, resulting in the previously mentioned impingement syndrome. (See Impingement Syndrome)
Even though the elasticity of fascia and muscles decreases with age, we believe that a pain-free shoulder can be regained or maintained through timely intervention. We view frozen shoulder, as well as calcific tendinitis, as consequences of persistent fascial-muscular imbalance in the shoulder joint, which, as described above, usually originates in impingement syndrome. A tendon rupture is also a late consequence of impingement. Therefore, we focus on addressing fascial-muscular imbalances in the solution to most shoulder problems.
Treatment
Before we discuss our treatment approach, we would like to emphasize that a thorough diagnosis is essential before any effective treatment. Often, one-size-fits-all solutions are recommended for sometimes complex pain issues, which, without a prior diagnosis, do not lead to the desired result or are even counterproductive. Following the diagnosis, our approach involves a combination of osteopathy, physiotherapy, and targeted training.
The initial osteopathic session includes a diagnostic assessment. After a thorough medical history, in which we gather information beyond symptoms to inform the subsequent treatment, we employ visual diagnostics to identify any misalignments or abnormalities in the body. Following this, numerous osteopathic tests are performed, encompassing joints, muscles, fascia, and even organs. Once the diagnostic process has yielded a diagnosis, we begin treatment immediately, addressing the structures responsible for the symptoms. In cases of shoulder pain, dysfunctions are often found in the thoracic and cervical spine, which, through their connection to the shoulder girdle, in turn affect shoulder position. The muscles surrounding the clavicle are particularly important, as the nerve bundle supplying the shoulder and arm must pass through this area on its way down the arm. As described above, osteopathic techniques are then used to release muscular and fascial structures that are in a state of increased tension. This should give the humeral head the necessary space to center itself in the glenoid cavity and prevent compression of the rotator cuff tendons.
To maintain a balanced state in the shoulder girdle in the long term, physiotherapy and personal training specifically target shortened muscles and fascia, while strengthening muscles that have atrophied due to improper strain. An individualized program will be created for you, which you will initially train with our therapists and subsequently continue at your gym or at home. You will receive your training plan, including exercise videos, to take home. After a period of time agreed upon by you and your therapist, a follow-up appointment is recommended to ensure that your shoulder position remains correct and that pain is being managed in the long run.
Treatment depends primarily on the severity of the symptoms, the woman's age, and her desire to have children. Conventional medicine offers the option of medication or surgery. Osteopathy provides a complementary or alternative approach to the treatment of endometriosis. Visceral osteopathy, in particular, focuses on the treatment of endometriosis. At TRIUNE, we employ osteopaths specializing in visceral osteopathy. Furthermore, we are currently the only practice using the Endo Stretcher – a device that allows patients to actively participate in their treatment at home.
