All About the Shoulder

The shoulder is one of the most frequently injured joints in the human body.  This is largely due to its structure.  The shoulder is a “ball and socket” joint similar to the hip, however, it has a very shallow socket.  This shallow socket is necesary to allow our shoulders to have a huge amount of mobility.  We are able to reach high over our heads, far out to the side, and twist and rotate to reach behind our backs.  

What holds our shoulder in place in its shallow socket is a complex network of muscles known as the “rotator cuff” as well as cartilage and numerous ligaments.  Due to this unstable structure relying on soft tissues, the shoulder is more prone to dislocation, muscle strains and tears, cartilage tears, and ligament sprains.    

Rotator cuff muscle injuries are common at any age due to a trauma such as a fall or from overuse.  In the elderly, rotator cuff tears can also happen insidiously (out of the blue) likely due to wear and tear over a lifetime.  As we get older our tissues have less elastin in them and can be more likely to tear instead of stretch.  Rotator cuff injuries typically present as pain in the shoulder with reaching up or behind your back, and pain with any lifting and reaching motions.

Arthritis can also affect the complex joints around the shoulder which include the shoulder joint itself as well as the AC joint (where your collar bone joins your shoulder) and your SC joint (where your collar bone joins your breast bone).  Arthritis will typically present as stiffness, pain, and a grinding feeling in the joint.

Sometimes shoulder stiffness is actually due to the thoracic spine.  For some individuals, particularly those with osteoporosis, the thoracic spine (mid back) will curve forwards over time.  As a person’s posture changes to be more forward-leaning the orientation of the shoulder joint moves downwards which limits overhead reaching.

Shoulder problems often limit a person’s activities of daily living such as getting dressed yourself or reaching into a cupboard.  Physiotherapists are here to help you with shoulder injuries and pain, as well as the prevention of stiffness in your shoulder joint.  All of the above conditions can be improved with a combination of manual therapy (hands-on physiotherapy techniques), specific exercise prescription, and modalities such as TENS or acupuncture.  The earlier the intervention for a shoulder issue, the better the outcome!