What is Shoulder Pain?
Shoulder pain is the third most common musculoskeletal complaint following low back and neck pain seeking care from a health care professional. Shoulder complaints account for almost 3 million patient visits each year in the United States.
A wide range of possible pathologies can arise from the shoulder including a simple sprain to a massive rotator cuff tear. The majority of these conditions can and do respond from conservative treatments.
Rotator cuff syndrome
is a very important entity because it occurs frequently and could possibly necessitate surgical intervention if a trial of conservative care is failed.
The shoulder is demonstrated to be an area of confusion to many clinicians. The shoulder is a very complex mechanism consisting of the ghenohumeral, acromioclavicular, sternoclavicular, first costovertebral, and scapula-thoracic joints. There are also various muscles, ligaments, and tendons that contribute to the shoulder.
Shoulder conditions and dysfunction are common complaints among overhead throwing athletes and people with physically taxing jobs that overuse the shoulder. Competitive athletes who use overhead motions, particularly baseball players place tremendous repetitive stresses on their shoulders. Painters, carpenters and various other professions place the same stress on the shoulder every day.
Although overuse of the throwing shoulder can promote a significant injury, many difficulties begin with improper mechanics and poor conditioning.
According to Hains, 95% of all cases of shoulder pain are attributable to the tendons of the rotator cuff becoming impinged between the greater tuberosity of the humerus and the anterior edge of the acromion. Common problems in pitching mechanics that can lead to shoulder injuries begin with the foot plant. Hyperextension of the knee while planting and striding leg landing on the heel cause a sudden deceleration of the body, which results in undue force to the throwing arm.
Evaluation of an athlete’s shoulder begins by obtaining an exhaustive history from the athlete. Upper quadrant pain can stem from cervical spine dysfunction. Therefore, cervical spine conditions must be ruled out in most shoulder cases. Examination should begin with observation of posture and symmetry in the standing position.
Shoulder range of motion should be evaluated in both sitting and supine positions. Conservative treatments of shoulder dysfunction are centered around rehabilitation. Some of the keys to rehab are the scapula pattern process beginning with stability and ended with strength gain.
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The shoulder joint is a multiaxial spheroid joint. The minimal bony stability in the shoulder permits a wide range of motion and the soft tissue structures are the major glenohumeral stabilizers. Several interconnecting ligaments and layers of muscles join these bones, providing the rather unstable joint with a great amount of strength.
Due to the curvature of the articular surfaces of the shoulder, the joint is not congruent and is referred to as “loose packed." It is only when the humerus is abducted and externally rotated that it becomes close packed and a congruent joint.
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