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Shoulder pain is a common problem, with 15-30% of people experiencing it at some point in their lives.1 There are various things that are thought to contribute to shoulder pain, such as repetitive strain injuries, falls, and accidents. The most common causes of musculoskeletal shoulder pain are injuries to the rotator cuff, glenohumeral joint instability, and acromioclavicular (AC) joint injuries.

Shoulder pain can negatively impact a person’s daily activities, their ability to play sports, and even their sleep quality and overall quality of life. Seeking early medical attention is essential to ensure an accurate diagnosis and timely treatment.

Rotator Cuff Pathology

Rotator cuff pathology is a condition that occurs when the rotator cuff muscles in the shoulder experience acute or chronic tears, resulting in shoulder pain.2 The rotator cuff is made up of four muscles: infraspinatus, supraspinatus, subscapularis, and teres minor. These muscles work together to stabilise and centre the humeral head in the shoulder joint, as well as enable rotational movements of the shoulder.

Management of Rotator Cuff Pathology

A crucial part of the recovery process is adequate pain management and prompt return to work or sport. Treatment should involve relative rest from and modification of painful activities, and gradually reintroducing them in a controlled manner. Physiotherapists may apply hands-on techniques to assist with pain reduction and improve shoulder movement. A comprehensive and individualised exercise program should be prescribed, working on individual specific deficits and should include three stages: shoulder mobility, building endurance and strength, and integration towards sports or occupation-specific activities. 

Glenohumeral Joint Instability

Shoulder instability is defined as a soft tissue or bony insult of the shoulder that causes the humeral head to sublux or dislocate from the glenoid fossa (shoulder socket). The bony anatomy of the shoulder makes it particularly susceptible to instability episodes. Acute trauma and overuse can cause changes to the shoulder stabilisers which could lead to subluxation or dislocation, mostly commonly in the forwards (anterior) direction.3 Young and athletic populations have a high risk of experiencing shoulder instability events, and the recurrence rate of these episodes is also high.

Management of Glenohumeral Joint Instability

Shoulder instability is a common condition that can cause discomfort and inhibit daily activities. While conservative treatment is often the first approach, sometimes surgery is required depending on the type and extent of the injury. It’s important for patients to be educated throughout their rehabilitation journey so that they can make informed decisions about their recovery and management.

However, it’s worth noting that the risk of recurrent shoulder instability episodes remains high, particularly in younger individuals under 20 years of age, those with underlying joint hypermobility, and those who participate in contact or overhead sports, regardless of whether they opt for non-surgical or surgical intervention.3

If you, or someone you know, is experiencing shoulder instability, it’s important to seek medical attention and discuss the available treatment options with a healthcare professional. Acute management should always consist of manual reduction by a medically trained professional, followed by appropriate imaging to investigate any potential complications as a result of the instability event, which could include fractures or compromise to surrounding neurovascular structures. Following a period of immobilisation and acute measures, including ice and relative rest over the initial 1-2 weeks, a structured physiotherapy-led rehabilitation program is recommended. This program commonly consists of range of motion exercises with a gradual progression to strengthening focusing on the muscles around the upper girdle. Once range of motion and strength are equal to the non-affected side rehabilitation can progress to incorporate a gradual introduction of sport-specific skills, with progression to return to play. With the right care and guidance, it’s possible to manage this condition and regain normal shoulder function.

Acromioclavicular (AC) joint

Injuries to the AC joint are common, with sprains being the most frequently occurring type. The AC joint forms the joint between the top of the shoulder (acromion) and the collarbone (clavicle), and is stabilised by three ligaments. Typically, these injuries are caused by direct force to the AC joint as a result of a fall.4

Management of Acromioclavicular Joint Injuries

AC joint injuries are classified on a 1-6 grading scale, with the lower grade injuries (grade 1-3) usually having a favourable prognosis with conservative rehabilitation, and the higher grade injuries (grade 3-6) requiring a surgical opinion or intervention.4 For the initial treatment of acute AC joint injuries, it is recommended to rest and modify activities, apply ice, and use appropriate pain relief medication. In some cases, immobilisation may be required. A physiotherapy-led rehabilitation program consisting of gentle range of motion exercises and manual therapy/’hands on’ techniques can assist in the early stages with pain relief and restoration of shoulder range of motion.

Our team is always ready to assist you. If you have any further questions or need any help, feel free to reach out to us today. Our friendly team of physiotherapists will be more than happy to help you out.