The most common cause of shoulder pain is sub acromial impingement. Impingement occurs when the space between the humerus and shoulder socket is narrowed, causing pain, swelling and degeneration of the rotator cuff tendons. Thorough assessment of the shoulder through examination, history and investigation is essential in determining the underlying cause of shoulder pain and dysfunction.
Through careful assessment and examination Simon will determine if the primarily cause of pain is:
1. An unstable joint that has an underlying labrum or capsule tear
2. A frozen shoulder (adhesive capsulitis)
3. An impingement of the tendons at the front of the shoulder (sub-acromial impingement)
4. Posterior Internal Impingement that occurs especially in swimmers and throwers where the labrum jams between the ball and the socket
5. A tear to the rotator cuff of tendons within the shoulder
Generally 50% of shoulder problems that he sees will recover well within the first four weeks with physiotherapy. Treatment is aimed at strengthening of the rotator cuff muscles that act by pulling the ball into the socket, and stopping it “riding up” and producing impingement. Strengthening of the muscles that hold the shoulder blade down also helps position the ball part of the “ball and socket joint” to minimize impingement. Hands on physio to release the muscles at the back of the shoulder helps minimize impingement. Simon does not use ultrasound therapy, a form of trteatment commonly used by physios as this has been scientifically shown not to aid in recovery.
If this short course of treatment is unsuccessful then he can order an MRI and x-ray to produce a more accurate diagnosis and then refer on for a surgical approach or a corticosteroid injection.