Injuries to the shoulder are a common problem encountered in an Osteopath clinic. The can include a wide range of problems such as dislocations, fractures, joint injuries and rotator cuff injuries etc.
Demands of modern life can have a significant impact on developing injuries to the shoulder, whether its from slouching forward at a desk all day meaning the shoulders are in a slumped position, lifting heavy objects as a manual worker or being stressed in an overhead position from painting etc. All these factors influence the prevalence of shoulder injuries.
With any joint, its important that the osteopath takes a full history to help identify what is going on. This includes identifying the mechanism of the injury. This is looking at how the injury occurred, whether its through a fall, a trauma or just came on gradually.
The site of pain. Its important for the osteopath to know exactly where you are feeling the symptoms, this can help to identify the structure or structures that are causing the problem.
Nerve injuries are very common in the shoulder so its important to know if there is any signs of nerve damage through questioning about pins and needles in the arms, hands and fingers, changes of sensation etc. Your osteopath will often conduct a full neurological examination to help with this.
What aggravates the pain? This can be very useful as it can help identify structures causing your symptoms. certain movements require certain muscle and joint activity so stressing these structures can help put us on the right path.
Has there been a history of injury to the shoulder before? Injuries like dislocations can carry a higher risk of re-occurrence so its important to know about previous injuries.
Family history also plays a role with regards to laxity within the joint.
Examination of the shoulder will involve active and passive movements of the shoulder, individual muscle testing, individual joint assessments, as well as any special tests to help with diagnosis.
Some cases, particularly a traumatic case may require some further investigations. The most common approach is through an x-ray which can help reduce the risk of making any errors in the diagnosis.
Ultrasound scans can be used to look at structures like the rotator cuff and other musculotendinous injuries.
A CT scan is used to look at the bony anatomy of a joint and can be very useful in situations that may require surgical intervention.
An MRI scan will show a detailed look at the muscles, joints and tendons of the shoulder.
Out of all the joints in the body, the shoulder has the greatest range of movement. This can result in an increased risk of dislocation and subluxation. The joint is provided with functional stabilisers which are either static or dynamic. The injury can occur when the head of the humerus (the arm bone) has been levered out of position at the joint. A dislocation is generally quite obvious while a subluxation of the joint may be described as a ‘dead arm feeling’ with a sensation of heaviness and numbness. With patients with recurrent instability its important to be able to identify the level of force needed to cause a dislocation as this can indicate the potential level of injury at the joint. Examination involves a full muscle, joint and nerve assessment, as well as assessing for generalised laxity and performing any special tests. X-rays should be performed after episodes on instability, with MRI’s often used as a secondary means of investigation to look for any soft tissue damage.
The rotator cuff is a group of muscles that help stabilise the shoulder. An injury to one of these muscles is one of the most common muscular injuries in the body, often down to overuse. Symptoms often include, pain, swelling and impaired use. The history of a rotator cuff injury is divided into three categories, traumatic, reactive and degenerative.
Acromioclavicular joint injury
A common site of injury due to the external stress placed on it. The injury can present as pain and swelling at the top of the shoulder with the pain sometimes spreading into the neck. The area will often be tender to touch and pressure can reproduce symptoms.
Common fractures associated with the shoulder include, the clavicle, the greater tuberosity, the scapula and the proximal humerus. Special care needs to be taken by the osteopath in these cases as often their symptoms can mimic that of a soft tissue injury.