The shoulder joint and the surrounding structures comprise one of the most complicated joints in the body. Its lack of intrinsic stability and restricted roots for the passage of important nerves, arteries and tendons makes it a region where most people will experience problems at some point in their lives.
Pain in the shoulder girdle may stem from a multitude of sources, from joint irritation in the neck, rotator cuff tears, adhesive capsulitis and many other problems. Many of the problems mimic the symptoms of other issues and care must be taken to understand the full scope of the problem before treatment is undertaken.
I will normally use a series of complex active and passive tests to identify the tissues causing the problem and, if in doubt, may refer you for an ultrasound scan or MRI before undertaking treatment.
Due to the anatomy of the shoulder, the rotator cuff of four muscles can be easily damaged. It has been suggested that up to 60% of adults have tears in their rotator cuff but are not necessarily symptomatic. The main focus of the rotator cuff is to manage the movement of the head of the Humerus so that the neurovascular structures that pass through the shoulder area not compromised, and the arm can be raised without jamming into the Acromion process situated at the end of the collar bone(clavicle). Most frequently one encounters partial tears to the Supraspinatus tendon. This then triggers an increase in tension in the other muscles of the rotator cuff and a consequent shoulder dysfunction.
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