The Shoulder Joint
The shoulder, or glenohumeral joint, is a ball and socket joint and is the most mobile joint in our body. The ball is the top of the humerus/arm bone and the socket on the outer scapula/shoulder blade.
In comparison to more stable ball and socket joints such as the hip joint, the shoulder joint sacrifices stability in order to allow for greater mobility. This allows us to move our arms in all sorts of different positions.
This trade off is a reduction in stability. The shoulder relies heavily on the surrounding muscles and ligaments for support. Therefore, weakness or lack of co-ordination of the surrounding muscles is one factor that puts us at a higher risk of shoulder pain.
Who is Most at Risk of Shoulder Pain?
- Athletes who participate in overhead, throwing and contact sports
- Individuals working in occupations requiring repetitive or sustained overhead work
- Poor posture e.g. having rounded shoulders
- Poor lifting mechanics inc. workplace ergonomics
- A history of shoulder dislocations
- Individuals with poor scapulo-humeral rhythm (i.e. poor shoulder blade control)
- People with hypermobility
- Elderly population
What are the Most Common Forms of Shoulder Pain?
- Shoulder impingement, also referred to as shoulder bursitis or subacromial bursitis
- Rotator cuff tears and/or tendinopathies
- Shoulder instability including sublaxations and dislocations
- Fractures of the humerus, AC joint and clavicle
- SLAP lesions/labral tears
What Does Research Say About Shoulder Pain?
What did the researchers look at?
Whether shoulder decompression surgery OR conservative management (in other words, physiotherapy/exercise) was more effective in improving pain, function and health-related quality of life among individuals with shoulder impingement/bursitis.
Note: Shoulder decompression surgery is one of the most commonly performed surgeries in Australia for shoulder bursitis/impingement
What did the researchers find?
Shoulder decompression surgery was shown to be no more beneficial than conservative management for improving pain, function and health-related quality of life at both 6 months and 1 year follow up periods and is associated with a higher risk of serious harm.
How does this influence our job as Physiotherapists?
Despite being one of the most common musculoskeletal surgeries performed in Australia, the research suggests that physiotherapy should be the first-line treatment for improving your shoulder impingement/bursitis.
Article: Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis
Authors: Lähdeoja, Tuomas, et al., Br J Sports Med (2019)