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The shoulder joint is a ball and socket joint. The upper arm bone sits in a rounded socket in the shoulder blade, allowing for movement of the arm in many different directions. Many muscles lay over this joint to provide stability as the arm moves. Another joint in the shoulder complex is the acromioclavicular joint, or AC joint, where the collar bone and shoulder blade articulate. The shoulder blade, upper arm, and collar bone all must work together to produce smooth pain-free movement.
Shoulder pain can be due to tendon inflammation (tendonitis), impingement of the rotator cuff tendons (subacromial shoulder pain), arthritis in the joint itself, a tear in the labrum of the joint, inflammation of the bursa (bursitis), or instability in the AC joint to name a few. A tear in one of the rotator cuff muscles can be due to trauma or degeneration over time. Another diagnosis is adhesive capsulitis, which is a self-limiting process of inflammation and stiffness at the shoulder joint. Shoulder pain can also originate from the neck in some cases.
When examining shoulder pain, it is important to examine the entire shoulder complex. This includes assessing not only how the ball and socket joint moves, but the scapula and collar bone as well. The neck and mid-back also need to be examined for any potential impairments. The physical therapist will begin with a comprehensive exam of all of these areas to identify the source of the shoulder pain. Treatment consists of soft tissue mobilization, joint mobilizations, and corrective exercise to support the shoulder complex.
There is ample evidence that physical therapy interventions can help reduce shoulder pain and improve overall function. According to the Journal of Orthopaedic & Sports Physical Therapy, an article examined nonsurgical treatments for subacromial shoulder pain and found that exercise reduced pain and improved mobility in patients with subacromial shoulder pain. Manual therapy was also recommended in combination with exercise. Another study found that patients with subacromial shoulder pain who had surgery or physical therapy alone had minimal differences in improvements 3 months up to 2 years following. Physical therapy can be an effective treatment for shoulder pain and improve functional mobility.
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