The Shoulder – Anatomy, How It Works, Why It Hurts!

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Shoulders are a common area of injury.

They are the linch-pin of many movement functions and control, that once pain sets in, it can make day-to-day activities extremely painful and difficult to do.

Simple tasks such as driving your car, working on the computer or washing your hair all become a challenge.

There are many possible bones, ligaments and nerves in that little shoulder capsule that can get damaged, however this doesn’t necessarily mean that any of them are the cause of your symptoms.


The most common causes of shoulder injuries are:

  • Rotator cuff – e.g. tear, tendonitis, swimmer’s shoulderbursitis frozen shoulder
  • Bursitis
  • Dislocation (Instability)
  • Frozen shoulder
  • AC joint injury
  • Bone injuries – e.g. arthritis, fractures, breaks
  • Muscle injuries – e.g. overuse, repetitive strain, muscle strain
  • Systemic conditions – e.g. fibromyalgia, rheumatoid arthritis
  • Referred pain – e.g. from the neck, pinched nerve, thoracic outlet syndrome

As you can see above, there are many things that can be the cause of your pain (and that’s not the full list!).

Shoulder injuries are complex and often it is about putting may pieces of the puzzle together to find the cause and solution.

It takes many years of training and experience for a Physiotherapist to be able to accurately assess and diagnose where the cause of your pain is coming from.

First we need to understand how it moves.

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Similar to a waltz, the shoulder has a dance partner – the shoulder blade.

They move together following what we call a scapulohumeral rhythm (scapular being the shoulder blade, humeral being the shoulder joint).

The “classic” rhythm is a 2:1 ration, meaning that for every 120 degrees the shoulder joint moves, the shoulder blade will rotated 60 degrees upwards with it.

However the ratio changes dependent on where the shoulder joint is.

There are many muscles that allow the shoulder blade to move.

These muscles keep the movement in sync with the shoulder, including the upper trapezius, lower trapezius, serratus anterior.

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The shoulder bone’s connected to the…

Issues with the shoulder usually involves more muscles and structures than just the shoulder.

It could be the thoracic, neck, back or even muscle spasm.

Injuries that involve your muscles would normal present as a movement impairment, the inability to move the shoulder in its full range of movement.

This may be due to pain or stiffness.

How about the shoulder joint itself?

The pain experienced, often attributed to the shoulder joint, is described as a pinching feeling or “very deep inside”.

The shoulder joint is a ball and socket. So it’s important to have structures that are strong enough to hold it together, to make sure it does not pop out or roll off the surface.

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Putting it all together

It is often difficult to pin-point the exact structure that is the culprit of discomfort.

The joint works on balance and equilibriums. If one structure moves out of line, other structures are affected as well – spiralling into a chicken and egg cycle.

Therefore, if you have shoulder pain, it is important that you seek expert Physiotherapy treatment.

A simple massage will not resolve the underlying causes affecting your pain. Shoulder pain often worsens without effective treatment.

It’s important to work together with your physiotherapist to understand and break that cycle. Only then can you move into the recovery stage.

At Wisdom Physiotherapy we have extensive experience treating shoulders.

We utilise treatment methods such as a whole-body assessment, trigger-point dry needling, soft and deep tissue massage, specific exercise prescription and postural retraining / muscle activation via clinical pilates.

Don’t wait for your pain to get worse, come an see us and start your recovery today. Click here to book online.


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