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 The shoulder is the most mobile joint of the body. The socket of the joint, on the side of the shoulder blade, allows a lot of movement because it is shallow. That is why the shoulder is quite prone to dislocation, Some people, especially sportsmen, suffer recurrent dislocations. The socket is made slightly deeper by a rim of cartilage, called the labrum. This can sometimes tear. (osteopaths cannot help with labral tears). The arm bone, the humerus, needs to be held if place by a four short muscles, called the rotator cuff muscles. Their tendons can get inflammed (rotator cuff syndrome); osteopaths can often help.
Separating some of the tendons are sacs containing fluid , called bursae. This can also get inflamed, especially with repetitive movements.
The shoulder’s mobility is also due to the shoulder blade also being able to move on the chest wall. As you raise your arm from the side, after about 60 degrees the shoulder blade starts to move. The only other bone attaching to the shoulder blade is the collar bone, which acts as a strut to keep it out from the chest. The orientation of the shoulder blade, and its movement, is entirely controlled by the play of muscles that attach from it to the spine and chest. That is why osteopaths always look at the spine and ribs when assessing shoulder problems. The shoulder blade and the chest wall (actually, the muscles between them) also form a type of joint, which can sometimes cause trouble such as pain and grating under the shoulder blade. Osteopathy can help a lot with this.
There are other muscles that move the shoulder – the biceps and triceps for instance. One of the tendons of biceps runs in a groove, where it can get inflamed. The tendon can, in the elderly, also snap suddenly, causing the “popeye” sign - a bulge of muscle lower down the front of the arm. One of the rotator cuff muscles – the supraspinatus – can also rupture, especially if too many cortisone steroid jabs are made in it. This leaves the patient with weakness at the start of trying to lift the arm fromthe side. Only surgery can help with these ruptured muscles, but as there is no pain with them, sometimes this is not advised.
The shoulder is also liable to adhesive capsulitis (“frozen shoulder”) and, in the older patient, osteoarthritis. In frozen shoulder the synovial lining of the joint becomes inflamed and looses its stretch. It is very painful, especially at night, and moving the arm in front, behind and outward is limited (outward to about 90 degrees). The movement in osteoarthrosis is similarly limited. Osteopaths treat patients with both these conditions. The natural history of frozen shoulder about 18 months to recovery, but the right osteopathic intervention at the appropriate stage can shorten this. Osteopathic treatment of shoulder arthritis can give relief,but long term maintaince treatment is usually needed.
Most shoulder problems arise from sports injuries, falls, repetitive strains, or wear and tear. How the shoulders moves, its orientation, the play of muscles around the shoulder, and the mobility of the scapula and spine also have a lot to do with how a shoulder problem develops and how quickly it improves
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