SHOULDER Pain
An optimally-functioning shoulder joint is both highly stable, and highly mobile. The ideal blend of strength and flexibility.
Unfortunately, the shoulder often falls short of ideal. Dysfunction and pain are common in this dynamic joint, the most mobile joint of the human body.
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A few notable dysfunctions, you may or may not be aware of:
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Adhesive Capsulitis or frozen shoulder
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Impingement Syndrome *
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Rotator Cuff tear, rupture, or tendinitis
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Bursitis
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Bicipital Tendinitis
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The * indicates a controversial diagnosis. If you have been diagnosed with impingement syndrome and are considering surgical intervention, reconsider.
A randomized controlled trial comparing long term efficacy of arthroscopic subacromial decompression surgery to a placebo surgical intervention and exercise found no greater benefit with surgery.
A systematic review and meta-analysis found no relationship between the acromiohumeral distance and pain in adults with subacromial pain syndrome.
So maybe, impingement syndrome isn’t really a thing?
Exactly, but the diagnosis and surgical intervention are still popular.
Adhesive Capsulitis or frozen shoulder is definitively a thing, and it really sucks, as do the popular treatment guidelines: If it doesn’t move, force it, which is synonymous with my personal favorite, “get a bigger hammer”.
The hallmark immobility of frozen shoulder can be caused by contracture of the capsule, or neurological inhibition. Two completely different mechanisms that produce the same result.
The glenohumeral capsule permanently contracts around the joint creating a structural barrier or the brain, the subconscious part, shuts down neural signaling. Either way, that shoulder isn’t moving and shouldn’t be forced. Treatment is tricky and takes time. An extended period. Think years, not weeks.