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Most people will be able to recall the reasons their shoulder pain began, however, it is not unusual for patients to be unable to identify a defining moment of onset. The shoulder itself may well be the source of your pain, but it could be referred from other areas of the body; your neck for example. Your physiotherapist will be able to carry out a thorough and comprehensive physical examination specifically tailored to you and your current symptoms. A personal rehabilitation programme will then aim to maintain range of movement, reduce pain, restore function, and educate you about your condition.

If it is appropriate, your physiotherapist can refer you to the correct medical professional when, for instance, injections, scans or review by a Consultant Orthopaedic Surgeon is indicated.

Treatment may include:

  • Passive and/or active assisted ranges of movement
  • Joint mobilisation
  • Tissue massage and manipulation
  • Scar tissue management
  • Ultrasound
  • Taping for proprioception and pain relief
  • Scapular stability exercises
  • Strengthening
  • Postural retraining
  • Assessment and correction of muscle imbalance
  • Assessment and correction of movement patterning and adaptive postures
  • All  post-operative shoulder rehabilitation
  • Fracture management and rehabilitation

Examples of some conditions treated:

Subacromial Impingement
Tendons are strong bands of connective tissue that attach muscles to bones. The rotator cuff is a group of four tendons responsible for keeping the head of the humerus (the “ball”) at the top of your long arm bone centred and down in the shoulder socket when the arm moves. Rotator cuff control allows the head of the humerus to glide freely under the bony “roof” of the shoulder above it.  (The acromion process). The rotator cuff is vulnerable to wear and degeneration during the aging process and can also be torn as a result of traumatic injury or overuse. If it is injured or damaged, it no longer functions well and the head of the humerus is allowed to rise up and squash the tissues above it against the acromion process. This is impingement.

Acromioclavicular Joint (ACJ)
The acromioclavicular joint is at the top outside edge of the shoulder blade where a bony prominence called the acromion process attaches to your collar bone (clavicle). Ligaments are strong bands of connective tissue that run from bone to bone and help stabilise the joint. The joint is partly filled with a thick pad of cartilage called a meniscus.

ACJ Dislocation: If the joint sustains traumatic impact, the ligaments supporting it can be torn and there may be displacement that causes a gap between the acromion process and the clavicle.

ACJ Sprain: A sprain occurs when the joint is injured, but the ligaments remain intact and there is no dislocation.

Meniscal Tear: Occasionally in an ACJ sprain, the thick pad of cartilage that partly fills the space between the acromion process and the clavicle can be damaged.

Frozen Shoulder
The shoulder joint is surrounded by a capsule, a watertight sac that encloses the joint and the fluids that lubricate it. The capsule is normally elastic and flexible and allows the shoulder to travel through a great range of movement, however in a frozen shoulder it becomes inflamed, contracted and extremely painful.

Frozen shoulder goes through three distinct stages.

  • Initially there is a significant degree of pain and the onset of stiffness (anything from 2-9 months).
  • This is followed by a period of diminishing pain but range of movement will be  compromised and patients will still suffer continuing stiffness ( a further 4-12 months).
  • The final phase there is little to no pain and a steady return to full range of movement (12-42 months).

The causes of frozen shoulder aren’t fully established but there has been association with injury, surgery, diabetes, heart disease and Dupuytren’s contracture.

The shoulder joint is incredibly mobile and this potentially predisposes it to be unstable. It is the most commonly dislocated joint in the body. A dislocation is when the ‘ball’ at the top of your long arm bone pops out of the socket. It can dislocate either out of the front, the back, or the bottom of the joint. The dislocation can be caused by trauma. In some people however, it can be positional and happen when they move their arm in certain directions. In others it may be a long standing “party trick” they have always been able to do. Dislocation may damage other structures in the area. Nerves, the labrum, ligaments, tendons, and cartilage can be stretched or torn. During a dislocation anteriorly, the back of the  head of the humerus can hit the front rim of the socket and be dented as a result. This is known as Hill-Sachs lesion or Hill Sachs fracture.

Labral Tears
A ring of cartilage called the labrum encircles the shoulder socket.  It increases the depth and surface area of the receiving socket and acts as a suction capsule to the head of the humerus.  If the labrum becomes frayed or torn, it will affect the stability of the joint.  The tears have different names according to where on the labrum they are.

Bankart Lesion: This is a tear at the lower front of the labrum. It can occur in dislocations or partial dislocations where the head of the humerus moves forward in the shoulder.

SLAP Tear (Superior Labrum Anterior-Posterior): A SLAP tear runs from front to back at the top of the labrum and occurs when a tendon that attaches a muscle called biceps is pulled off. It can occur with wrenching, throwing or falling onto the elbow.

Posterior Labral Tear: This tear happens at the back of the labrum. Associated with a backward movement of the humeral head. Falling onto outstretched hand for example.


Ligaments, muscles, tendons and the labrum support the shoulder joint and offer stability. If the tissues are over stretched or injured, the shoulder can feel unstable. It may sublux or dislocate.