Osteopathic Journals and Research by Darren Chandler


Shoulder pain

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  • Shoulder injuries
  • What can cause (and stop from getting better) shoulder pain
  • How can osteopathic manipulative treatment help shoulder pain 


In a survey(1) 17% of people had experienced shoulder pain in just the last 4 weeks. Shoulder pain can be debilitating seriously impacting on the life of sufferers.

Conditions that can cause shoulder pain include:

1. Myofascial trigger points

2. Frozen Shoulder (Adhesive Capsulitis)(2)

3. Rotator cuff disorders(2)

4. Shoulder instability(2)

5. Acromioclavicular joint disorders(2)  

6. Broken arm or collarbone(2)


1.   Myofascial trigger points

Myofascial trigger points are tight bands or special types of ‘knots’ in muscles. They have been estimated at causing a high percentage of shoulder pain(3). They are not picked up on conventional scans i.e. MRI, CAT or ultrasound but can be felt by the trained hand.

The shoulder joint is not designed to last more than 40 years. If we scanned people over 40 who had NO problems at all we would find something wrong in 96% of them(4). The question is can these myofascial trigger points (special knots) turn these underlying problems that we’re unaware of into painful conditions?

Studies have shown a high prevalence of muscles containing myofascial trigger points in patients with chronic shoulder pain(3). Osteopaths loosen these trigger points with the aim of switching back off and calming down any pain and underlying problems.

 2.   Frozen Shoulder (Adhesive Capsulitis)(2)

(refer to our previous blog)

The capsule of the shoulder joint encases and forms an outer ‘skin’ of the shoulder joint. A frozen shoulder occurs when scar tissue forms inside the shoulder capsule causing it to thicken, swell and tighten. On top of this patients experience tightness of the muscles and other soft tissues giving pain and restricted movement.

The symptoms of a frozen shoulder tend to be variable. It has three stages. The average length of these stages without treatment is 30 months(5).

3. Rotator cuff disorders(2)

The rotator cuff are the muscles and tendons surrounding and supporting the shoulder joint. They stabilise and control the movement of the shoulder.

The different types of rotator cuff disorders include:

  • Tendonitis and bursitis
  • Tears
  • Rotator cuff syndrome

Tendonitis and bursitis

The tendons attach the muscle (rotator cuff muscles) to the bones (the arm and shoulder blade). Tendonitis is inflammation (swelling) of a tendon. Bursa is a sac of fluid usually found around joints and between tendons and bones. Bursitis is a swelling of this sac of fluid causing it to swell and push on things.

Tendonitis and bursitis often occur together. Most commonly from an injury or overuse of the shoulder causing inflammation.

Sometimes the tendons and/or bursa get trapped between the bones at the outside and front of the shoulder. This is called "impingement syndrome".

Sometimes it can be due to the tendon and bursa enlarging and pressing against the bones. Sometimes it can be due to the bones enlarging (from ‘wear and tear’) and pushing against the tendons and bursa.

If this trapped tendon keeps scrapping against the shoulder bones it can weaken and possibly tear.


A tear in muscles or tendons can cause pain and even weakness when moving the shoulder. It can also give a ‘popping’ sensation.

In the elderly, as mentioned above, tears can be caused by an impingement syndrome. Around 50% of people over 60 will have partial or complete rotator cuff tears. This is because your tendons weaken the older you get.

Rotator cuff syndrome

Rotator cuff syndrome is a generic term describing any injury to the rotator cuff tendons, including complete tears.

4. Shoulder instability(2)

 Shoulder instability can be either:

  • Traumatic: where the shoulder is forced out of place.
  • Atraumatic: repeatedly stretching the shoulder over time causes it to edge out of place e.g. throwing or swimming.

 5. Acromioclavicular joint disorder(2)

The acromioclavicular joint is at the front of your shoulder. It’s a seperate joint to what is commonly termed ‘the shoulder joint’. It joins the collar bone (clavicle) to the front of the shoulder blade (acromion).

 Injuries to the acromioclavicular joint include:

  • Osteoarthritis aka “wear and tear”: the cartilage between the bones wear down.
  • Torn or stretched ligaments: the ligaments attach the two bones of the acromioclavicular joint together and get stretched with trauma or repetitive strain.
  • Dislocation: this is where the two bones of the acromioclavicular joint move out of position.

 6. Broken arm or collar bone(2)

After any impact to the bone a fracture should be checked for. This may be direct trauma (e.g. falling on the shoulder) or indirect (e.g. falling on to an outstretched arm) where the force can be transmitted to the shoulder.

Any patients at risk from weakened or brittle bones (osteoporosis) or have had previous fracture to the shoulder should have a fracture excluded.


This is a list of common, not all, causes of shoulder joint problems. Just as these can cause shoulder problems it can also stop them getting better.

  1. Wear and tear
  2. Repeated injury to the shoulder
  3. Repeated activities having your arm elevated
  4. Lack of movement (immobility) in the shoulder and shoulder blade
  5. Carrying bags over one shoulder or objects in one hand
  6. Breathing pattern disorders (see our previous blog)
  7. Poor posture: any postural faults can predispose to shoulder problems. The most common faulty posture associated with shoulder pain is where the shoulders become round and the head shoots forward. This is common in people working at computers. Previous blogs offer advice on how to correct this posture and measure up your computer workstation.

 Several illnesses can predispose to shoulder problems including(2): 

  1. Diabetes 
  2. Heart or blood vessel disease
  3. Lung disease
  4. Hyperthyroidism
  5. Dupuytren's contracture  


Osteopaths use a variety of techniques from massage, mobilizing and manipulation to address any injuries or postural faults affecting the shoulder. They can address areas of tightness (including myofascial trigger points mentioned above) and address imbalances. Osteopaths can also advise on lifestyle factors including posture and ergonomics and also advise on appropriate exercises.


(1) Parsons SBreen AFoster NELetley L,  Pincus TVogel SUnderwood M. Prevalence and comparative troublesomeness by age of musculoskeletal pain in different body locations. (2007)

(2) http://www.nhs.uk/Conditions/shoulderpain/Pages/Causes.aspx. Accessed 20.10.2016

(3) Carel Bron, Jan Dommerholt, Boudewijn Stegenga, Michel Wensing, and Rob AB Oostendorp. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain (2011)

(4) Girish, G., Lobo, L. G., Jacobson, J. A., Morag, Y, Miller, B. and Jamadar, D. A. 2011. Ultrasound of the shoulder: Asymptomatic findings in men. AJR Am J Roentgnol, 197, W713-9.

(5) Page P Labbe A. Adhesive Capsulitis: use the evidence to integrate your interventions (2010).


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