1. Wendy Emberson MCSP Consultant Physiotherapist Shoulders Have you got a chip on your shoulder? Stort Physio Academy Jointworks Seminars 12th January 2015 Stort Physio Jenkins Lane Bishops Stortford Herts CM22 7QL 01279 654020

2. Shoulder pain?

3. Non of these pains is coming from the shoulder! Problems with the main shoulder joint give pain that starts BELOW the joint. So if you have pain that you feel in these areas, then it is more than likely coming from the neck. A detailed clinical examination gives us the information to identify which structure is causing your pain.

4. The Shoulder Joint These are the structures that make up the shoulder joint.

5. Referred pain The problem is that the shoulder joint is supplied by the Median nerve that comes from the middle of the neck. This means that as far as your brain is concerned, it feels pain in the area of the shoulder and even the arm, so it cannot identify whether the pain is coming from the neck or the shoulder! It needs a clinical examination that puts all the possible structures under selective tension to identify the problem.

6. Pain never goes up! Almost all pain is never referred up. In this instance, if you have pain above the shoulder then it is not coming from the shoulder joint. It has to be coming from a structure higher up. Another example is Tennis Elbow - if you feel pain in the upper arm ie above the elbow, then it is coming from the shoulder, or the neck.

7. Things that can go wrong at the shoulder Fractures

8. Dislocations

9. Impingement syndrome There are some key muscles around the shoulder that are essential to good and pain free movement. These are known as the Rotator Cuff group and they push the top of the arm DOWN as you lift your arm. This allows the top of the arm bone to slide under the joint between the collar bone and the shoulder blade. They also rotate the arm inwards and outwards. If one or more of the tendons to these muscles gets stretched or damaged, then this mechanism fails and the tendons can become "impinged" as they pass under the bony arch above the main shoulder joint.

10. Pain from the neck The examination of the neck. We apply the same method of examination to the neck, which includes looking at how the joints in the neck move; what is the feeling at the end of range; what movements reproduce the pain. We also carry out neural dynamic tests that tell us whether the nerve is able to slide and glide, as it should, or whether it is being caught as it emerges from the spinal cord on the side of the neck. There are 3 main nerves that we look at and these are the Median, Radial and Ulnar nerves.

11. The examination of the shoulder The same principles apply here. Selective tension applied to all the various structures that could cause the pain are tested to find which reproduce the pain. A key point here is that it takes about half an hour to carry out a full examination of the shoulder. The same for the neck. So you should allow an hour to really find out the cause of your pain. Doctors do not have the time are generally the skills, to carry out these tests and they are more reliable than X-rays or MRI.

12. Preventative exercises Six by Six series At Stort Physio we use these exercises as a solid foundation to keep all the muscles around the shoulder and the upper back and neck, strong and working well in order to help prevent injury. We discussed the value of good posture to allow the shoulders to work in the best mechanical position, and to make sure the neck sits at the right position on the trunk and shoulders. Our FREE ASSESSMENT scheme is on offer to anyone who wants to know where their pain is coming from and whether we can help. 01279 654020