Shoulder Injuries

Shoulder pain can present as a result of repetitive overuse, sudden direct or indirect trauma (FOOSH injury) or sustained incorrect postures and/or positions (sleeping prone with arms in flexion, abduction and internal rotation).

Patient will present with signs and symptoms of;

• Weakness
• Instability
• Clicking/Clunking
• Subluxation
• Pain (sharp, dull, deep, superficial, throbbing)
• Tension
• Tenderness
• Swelling
• Restricted movement (direction will depend on specific diagnosis)

Without the aid of advanced imaging, it can be difficult to identity the specific tissue/s in lesion, the severity of the injury, and the prognosis.

There are however many orthopaedic tests that have high specificity and sensitivity, that practitioners can use to formulate a differential diagnosis. Some of these include:

• Empty Can Test (Jobe’s Sign – Supraspinatus)
• Infraspinatus Resisted Test
• Subacromial Impingement Testing
• Infraspinatus ERLS Test
• Hornblower’s Sign – Teres Minor Testing
• Belly Press Test – Subscapularis Tear (Upper fibres)
• Bear Hug Test – Subscapularis Tear (Lower fibres)
• O’Briens Test – Anterior Labral Tear & Superior Labral A-P Tear
• Speed’s Test – Bicipital Tendinopathy
• Yergason’s Test – Bicipital Tendinopathy & Transverse Humeral Ligament Rupture
• Sulcus Sign – Inferior Glenohumeral Instability

The common neuromusculoskeletal diagnoses for injuries of the shoulder include:

• Scapular instability (winging)
• Labral tears
• Rotator cuff tears and/or strains
• Ligament tears and or strains
• Dislocations and/or subluxations
• AC joint strains
• SC joint strains
• Impingement syndrome
• Bursitis injuries
• Overlying muscle tissue strain
• Brachial Plexus Irritation

Depending on the diagnosis and the severity of the shoulder injury, patients may respond well to a conservative manual approach involving:

• Soft tissue therapy
• Passive joint mobilisation
• Musculoskeletal dry needling
• Advanced taping techniques (rigid taping and/or kinesio taping)
• Progressive injury rehabilitation