Causes of chronic shoulder pain

Many of the shoulder injuries that we suffer from occur gradually overtime and are not caused by a fall or trauma to the shoulder.

Many of the shoulder injuries that we suffer from occur gradually overtime and are not caused by a fall or trauma to the shoulder.

Indeed an underlying dysfunction of the shoulder blade known as a SICK scapula is very often the cause of shoulder pain.

A SICK scapula is a dysfunctional muscular fatigue syndrome that leads to five common shoulder problems that are discussed below. The scapula (shoulder blade) forms a base for shoulder muscle attachment and houses the acromion bone which forms the ‘roof’ of the shoulder joint, hence it is a very important structure in creating stable joint mechanics at the shoulder joint.

Signs of a SICK Scapula

When viewing the left and right shoulder blade (scapulas), the dysfunctional scapula will be lower in height than the good scapula.

The inside border of the dysfunctional scapula will be positioned further away from the spine

Shoulder problems caused by a SICK scapula:

- Pain at the tendon attachment point of the Pectoralis minor tendon below the collar bone. This muscle becomes short and tight due to the forward leaning scapula. With repetitive overhead activity tendonitis develops.

AC joint pain when moving the shoulder due to stress caused in the joint from restriction in the rotational movement at the AC joint.

Subacromial impingement pain which occurs on the outside aspect of the shoulder when the arm is being elevated upwards.

Thoracic Outlet Syndrome which causes achy or tingling pain into the shoulder that refers into the forearm and further down into the small finger and index finger.

Neck pain located just below the base of the neck at the Levator Scapula tendon attachment to the upper corner of the shoulder blade (scapula). The abnormal low lying SICK scapula causes an over tensioned stretch on this tendon that leads to neck pain.

and treatment:

Once a SICK scapula has been clearly identified in a person presenting with shoulder or neck pain then the objective is to reposition the scapula in its 
healthy and normal position by releasing the abnormal tightness in the pectoralis minor muscle of the chest region and strengthening the weak muscles of that attach to the back of scapula. This will serve to free up movement in the shoulder joint thus releasing stress in the Thoracic Outlet and AC region.

Tomás Ryan is a registered physical therapist (MIAPT) with the Irish Association of Physical Therapy and is based in Clonmel and Thurles.

Contact 0504 26672 or email