The sporting shoulder

The most commonly encountered clinical condition in general practice, and certainly the most common shoulder-related problem deserves some attention. Here we go through the actual pathology and revisit some myths that are causing way too many people to have unnecessary surgery.

Known since the time of Galen, shoulder instability remains a common cause of disability. Understanding the presentation of the most commonly seen forms of instability, and the associated morbidity, as well as understanding the rationale behind clinical decision-making for management – conservative or surgical is crucial. Additionally some myths will be cleared up regarding the scapula and rotator cuff in the genesis and management of instability.

The principal misunderstanding of SLAP injury relates to failure to adequately describe the anatomy of the superior labrum, and how this relates to the long head of the biceps. Additionally understanding the surgical descriptions of “pathology” in light of this improves our ability to discern true pathology from normal anatomy, and describe appropriate management.

Increasingly physiotherapists and other health care practitioners are distancing themselves from socalled “special tests”. This has led to a rise in the categorisation of patients as “non-specific…”. It will be argued that it is possible to actually reach a likely diagnosis through the use of special tests, but not in the manner which it has been traditionally taught.

A common masquerade of “impingement” pain is the A-C joint, especially in overhead active athletes, moreso in those involved in collision sports. Understanding the presentation of these patients as well as the physical examination associated with this helps inform the management of these patients.

Less common, but not to be missed are shoulder pain arising from the thoracis outlet as well as shoulder dysfunction from suprascapular neuropathy. The anatomy and examination of these patients along with suggestions for monitoring and progressing rehabilitation vary significantly from typical shoulder pain patients.