There are many different problems within the shoulder that can cause pain. These are the most common:

Instability
The shoulder has a wide range of movement and requires the joint to have sufficient movement at allow normal shoulder function. The downside to this flexible joint is that following trauma or after repeated shoulder movements (e.g. prolonged swimming, throwing a javelin or just poor posture for many years), it is possible to lose the control of shoulder movement and a catching pain on certain activities may be elicited. The shoulder still has its normal range of movement, but the patient complains of a ‘catching’ pain and /or ‘clicking’ in the shoulder. This abnormal movement of the shoulder can produce structural damage to the joint and if conservative treatment fails, surgery may be indicated.

Treatment is aimed at restoring the correct shoulder control around the joint (and surrounding joints) and addressing weakness of specific muscles within the shoulder that provides dynamic stability to the joint. Re-educating correct upper limb function is also important to prevent future problems and help the person manage their problem more effectively. Success is judged by returning you to your normal functional state, be that climbing to international standard or just being able to reach for objects ion a top shelf.

Impingement
This is usually catching of a shoulder tendon or muscle as it passes through a narrow opening within the shoulder joint. The problem may be the result of trauma or, more commonly, repeated stress on the shoulder following poor posture in which the shoulder moves forward (or protracted) when sitting at a computer or desk. Symptoms are experienced as the arm is moved away from the body (abduction) and often worse at 80 to 100 degrees of movement (an ‘arc’ of pain).

Treatment restores the normal control of the shoulder and prevents the tendon ‘impinging’ on specific structures within the shoulder. This may include mobilising stiff joints, strengthening weakened muscles and re-educating faulty movement patterns in symptomatic directions.

Stiff Shoulder
Shoulders become stiff for many reasons and it is important to exclude the neck or thorax as a source of the problem. ‘Frozen shoulder’ is caused by tightening of the sac surrounding the shoulder (or capsule) and this condition is hard to manage and people can have symptoms for years. Fortunately, most stiff shoulder problems (including many diagnosed incorrectly as ‘frozen shoulder’) are easily treated by mobilising the shoulder and home stretching exercises. Incorrect shoulder movement during a specific activity, e.g. lifting at work or playing a specific racquet sport can cause structures in the shoulder to tighten and produce symptoms. Pain is usually encountered at the end of the available range, for example reaching to a high shelf or using a hairdryer.