Why does my shoulder hurt?   January 1st, 2014

Dean et al. recently reviewed the neuroanatomical and biochemical basis of shoulder pain. Shoulder pain is often a very challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. As shoulder pain is very common in the physiotherapeutic clinical practice, a vast understanding of pain processing could enlarge the specificity of the patients’ diagnosis and steer treatment. 

The effective diagnosis and treatment of shoulder pain relies not only upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also a comprehensive understanding of how pain can be generated, propagated and modified in the human body. Consequently, the authors provide a clinical advise towards a reasoned management plan for the patient’s pain. E.g. a history of the pain radiating down the arm and the presence of ‘light touch’ hyperalgesia around the shoulder are both features of central sensitization pain. 

The review of Dean et al. also provides a rationale for the lack of reliable diagnostic tests for many shoulder pathologies. They state that this can be explained by mechanosensitivity changing as a result of any form of periarticular inflammation with the majority of nociceptive fibres showing increased mechanosensitivity. This means that any cause of inflammation in or around the shoulder may give rise to the so-called ‘irritable’ shoulder joint.

Finally, treatment options for shoulder pain (nonspecific for shoulder pathologies) are addressed. First they formulate advises regarding pain assessment, as well as quality of life assessment. Next, the importance of maximising the placebo effect is explained. Finally, treatment options such as acupuncture, physiotherapy and surgery are addressed in terms of their effect on pain processing. 

Filip Struyf 

2014 © Pain in Motion

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