Why Does My Shoulder Hurt ?

Continuing on the same theme of “pain” from my last post, I felt it timely to highlight an excellent review on pain and the shoulder published in the British Journal of Sports Medicine from December 2013 (Dean, B; Gwilym, S and Carr,A: Br J Sports Med 2013;47:1095-1104)

As a Sports Physiotherapist treating shoulder injuries, one of the most common questions I am asked is “why does my shoulder hurt?”. The patient, in most cases, is hoping for a simple answer with a simple model of tissue damage = pain ; with the belief that correction of “what is broken will fix the pain”. Unfortunately research increasingly shows us that such a simplistic approach is… well-honestly- considerably too simplistic. I strongly urge the clinician with an interest in the sporting shoulder to read this excellent review which considers the role of 1) peripheral receptors, 2) nociception or peripheral pain processing , 3) the spinal cord , 4) the brain , 5) the location of receptors in the shoulder and 6) the neural anatomy of the shoulder. It is only when considering the complex nature of shoulder pain can one truly consider appropriately the variability in the clinical presentation, treatment and diagnosis of shoulder pain. For those of you interested in reading a guest post on this subject from one of the articles authors, this link from British based Sports Physiotherapist Adam Meakins makes excellent reading.

shoulder_MRI

Understanding Pain- Essential Education

painpain site 2There is no doubt that one of the greatest challenges for the clinician working in the field of musculoskeletal medicine is explaining to a patient the concept of chronic or persistent pain. I daily review investigations and findings which do not adequately explain many patients pain symptoms, only to be asked “if nothing’s broken, why do I have pain?” Even more difficult is the patient that is fixated on surgery as the answer for a painful condition where there is no evidence (beyond the presence of pain)for surgical intervention.
It is now well established that treatment approaches utilising a bio-psycho-social approach are far more successful, and do require an active education component on the nature of pain.

The Hunter Integrated Pain Service has produced a wonderful video resource explaining the nature of pain – well worth the time for the clinician and patient reviewing and planning management going forward. Equally useful is the ACI Pain Management Network education video.
For those who love written resources to assist patients and younger professionals, “Explain Pain” by NOI is in its 10th anniversary remains one of my all time favourites.