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Shoulder Pain Unveiled: A Detailed Examination of Etiologies, Evidence-based Therapies, and the Role

Updated: Jun 3, 2023


mathieu zelechowski physiotherapist osteopath in courchevel treating a shoulder

The shoulder, a ball-and-socket joint with an extensive range of motion, is ingeniously designed yet susceptible to a multitude of injuries due to its structural complexity. Shoulder pain, a widespread musculoskeletal complaint, can stem from various etiologies. This article provides a comprehensive overview of these causes, delves into the therapeutic options grounded in scientific research, and elucidates the roles of physiotherapy and osteopathy in managing shoulder pain.

Unraveling the Etiologies of Shoulder Pain

  1. Rotator Cuff Disorders: This term encompasses several conditions affecting the rotator cuff, a group of muscles and tendons vital for shoulder stability and movement. Key disorders include:

    • Tendinitis: Chronic overuse or acute overload can trigger tendon inflammation. This condition presents as pain and stiffness exacerbated during overhead activities.

    • Rotator cuff tears: These can be partial or full-thickness, often resulting from trauma or age-related wear and tear. Symptoms include sharp pain and muscle weakness.


  1. Adhesive Capsulitis or Frozen Shoulder: A poorly understood condition characterized by a gradual increase in shoulder pain followed by a progressive loss of motion. It tends to affect those aged 40-60, with a higher prevalence in women and people with diabetes.

  2. Osteoarthritis: This degenerative joint disease involves the erosion of cartilage, the body's natural cushion between bones. In the shoulder, it leads to joint inflammation, pain, and limited mobility.

  3. Fractures: These occur commonly in the clavicle (collarbone), humerus (upper arm bone), or scapula (shoulder blade), typically due to trauma, resulting in severe pain, swelling, and bruising.

  4. Impingement Syndrome: Here, repetitive overhead motion leads to the "impingement" of the rotator cuff tendons and subacromial bursa against the bony scapula, causing pain and limited range of motion.

The Clinical Efficacy of Physiotherapy in Shoulder Pain

Physiotherapy forms a crucial element in shoulder pain management. This non-pharmacological intervention starts with a comprehensive assessment followed by an individualized treatment protocol.

  1. Therapeutic Exercise: The American Physical Therapy Association (APTA) endorses exercise as the principal intervention in managing shoulder pain. It includes:

    • Range of Motion (ROM) Exercises: These aim to maintain joint flexibility and counteract stiffness. Passive ROM exercises are initiated early, progressing to active-assisted and active ROM as pain subsides.

    • Strengthening Exercises: These are particularly vital for rotator cuff disorders and include isometric exercises and dynamic strengthening exercises using resistance bands.


  1. Manual Therapy: This includes joint mobilization and soft tissue massage. Systematic reviews have shown that combining manual therapy with exercise can improve pain, function, and quality of life in patients with shoulder pain.

  2. Modalities: These are used to manage acute pain and inflammation. Options include cryotherapy, thermotherapy, and transcutaneous electrical nerve stimulation (TENS), though exercise and manual therapy typically form the mainstay of treatment.

Osteopathy: A Comprehensive Approach to Shoulder Pain

Osteopathy takes a holistic, whole-body approach, assessing the shoulder within the broader context of overall health, posture, and lifestyle.

  1. Osteopathic Structural Assessment: This encompasses a detailed evaluation of body symmetry, alignment, and biomechanics, aiming to identify structural imbalances that may contribute to shoulder pain.

  2. Osteopathic Manipulative Treatment (OMT): These hands-on techniques aim to restore normal joint movement, improve muscle flexibility, and enhance circulation. Several studies suggest that OMT, when combined with standard care, can improve pain and function in various musculoskeletal disorders, including shoulder pain.

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