Catching/Clicking Shoulder

The shoulder has many structures that can cause catching and clicking around the shoulder region.

Catching pain/clicking in the shoulder is most common when you abduct the arm out to the side and up towards your head. Some patients describe a clicking sensation with or without pain around 60-130 degrees. If pain is felt during this arc of movement it is called a painful shoulder arc. This could mean one of many pathologies such as calcific tendonitis, bursitis, rotator cuff tendinopathy, a bony spur or a combination of them all (see Impingement Syndrome).

If pain is absent then it could be a control issue, due to poor posture, weakness and a muscle patterning issue (the way you move and what muscles you use). This is sometimes referred to as stability or motor control.

The shoulder blade and rib cage is a well-documented site associated with clicking, sometimes referred to as scapular-thoracic instability or clicking scapulae. In our experience, this is less likely to be associated with pain and more the sensation of clicking or crunching at the back of the patient’s shoulder. The cause is generally due to the shape or curvature of your mid-back – scoliosis – (thoracic spine), rib cage shape, posture and overactivity of some of the larger muscles around the shoulder such as your pectorals or latissimus dorsi. Clicking scapular seems to be more prevalent in younger females.

Again physiotherapy is the front line treatment for both of the above presentations and will look closely at muscle length, posture re-education, muscle strength around the shoulder and muscle imbalances. The British Journal of Sports Medicine in 2014, state that ‘for pain, exercise was superior to non-exercise control interventions and that specific exercises were superior to generic exercises‘. They also found that ‘Manual therapy was superior to placebo and when combined with exercise, manual therapy was superior to exercise alone. Extracorporeal shockwave therapy (ECSWT) was superior to sham and tape was superior to sham.’

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