PART 2; Pain/discomfort/numbness... you name it. Anything bothering you around shoulder.

Let's just cut to the chase. I'll make decisions about the next steps and identify what could likely be causing your issues based on these 3 key factors

1. Subjective assessment (I will listen to your story & ask detailed questions about your previous injuries, when whatever is bothering you started, whether any specific movement/event triggered it or it developed gradually, random, medications, if the problem progressed, what makes it better/worse... there are many things to consider.

   
   

2. Objective assessment- performing a variety of tests (orthopedic, neurological, strength, range of motion etc.). These are mostly not conclusive on their own, but in clusters (more tests) and alongside everything else. Based on your potential sport/activity, age etc. I will adjust the tests accordingly starting more general and then moving towards more specific ones as I start building a clearer idea of what might be going on.

   
   

3. Any potential imaging results (MRI, CT, neurography...), direct notes from doctor. Now, this is tricky because even imaging is not 100% sensitive and can miss things or it can reveal certain structural ''abnormalities'' such as torn labrum/ rotator cuff tendons etc., which can be, but are also not always the direct cause of your pain (many people show structural changes on scans, yet remain symptom-free). For example, say you've been diagnosed with rotator cuff tear, the impact depends on the type of the tear (full-tendon, full-thickness tear or partial tendon, full-thickness tear etc.) *this is for separate debate specifically about cuff tears*, your sport, age, the overall condition of the surrounding structures...

   These rotator cuff tendons kinda all merge together into the joint capsule see pics (this could be one of the reasons why so many people even with full-thickness tears remain pain-free as there is lots of remaining intact tissues compensating for the structural changes). So simply identifying a tear doesn’t automatically mean surgery is required (see appendix, if you interested). What’s crucial is interpreting the imaging within the context of your symptoms, overall health, goals, and activity level rather than jumping to conclusions based on the scan alone. And just to finish off, everyone will have slightly different genetics and morphology (structural predispositions like hyper-mobility syndromes or disorders, shape of bones such as glenoid dysplasia etc.) which can all affect your shoulder functionality and condition and why your shoulder could be painful. It could be that you simply overloaded it (massive volumes of training, the capacity in your shoulder can't keep up), it could be biomechanical compensations which can become more important as you get more fatigued etc.

Now that I have gathered as much information as possible, this is where things get highly nuanced. Sometimes, solely the diagnosis will be more clear like with adhesive capsulitis (''frozen shoulder''). But other times, it’s much more complex. For example, what was once called "shoulder impingement" is now known as subacromial pain syndrome based on new evidence. We say that it's non-specific shoulder pain which doesn’t mean that there’s no structural cause—it means the pain could stem from multiple structures, making it difficult to pinpoint a single source. The important thing for you is that whether we call it impingement syndrome or subacromial pain, the treatment plan will often not differ, it just helps us explain you the things a bit better, for example: ''You have a shoulder which is quite pissed off right now, there is potentially some localised fluid in tendon causing the stiffness and soreness etc. because yadyyada... so instead of telling you that impingement is the main driver of your discomfort (as things get impinged in shoulders all the time and it's completely normal), we try to educate you a bit better in a reasonable way.

In conclusion, the diagnosis & condition of your shoulder can be influenced by a wide range of structural, functional (strength, assymetries*- again, very nuanced topic for another day which can be meaningful, range of motion...) and well because you are not a car but human being, also psycho-social factors that can affect in what condition is your shoulder.

Treatment options, specific injuries etc. will be discussed in the next parts :)

Appendix

There's research comparing outcomes of different treatments, and in some cases, non-surgical options might be equally effective or even preferable (topic for separate discussion as these studies are not always useful for athletes when they've done it on sedentary people & vice versa, we sometimes don't know what kind of rehab was done etc., so studies are important, just sometimes more, sometimes less).