Kerys Holding – 25/10/2019
Assignment task
With reference to appropriate literature, explain why a person with acute
inflammation following a recent musculoskeletal injury to their glenohumeral joint
capsule may experience shoulder pain.
You must include a reference list in MMU Harvard format as part of your submission.
The reference list is not included in the two-page word limit.
LO1 Explain the pathology and clinical features of selected pathologies of the
upper quadrant with reference to the structure and function of the upper quadrant
LO5 Support clinical decision making with reference to appropriate, relevant and
contemporary evidence
The glenohumeral joint is complex with low stability to allow for a large range of
movement. The head of the humerus sits in the glenoid fossa created a ball and
socket synovial joint known as the glenohumeral joint. Only one third of the head of
the humerus articulates to the glenoid fossa at any one time, the glenoid labarum
increases the stability of this articulation. It is a fibrocartilaginous band that
articulates between the head of the humerus and glenoid cavity to increase the
depth of the glenoid fossa and therefore increases stability (Carmichael and Hart,
1985). It is also the attachment site for ligaments and tendons such as the bicep
tendon (Trantalis, 2010). The glenohumeral joint as a whole is supported by a
capsule that surrounds it, the capsule has a laxity or axillary fold to allow for full
range or movement and flexibility. However, the laxity of the capsule also causes
instability in the joint and increases the risk of dislocation (Henderson, 2015). The
glenohumeral joint is then supported by rotator cuff muscles (Supraspinatus,
Subscapularis and Infraspinatus) which help compress the head of the humerus into
the glenoid fossa; as well as larger muscles such as deltoids, pectoralis major and
minor, and latissimus dorsi which produce larger movements at the shoulder.
(Trantalis, 2010). Ligaments in the glenohumeral joint such as the coracohumeral
and coracoacromial ligaments also increase joint stability by holding the head of the
humerus in the glenoid fossa, and ligaments such as the coracoclavicular and the
acromioclavicular ligaments anchor the clavicle to also add stability to the joint.
Despite mechanisms and structures in place to keep the joint a stable as possible,
the glenohumeral joint is very unstable. Injury is common in the shoulder and
inflammation of the joint will cause a patient pain.
When an injury is detected by cells, chemokines send signals to the brain that nonneural cells have been damaged, this is known as nociceptive pain and is acute
(IASP, 1994). The signals received at the brain from the chemokines then trigger
mast cells and macrophages to release chemical mediators such as histamine and
bradykinin (Watson, 2012), which change the size of the gap between capillary
endothelial cells, allowing plasma proteins to move from the capillaries to the
interstitial spaces. In turn causing a loss of osmotic pressure, the net flow of
inflammatory exudate fluid is now greater into the interstitial space, this is what is
known as swelling. Inflammatory exudate is important in the removal of toxins and
allows antibodies and plasma proteins which promote tissue repair. Neutrophils and
Kerys Holding – 25/10/2019
macrophages also dispose of debris and bacteria in the area via phagocytosis
(Suvas, 2017)
This will cause pain in the patient as when the chemical mediator are released they
stimulate nerve endings, when the area is acutely inflamed the body will perceived
these signals as pain until the inflammation reduces (Choi, 2017). In conclusion the
best treatment for this patient will be acute inflammation treatment including ice,
compression and elevation. The body’s inflammatory response is a vital process of
tissue repair and while reducing inflammation can be helpful for comfort, it is
imperative that the body has time to follow the tissue repair cycle for the most
effective healing.
536 words.
Reference list:
Carmichael, S.W. and Hart, D.L. (1985). Anatomy of the Shoulder Joint. [Online]
[Last accessed 22nd October 2019]
https://www.jospt.org/doi/pdf/10.2519/jospt.1985.6.4.225
Godfrey, H. (2005) Understanding pain, part 1: physiology of pain. British Journal of
Nursing, 14(16), p. 846-852.
Henderson, R. (2015). Shoulder Dislocation. [Online] [Last accessed 22nd October
2019] https://patient.info/doctor/shoulder-dislocation
Merskey, H. and Bogduk, N. (1994) Part III: Pain Terms: A Current List with
Definitions and Notes on Usage. In: Classification of Chronic Pain, Second Edition,
IASP Task Force on Taxonomy, 209-214.
Suvas, S. (2017) ‘Role of substance P neuropeptide in inflammation, wound healing,
and tissue homeostasis.’ The Journal of Immunology, 199(5), pp.1543-1552.
Trantalis, J. (2010). Anatomy of the shoulder (glenohumeral joint/scapulo-thoracic
joint). [Online] [Last accessed 22ng October 2019]
https://healthengine.com.au/info/anatomy-of-the-shoulder-glenohumeraljointscapulo-thoracic-joint
Watson, T. (2012) Tissue repair. [Online] [Last accessed 8th October 2019]
http://www.electrotherapy.org/modality/soft-tissue-repair-and-healing-review