Hello and thank you for visiting my blog this week – Looking After Your Shoulders. Hopefully I am another week closer to opening my clinic doors again to see you and treat you in person.
This week I am going to talk a little bit about shoulders, so if there is anything you are suffering with in your shoulder, maybe I will be able to shed a little light on it for you. As ever, this will give you a point from which to go and research a little more yourself. Or to help you understand a little more about the function of your shoulder.
There are lots of words associated with shoulder injuries, from impingement to frozen, from bursitis to tear, each one requiring it’s own set of treatment and rehabilitation protocols, whether you visit a sports massage therapist or a physiotherapist or other health professional. Here is a little about the anatomy of your shoulder to aid your understanding, and then I will give an overview of some common shoulder issues.
There are three bones of the shoulder: the clavicle, the scapula (shoulder blade) and the humerus (upper arm). It is often called the shoulder girdle, but it is not a true girdle like the pelvis, because the shoulder girdle is not an attached circle of bones. There is a gap between the clavicles filled by the manubrium and the scapula ‘float’ on the back.
There are nine muscles involved with each shoulder, and four of these belong to the rotator cuff group. It is called the rotator cuff because of the way the four muscles ‘cuff’ the humerus bone of the upper arm and allow it to rotate without dislocation. Without these muscles, we would be useless with our arms because of the shallow nature of the shoulder socket. Unlike the hip, which is incredibly secure within a socket, without muscular aid, the shoulder merely sits next to its socket, and it is the muscles holding it in place.
Meet your rotator cuff:
Supraspinatus – attaches from the scapula to the greater tubercle of the humerus, this muscle initiates the abduction of the arm as well as stabilisation of the humeral head in the glenoid cavity.
Infraspinatus – attaches from the scapula to the greater tubercle of the humerus, this muscles externally rotates the arm, and stabilises the humeral head in the glenoid cavity.
Teres Minor – attaches from the lateral edge of the scapula to the greater tubercle of the humerus, this muscle externally rotates the arm and adducts it, and stabilises the humeral head in the glenoid cavity.
Subscapularis – attaches from the underside of the scapula to the lesser tubercle of the humeral head, this muscles internally rotates the arm as well as stabilises the humeral head in the glenoid cavity.
Ok… so that was a little mind numbing to read if you’re not sure about anatomical terms, but it didn’t escape your notice that all the muscles attach to the humeral head, that’s the top of the arm bone, and they all ‘stabilise the humeral head in the glenoid cavity’. The glenoid cavity is the shallow indentation upon the scapula bone where the humerus sits. If there were not the rotator cuff muscles there, the humerus would just slide off the glenoid cavity.
So, there you have it, the stabilising rotator cuff.
The other muscles of your shoulders to take into consideration are:
Deltoid – a thick triangular muscle covering the shoulder, allows abduction of the arm.
Teres Major – attaches from the scapula to the humerus and medially rotates and adducts the arm.
Those two arise and exist in the shoulder region itself. The following muscles assist the shoulder in its actions:
Serratus Anterior – attaches from the ribs to the scapula, aids in forward rotation of the arm.
Latissimus Dorsi – the largest upper body muscle, attaches from the vertebrae, scapula, and pelvis to the humerus and aids in internal rotation of the arm (think lat. pulldown)..
Pectoralis Minor – attaches from the ribs to the coracoid process of the scapula and stabilises the scapula.
Levator Scapulae – attaches from the vertebrae to the scapula and its action is to lift the scapula.
The following two muscles can contribute to shoulder pain:
Biceps Brachii – attaches from the coracoid process and supraglenoid tubercle (both in the shoulder) and aids flexion and abduction of the shoulder.
Triceps Brachii – attaches from the infraglenoid tubercle of scapula and aids adduction of the arm and extension of the shoulder.
Phew that was a lot of anatomy! But it was necessary for you to understand the sheer number of things happening at the shoulder. Consider for a moment the small area of space that there is between the bones of the shoulder and all the muscles that attach there and need space to operate. If one muscle is a little bit swollen because it has been injured or damaged in some way, then that can easily compress the other muscles, tendons and ligaments in the area and have a knock-on effect.
Issues at the Shoulder
Sprain – an injury to the ligaments of the shoulder
Strain – an injury to the muscles or tendons of the shoulder
Impingement – when a tendon rubs or catches on a nearby bone
Tear – a tear in the muscle, tendon or ligament and is characterised by discomfort in the shoulder even while resting
Instability – usually common in younger athletes who have not finished growing, when the ligaments or tendons get stretched beyond normal length and the shoulder feels ‘loose’
Frozen Shoulder – discomfort and stiffness in any of the normal ranges of movement in your shoulders
Bursitis – a swelling of one of the bursa in the shoulder
Most of the issues at the shoulder can be resolved with rest and strengthening exercises, but that does not mean you should assume that your shoulder issue can be solved in the same way.
Looking After Your Shoulders
You need to seek an official diagnosis of what the issue is, usually confirmed by ultrasound or another scan. Remember it might be an issue with one of the associated muscles that has an attachment in the shoulder region, rather than an issue with the shoulder itself. I see and treat a lot of biceps brachii tendonitis in clinic because of the strain this muscle takes during lifting activities, and the attachment it has in the deep shoulder area.
It’s a very quick way to get an idea of what is happening at your shoulders, when you visit me in clinic, because I can assess your range of movement and perform some tests to aid our understanding of what hurts and why. This information can help speed up your self-rehabilitation, or help your doctor understand what you need when you do get to see her/him.
I hope that this blog has helped you understand the mechanics of your shoulder a little better, there is such a lot to talk about when it comes to shoulders and even something like wearing an ill-fitting bra can contribute, or be the sole cause, of shoulder discomfort. Maybe even that heavy bag you always carry on one shoulder could be causing damage and discomfort? What about the repetitive movement you do with one arm for your sport, hobby, or job? And maybe the way your baby likes to be held in your arms has not helped the way your muscles are feeling. These are the sorts of questions and observations I make during an appointment to help ascertain what is happening to cause your discomfort and to help you solve it.
Thank you for reading – Looking After Your Shoulders and I hope to be able to treat you soon. As ever, pop over to my bookings page if you need an immediate online consultation to get you on the road to recovery.
See you on the other side, Chloe.