Let’s talk about one of the most functional, but prone to injury areas in the human body, the shoulder complex.

 Shoulder Anatomy

The shoulder is comprised of three bones – the Clavicle (collar bone), Scapula (shoulder blade) and the Humerus (arm bone), which articulate to create 3 separate joints. The Sternoclavicular (SC) joint, the Acromioclavicular (AC) joint and the Glenohumeral Joint (GH).

The “ball and socket joint” of the shoulder, which is an articulation between the humeral head (ball) and the glenoid fossa (socket), is aptly named the Glenohumeral joint. This joint has the most range of motion out of any joint in the human body, but that range of motion comes at a cost. That cost being instability.

In and around the shoulder are two groups of muscles that work synergistically to produce movement and stability. The intrinsic muscle group, the rotator cuff, surrounds the scapular and attaches onto the Humerus. It is involved with the intricate movements of the shoulder, such as rotation of your arm. It also helps stabilize the humeral head by “pulling” it into the glenoid fossa.

The extrinsic muscle group is comprised of muscles that originate from the torso and insert onto the bones of the shoulder. These muscles are responsible for the big, global movements of the shoulder, such as reaching above your head, swinging a golf club or throwing a ball.

Common Problems of the Shoulder

Because there are numerous structures that can cause pain around the shoulder, it can be difficult to ascertain the source of the problem. To reduce confusion, shoulder pain can usually be narrowed down to one of five categories:

1. Rotator Cuff pathologies
2. Instability – loose feeling shoulder
3. Stiffness – restricted range of motion
4. AC joint pain
5. Referred pain – pain travelling to the shoulder from another site

Rotator cuff pathologies (strain, tear, tendinopathy) will present with pain in the shoulder and decreased range of motion, especially rotation. A common symptom associated with rotator cuff injury is impingement. Impingement occurs when inflamed tendons get “pinched” in the subacromial space, which is a passageway formed by the acromion, coracoacromial arch and AC joint, and sits just above the Glenohumeral joint.  When reaching above your head or across your body, you may feel the pinching sensation through the front of your shoulder. Following a rotator cuff injury, simple tasks, like brushing your teeth, may feel like a monumental effort due to pain/weakness.

Shoulder Instability refers to the inability to maintain the humeral head (ball) in the glenoid fossa (socket). Damage to the ligamentous and/or muscular structures surrounding the shoulder can cause it to feel “loose”. Instability is commonly a result of repetitive overhead movements or a traumatic event such as a shoulder dislocation.

Shoulder stiffness is commonly felt after a shoulder injury and can indicate the shoulder is healing. When a shoulder progressively becomes stiffer over time, and you progressively lose range of motion, you may be dealing with adhesive capsulitis, “frozen shoulder”.

How to prevent shoulder injuries

If you want to avoid having an unstable, stiff or sore shoulder, there are a few principles to follow. Flexibility, rotator cuff strength, core strength and general strength around the shoulder are important in keeping your shoulders healthy. If your shoulders are healthy, you are less likely to suffer from shoulder injuries.

To help you out, I will provide a few simple exercises which only require you to have a theraband and a chair.

• Internal Rotation
  • Put a spacer, such as a rolled hand towel between your ribs and your elbow. Once the spacer is firmly in place, simply move your arm towards your body keeping that spacer in place. Move in a counterclockwise motion with your thumb pointed up towards the ceiling. When moving the arm, do not move your shoulder. For extra cueing, try in front of a mirror and use your opposite hand, touch your shoulder to keep it from moving.

• External Rotation
  • Put something in-between your ribs an elbow, such as a rolled-up towel. Holding onto the band, move your arm away from your body whilst holding the towel in place. Move in a clockwise motion with your thumb pointed up towards the ceiling. Do not move your shoulder.

• Lateral Raises
  • Engage by pinching your shoulder blades together. With your hands starting at your hips, move your arms towards the sky, ending in a T shape.

• Anterior Raises
  • With your hands together and thumbs pointing up, move your arms towards the sky, ending your hands as high as possible while keeping your shoulder blades together.

• Standing Scapula Pinches
  • Start with pinkies touching and thumbs pointing outwards. Try to keep the shoulder blades pinched together the whole time. Separate your hands as much as you can, keeping your elbows locked in. Try not to hike your shoulders at all

• Serratus Push ups
  • Palms flat against the wall, lock your elbows and squeeze your shoulder blades together then push up.

All together, these exercises take about 5 minutes to complete. You can either follow the rule of 3 sets, 10 reps each set, or you can complete each exercise until your arms/shoulders fatigue.

Having strong, healthy shoulders will make your life a lot easier. You use your shoulders so much, that they need to be strong to be able to deal with the demands of life.

Written by

Dr. Tim Roberts (Osteopath)