The Shoulder

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Shoulder Mechanics

Whether throwing a ball, paddling a canoe, lifting boxes, or pushing a lawn mower, we rely heavily on our shoulders to perform a number of activities. Normally, the shoulder has a wide range of motion, making it the most mobile joint in the body. Because of this flexibility, however, it is not very stable and is easily injured. The shoulder is made up of two main bones: the end of upper arm bone (humerus) and the shoulder blade (scapula). The end of the humerus is round, and it fits into a socket in the scapula. The scapula extends around the shoulder joint to form the roof of the shoulder, and this joins with the collar bone (clavicle). Surrounding the shoulder is a bag of muscles and ligaments. Ligaments connect the bones of the shoulders, and tendons connect the bones to surrounding muscle. Four muscles begin at the scapula and go around the shoulder, where their tendons fuse to form the rotator cuff. When the shoulder moves, the end of the humerus moves in the socket. Very little of the surface of the bones touch each other. Ligaments and muscles keep the humerus from slipping out of the socket and keep the clavicle attached to the scapula.

To keep shoulders healthy and pain-free, it's important to know how to spot and avoid common injuries.

Recommended Treatments for Shoulder Injuries

Signs that you should seek treatment include:

1. Shoulder pain that persists beyond a few days

2. Recurring shoulder pain, even if it has a history of settling on its own

3. Inability to carry objects or use the arm

4. Injury that causes deformity of the joint

5. Shoulder pain that occurs at night or while resting

6. Inability to raise the arm

7. Swelling or significant bruising around the joint or arm

8. Signs of an infection, including fever, redness, warmth or swelling

Dr. Rodwin can assess your shoulder problem and will recommend treatments specific to your issues based on her diagnosis which may include: chiropractic adjustments, massage therapy, Active Release Treatment, acupuncture, stretches, etc. It is very important to seek out treatment early on before the problem becomes a chronic issue.

Common Injuries of the Shoulder

Bursitis: The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff. Bursitis is an inflammation of a fluid-filled sac, or bursa that lies between tendon and skin or between tendon and bone. Normally a bursa protects the joint and helps make movement more fluid.

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Rotator Cuff Tear: A Rotator cuff tear occurs when the tendons of the rotator cuff separate from the bone. Surgery is sometimes necessary for this condition.

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Shoulder Instability: Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition

Shoulder Dislocation: A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.

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Shoulder Separation: Also called an AC separation, these injuries are the result of a disruption of the Acromio-clavicular joint. This is a very different injury from a dislocation!

Arthritis: Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery. Arthritis is a gradual narrowing of the joints and loss of protective cartilage in the joints about the shoulder.

Frozen Shoulder: Also called 'adhesive capsulitis,' this is a common condition that leads to stiffness of the joint.

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Motions of the Shoulder Explained

Normal movement of the shoulder requires fluent action at four different joints and these often are out of alignment with shoulder problems.

• Scapulo-thoracic Joint: Movement of the scapula (shoulder blade), gliding on the rib cage and with the thoracic spine (midback).  Normal motion is: for every 2/3 of gleno-humeral elevation (shoulder), there is 1/3 of scapulo-thoracic (midback with shoulder blade) elevation. Movements occurring here include elevation/depression, retraction/protraction and superior/inferior rotation. When someone undergoes a shoulder injury their body adapts and switches the mechanics from 2/3 shoulder motion to 1/3 shoulder motion and from 1/3 midback-shoulder blade motion to 2/3 midback-shoulder blade motion. Commonly this movement is not fixed completely for patients that have shoulder problems and this is the main reason why their problem does not go away.  The thoracic spine (mid back) needs to be treated as well to aid in resolving their shoulder issues.
• Acromio-clavicular Joint: Movement about this joint is very slight- but this synovial joint actually allows small amounts of superior and inferior glide.  When this goes out of alignment there can be discomfort or pain in the front of the shoulder.
• Sterno-clavicular Joint: This refers to the joint of the acromion at the manubrium of the sternum. Movements allowed here include elevation/depression, anterior/posterior translation and small amounts of rotation.  Problems in this area can lead to discomfort/pain in the front or the upper back area.
• Gleno-humeral Joint: Movement of the head of the humerus in the glenoid fossa.  Problems with this joint can lead to muscle imbalances and tightness in the muscles in the shoulder.

It is important with shoulder problems to evaluate the motion of all these shoulder joints to aid in resolving the shoulder problem.