Shoulder Pain, Injury & Rehabilitation
By far and away the most common thing we see in clinic are shoulder associated issues. Every day we hear terms like ‘Frozen Shoulder’, ‘Impingement’, ‘Rotator Cuff’, ‘Biceps Tendon’ and ‘Dislocation’. However, I have found the understanding of these does not match up whatsoever with the perceived understanding and a bit of education can really help people to feel informed, empowered, positive, confident and encouraged. So, let’s dive in!
Anatomy
Shoulder strength, power, range of motion and function rely on the labrum, ligaments, capsule and rotator cuff / scapular muscles for both dynamic and static stability. Objectively, one might say that due to its anatomical make-up it should be a much more unstable joint but these structures work very well together to make it very stable and prevent regular dislocation etc.
Static Stabilizers:
- The Anterior Band of the Inferior Glenohumeral Ligament which attaches to the labrum and glenoid fossa prevents anterior translation and subluxation
- The Posterior Band of the Inferior Glenohumeral Ligament which attaches to the labrum and glenoid fossa prevents posterior translation
- The Glenoid Labrum itself is a ring of thick, dense, fibrous tissue that increases the diameter of the cavity by up to 75%
Dynamic Stabilizers:
- The Rotator Cuff muscles act in co-ordination to keep the head of the humerus (upper arm bone) in the glenoid (socket) therefore reducing dislocation
- The Supraspinatus, Infraspinatus, Teres Minor and Subscapularis work symbiotically and synergistically against the Deltoid muscle to maintain humeral head position during abduction
Scapulohumeral Rhythm
- For the shoulder to function smoothly and effectively the scapula stabilizers listed above work together at three main joints to achieve ‘scapulohumeral rhythm’.
- Glenohumeral Joint
- Scapulothoracic Joint
- Acromioclavicular Joint
- This movement should be in symmetry, well-coordinated and smooth
- Abnormalities in this are usually due to weakness, poor motor control, shortening or involuntary adaptation of the aforementioned muscles for a variety of reasons we will discuss later.
- The muscles that control the scapula are:
- Pectoralis Minor
- Levator Scapulae
- Rhomboids
- Serratus Anterior
- Trapezius
This importance of a little anatomical knowledge is stated above but will become more understandable and relevant as we delve into the clinical perspective and practical approaches to shoulder issues tomorrow. I’ll finish today by saying strengthening and training the scapular stabilizers following shoulder injuries should be used by all experienced clinicians and your own healthcare professional.