Stiff shoulder? Limited range of motion? Let's not forget pain! More than 9 million people each year visit their doctor for shoulder problems. Why is this so common?
First of all let's understand the shoulder a little more. The "shoulder bone" is composed of 3 separate bones: the humerus, clavicle, and scapula.
Most people understand that the humerus is the upper arm. At the top of the humerus is the humeral head, which has a couple pointy parts on one side and a round smooth aspect on the other. The rounded part fits into the other bone, the scapula, at the glenoid fossa forming the glenohumeral joint (a.k.a. the shoulder joint). The clavicle is a long slender bone above the shoulder that acts as a strut for movement, as well as a spot for multiple muscles to attach to. The clavicle also protects nerves and blood vessels that lie directly behind it.
Four muscles start from the scapula and wrap around the head of the humerus to form the rotator cuff. These are the supraspinatus, infraspinatus, subscapularis, and teres minor. They give the humerus the strength to move around in whatever direction we please. Rotator cuff tears account for more than half of all the visits to the doctor for injuries regarding the shoulder. They are, by far, the most common shoulder injury we see in Radiology.
Virtually all patients with rotator cuff injuries present with pain during movement of the arm or shoulder. This is because the upper arm moves by way of the 4 muscles of the rotator cuff. Their function is to contract and pull the arm in the desired direction.
When one of these muscles are damaged the patient usually has pain that is specific to the directional function of the specific muscle. For example, the supraspinatus muscle is the major muscle responsible for lifting the arm up and directly away from the body. When this muscle is torn the patient presents with pain when raising the arm. This is actually the most commonly torn muscle in the rotator cuff.
Rotator cuff tears can present in different grades but can be lumped into 2 different categories: partial tear and full thickness tear. A partial tear is the most common type. The muscle tendon is torn (injured) but still attached to the humeral head. These types of injuries can be seen with trauma to the shoulder or from repetitive motions that wear on the cuff. Partial tears typically respond well to conservative treatment like physical therapy and steroid injections. The only time surgery is needed is if the patient is not responding well to treatment or if the pain is intolerable.
A full thickness tear, as the name implies, is a type of injury in which the tendon is completely torn off the bone or from itself. These types of rotator cuff tears require surgery 100% of the time for a full recovery. Without surgical intervention the muscle will retract and the patient will never recover 100% of their strength and function in that shoulder. Although partial tears can eventually turn into full tears, full thickness tears are normally the result of trauma to the shoulder.
Figure 1A is an example of a fully intact supraspinatus muscle tendon. 1B shows a partial tear and 1C shows a retracted full thickness tear. In an MRI, edema (fluid), indicating damage, shows up as bright signal (In T2 imaging). Notice the fully intact supraspinatus tendon has little to no signal. The partial tear demonstrates moderate signal within the muscle and tendon. The fully torn supraspinatus demonstrates significant edema within the muscle and tendon extending into other portions of the shoulder girdle.
The shoulder joint is part a group of unique joints in the body classified as ball and socket joints. These joints are, by far, the most versatile type of joint. Since there are no bony structures to stop movement, ball and socket joints are free to move is virtually any direction. Although more restricted by the pelvis, the hip joint is another example of a ball and socket joint.
Between the respective ball portion and socket portion there is a small fibrous structure that helps stabilize the joint by deepening the socket and allowing for a greater range of motion; this is called the labrum. Although the labrum is an integral part of a healthy shoulder, we image a great deal of patients with labral injuries.
Labral injuries are common in patients that use their arms in a strenuous repetitive motion. A perfect example is a baseball pitcher. The stress from the arm grinding from one side to another on the the larbum against the glenoid fossa causes it to fray and tear off the scapula. Weight lifters who perform a lot of bench press and military press can also develop labral tears.
Traumatic injuries,including shoulder dislocations, can also cause labral tears.
Figure 1A and 1B are the same image with different MRI weightings. The labrum looks like a small triangular structure on the anterior and posterior part of the shoulder joint (on an axial MRI image). It is supposed to be flat on the glenoid. As you can see, it has torn off and fluid has filled the space between.
Other common shoulder problems include tendonitis and bursitis, which can affect any tendon or bursa sac in the shoulder. These types of injuries can be nagging but rarely require surgical intervention. A little TLC and conservative treatment goes a long way in these instances.
Shoulder injuries can be a tough on a patient. Choosing a doctor who has experience in the management of shoulder care can make all the difference when it comes to the duration and severity of shoulder pain. One of the first steps in a proper diagnosis is to get X-rays and an MRI to see what exactly is happening.
You can improve nagging shoulder pain by being pro active! You can prevent further injury as well and improve the strength of the shoulder muscles and shoulder joint.
Here are a few simple exercises you can do with a couple light resistance bands. Please also refer to the pictures and the text on the pictures for additional details.
The first set of movements will have essentially the same starting point but will finish in 3 different final positions: Close to your body and low, away from your body and at the level of your rib cage, and finally up overhead and away from your body in a "Y" position.
Do 5 to 10 reps for 5 rounds, as you do these keep the movement slow and controlled always keeping the back engaged and the shoulders suppressed.
Each of these movements will mobilize and strengthen your shoulder as well as strengthen the rhomboids and other accessory back muscles.
Keep in mind throughout the movements to stay engaged, suppress your shoulders letting them drop down, and pinch your shoulder blades or scapula's together.
Tie off two light resistance bands on a stable structure as in the picture below.
Starting Position: For the first two finishing positions you will keep your palms facing out as you perform each motion. For the final finishing position over head you will keep you palms facing back until the very end as you finish over head (shown in the picture). Grab the band on the left with the right hand and the band on the right with the left hand, so the bands will cross.
Below is the in between phase of the low pull, as you pull through the movement stay engaged. In all of the movements stay focused and visualize your muscles as they work and get stronger.
Finishing Position 1: Do 5-10 reps of this lower pull x 5 rounds.
Finishing Position 2: Do 5-10 reps of this midway pull x 5 rounds. Note: This is a little more challenging to keep your shoulders suppressed, focus and fight to keep them down.
Finishing Position 3: Do 5-10 reps of this overhead pull x 5 rounds.
Bonus Movement / Exercise for a strong healthy rotator cuff!
In Between Phase
Finishing Position - Rinse & Repeat
Below are some illustrations of Rotator Cuff Anatomy:
Performing these basic exercises will help strengthen your shoulder joint as well as all the muscles that support it. Throw these into your workout schedule 2 or 3 times a week and improve your shoulder mobility and strength. If you have any question about these movements please send us a message on FB or through our website.