Posted on 12-15-2016
The shoulder part 2
So in the first part of the article we talked about the shoulder and its anatomy. Now on to the clinical gems accumulated after treating shoulders for 21 years.
First, stuff moves. The humerus has a range of motion, the shoulder blade has a range of motion and the clavicle as a range of motion.
The scapula moves roughly one degree for every two degrees of shoulder motion in abduction (moving the arm straight away from the side) when the arm starts moving. This needs to be evaluated. The scapula allows for powerful shoulder movement. Sometimes the scapula becomes fixed in place or too mobile in cases where it wings out or flares. Instability here greatly undermines power. You cant fire a cannon from a canoe, you need stability to use shoulder power.
The clavicle rotates back with arm motion and forward as the arm comes back. The clavicle attaches at two points, distally(away from the body) at the AC joint and proximally (closest to the body) at the sternum. You need to check both places for distortion.
The humerus itself moves a lot and the ball actually moves front to back and up and down in the socket which is called called glide.
When ranges of motion are distorted the function of the shoulder as a whole begins to be compromised. These could lead to pain, loss of power or loss of mobility, often all three. A person can identify a site of pain, but again, you need to look at that and beyond to find where the underlying causes are.
The common thing everyone jumps on is the rotator cuff, and although the rotator cuff may be injured especially the supraspinatus, that generally occurs after the dysfunction is established. The supraspinatus fails because it is working in a compromised position in a chronic shoulder. The supraspinatus is the most commonly torn rotator cuff muscle because of its weak anatomical position and herculean task it performs. Complicate this by placing the humerus in a poor position and the mechanical disadvantage multiplies and things break.
Two most overlooked muscles in a chronic shoulder are:
Subscapularis- a rotator cuff muscle on the inside surface of the shoulder blade. Imagine laying on your back with you arm up along the side of the your head. The subscapularis would be sitting against the back wall of the arm pit attaching to the humerus. Technically the subscapularis is an internal rotator but it is so much more. The subscapularis is really the dynamic stabilizer of the shoulder and keeps the ball, or head of the humerus depressed in the shoulder socket. When the subscapularis is not functioning properly the humeral head can ride up into the fossa and begin to grind, pinch or rub against the tendons of the other rotator cuff muscles, eventually the ball will begin to rub until the joint begins to break down and degenerate. A saw a lady with chronic subscapularis problems a few weeks ago. He shoulder joint was very badly degenerated as a result. I was able to restore a good amount of her lost mobility by treating the subscapularis and the next overlooked muscle. Her pain level decreased 80% in a few weeks because the pressure of the humerus rubbing was greatly reduced.
Subclavius a tiny muscle under the clavicle. Improper function can stop the clavicle from rotating during arm motion and block shoulder glide from front to back. These are two muscles I find myself working quite a bit, as part of a shoulder protocol and checksheet to uncover all the problem areas when someone say "my shoulder hurts here".
Things such as scapula and clavicle motion are not evaluated in some cases, but they are almost always part of a chronic shoulder condition. Simply adjusting the shoulder can help a great many people recover normal motion quickly, but its the tiny little details that are the difference between a chronic painful shoulder and a well functioning one.
This past weekend at a grappling seminar I evaluated a guy's shoulder. He told me he had a torn labrum, and I believed him, but after checking him I found that his shoulder problem was not related to his labrum, it had apparently healed, but his shoulder was out of normal balance. I worked the two overlooked issues, and a tendon insertion from the supraspinatus. After about 5 minutes of work I had him move it. He looked at me like I was doing sorcery, as his arm moved completely through the normal range of motion without pain. He said "what the hell did you do to me" and I said "its a secret" unless of course you read this article, then it isn't
Do you have a chronic shoulder issue? Have you been told it is one thing or another? Want to find out if there is help for you?
Dr Anthony Talorico
Call Us 724 443 8444
There are no comments for this post. Please use the form below to post a comment.