Anatomy of an Injury – Shoulder
Over the last three weeks we have discussed the three various types of injuries, injuries associated with the Ankles & Knees, Core & Back. This week we will look at the injuries associated with the Shoulder and how to offset with strength training & flexibility. Before we discuss the muscles and how they create movement, it is important that you understand where your pain is originating from and the specific muscles associated with that movement. The terminologies are straight physiology, but please refrain from becoming distracted by the terms. Instead, become a student of what muscles create the movement that you may have associated with pain. Typically, most athletes are not aware of the fact that they are actually over strengthening what is already tight and neglecting the other muscles associated with movement. Additionally, flexibility and trigger point therapy is usually overlooked which can help offset pain associated with movement.
Your shoulder is made up of three bones: the clavicle (aka collarbone), scapula (aka shoulder blade) and humerus (the long bone that inserts into your shoulder joint). Additionally, the shoulder is made up of three joints: sternoclavicular, acromioclavicular & glenohumeral joint.
Sternoclavicular: the junction between your sternum (breastbone) and clavicle (collarbone).
Acromioclavicular: the junction between your scapula (shoulder blade) and clavicle
Glenohumeral: the junction between the humerus and scapula (as referred to as the shoulder joint)
The shoulder joint is one of the most flexible joints in the body because of six specific movements that can take place in the shoulder girdle.
Flexion: raising your arm forward in front of the body and up (like raising your hand to answer a question)
Extension: lowering your arm after raising a question; bringing your hand back down to your side
Abduction: raising your arm directly up from your side (like you are flapping your arms like wings)
Adduction: lowering your arm back down to your side (second half of your flapping wings)
External rotation: rotating your hand away from your midline of the body rotating outward
Internal rotation: rotating your hand towards your midline of your body
The muscles of the shoulder can be broken into four categories:
- Shoulder Pivoters (upward & downward pivoting motion, elevation & depression, retraction and protraction of the shoulder blade). Muscles involved: trapezius, rhomboids, serratus anterior and pectoralis minor
- Shoulder Protector (also referred to as the rotator cuff is responsible for rotational movements at the shoulder joint). These muscles are responsible for stabilizing the shoulder joint which is a ball and socket joint. These muscles act dynamically against forces that keep the ball centered in the joint. Muscular strength & flexibility imbalances within these small muscles creates compensation which inhibits these muscle from performing stabilization (the shoulder protectors will sacrifice stability for mobility), resulting in injury. Muscles involved: supraspinatus, infraspinatus, teres minor and subscapularis.
- Humeral Positioners are the primary muscle involved in changing the position of the entire arm; it drapes over the upper portion of the shoulder joint and divided into three divisions. Muscles involved: anterior (flexing & internally rotating the shoulder joint), middle (abduction – lifting the arm to the side) and posterior deltoids (extension and external rotation)
- Humeral Propellers: these are also referred to as the power generators of the arms and shoulders. Muscles involved: latissimus dorsi and pectoralis major. Pectoralis major contracts and pulls on the humerus, creating flexion, extension, adduction and internal rotation. Latissimus dorsi attaches on the humerus, and when it contracts movement includes extension, adduction and internal rotation of the shoulder.
Source of Shoulder Pain:
- Dislocation: according to the Mayo Clinic, a dislocation is an injury to a joint — a place where two or more of your bones come together — in which the ends of your bones are forced from their normal positions. This injury temporarily deforms and immobilizes your joint and may result in sudden and severe pain.
- Tendonitis: tendinitis is inflammation or irritation of a tendon — any one of the thick fibrous cords that attaches muscle to bone. The condition causes pain and tenderness just outside a joint. While tendinitis can occur in any of your body’s tendons, it’s most common around your shoulders, elbows, wrists and heels.
- Bursitis: Bursitis: is a painful condition that affects the small fluid-filled pads — called bursa that act as cushions among your bones and the tendons and muscles near your joints. Bursitis occurs when bursa become inflamed. Bursitis often occurs near joints that perform frequent repetitive motion.
- Rotator Cuff Tears: Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a network of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
There are different types of tears:
- Partial Tear. This type of tear damages the soft tissue, but does not completely sever it.
- Full-Thickness Tear. This type of tear is also called a complete tear. It splits the soft tissue into two pieces. In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon.
Impingement syndrome: occurs when there is impingement of tendons or bursa in the shoulder from bones of the shoulder. Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome. Examples include: painting, lifting, swimming, tennis, and other overhead sports. Other risk factors include bone and joint abnormalities. With impingement syndrome, pain is persistent and affects everyday activities. Motions such as reaching up behind the back or reaching up overhead to put on a shirt, for example, may cause pain.
How to Handle Shoulder Pain
Dislocation: If you suspect a dislocation, seek prompt medical attention to return your bones to their proper positions without damaging your joint. When treated properly, most dislocations return to normal function after several weeks of rest and rehabilitation. However, some joints, such as your shoulder, have an increased risk of repeat dislocation.
Tendinitis: tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. But most cases of tendinitis can be successfully treated with rest, physical therapy and medications to reduce pain.
Bursitis: Treatment typically involves resting the affected joint and protecting it from further trauma. In most cases, bursitis pain goes away within a few weeks with proper treatment, but recurrent flare-ups of bursitis are common.
Rotator Cuff Tears:
Rest: limit your overhead activities and let pain be your dictator – if what you are doing hurts, stop!
Non-steroidal anti-inflammatory medication: ibuprofen to reduce pain and swelling
Strength training: strengthening the various muscles that support the shoulder and create movement will eliminate imbalance related inflammation and swelling.
Flexibility & trigger point therapy: by getting the range of motion of each muscle back to normal, this will reduce the tension on the attachments and reduce the risk of injury.
In addition to taking medications, daily stretching & trigger point therapy after a warm shower will help. You should work to reach your thumb up and behind your back. Avoid repetitive activities with your injured arm, particularly activities where the elbow would move above shoulder level.
Flexibility Exercises for Back Strength
Prior to exercising, complete 10 minutes of sport specific activity. After these 10 minutes, complete this upper body stretching sequence & few trigger point therapy exercises.
Shoulder & Back Strength Exercises
Click here for various exercises associated with your upper body strength and muscular balance. Choose the specific exercise based on your historical pain associated with movement. Strive to complete 2 sets x 8 to 10 repetitions with 30 seconds rest after each exercise. Keep in mind that some exercises may not be
One of the biggest causes of muscle tears is chronic dehydration. As a general rule of thumb, strive to consume half of your body weight in ounces of filtered, cold water (i.e. 150 pound athlete x .5 = 75 ounces) plus what you typically lose during exercise. If you would like a copy of my Sweat Rate Calculator, please email me and request Sweat Rate Calculator in your subject line.
Next week we discuss: The Anatomy of an Injury: Elbows & Wrist. If you have any questions or need anything clarified, please email me directly.
Until next time, Train Smart-Not Hard!