What’s causing your shoulder pain?
This is always a difficult question, due to numerous problems that could happen and the fact that the shoulder is made up of several boney, muscular, and ligamentous structures. Let's start off with a little anatomy review.
The shoulder is made up of three large muscles collectively called the deltoids, 4 rotator cuff muscles, and several other muscles.
The deltoids individually are the anterior deltoid, medial deltoid, and posterior deltoid. These muscles help the arm with flexion (moving forward), abduction (taking the arm away from the body), and extension (bringing the arm back behind the body).
Four muscles together make up the rotator cuff. This is commonly, incorrectly, called the rotator cup or rotary cup. The rotator cuff is made up of the supraspinatus, infraspinatus, teres minor, and subscapularis. Together they stabilize the shoulder, hold the head of the humerus into the glenoid cavity, and maintain the shoulder joint.
Other muscles related to the shoulder are:
Triceps brachii, which is the large muscle in the back of the upper arm that helps straighten your arm.
Pectoralis major, which is a large fan-shaped muscle that stretches from the armpit to the collarbone and down across the chest. Although it seems like a chest muscle, it also is a very important shoulder muscle which helps with bringing the arm towards the body and inwardly rotating your arm.
Pectoralis minor which is the smaller pec muscle that fans from the upper ribs to the shoulder. The pec minor can draw the shoulder down, or the shoulder blade (scapula) upwards.
Teres major runs under the shoulder and helps rotate the shoulder upward.
Biceps brachii, known as the bicep muscle, is a thick muscle that rests on top of the humerus and rotates the forearm and also flexes the elbow.
Latissimus dorsi, usually just calls the lats, is a flat rectangular muscle of the back that helps rotate the arm and move the arm away and closer to the body.
So why are you having shoulder pain? This is a loaded question as you can see the overwhelming amount of muscles that could be part of the problem.
Some problems include:
Shoulder pain coming from the deltoids. This could be a strain or caused from trigger points in the muscle belly. Trigger points are when the muscle binds up in one spot making a knot. Think of it like a wrinkle in a fabric.
Bursitis, which is inflammation of the bursa (a fluid-filled space) and tendons, which connect your shoulder muscles to your upper arm bone.
A rotator cuff tear which could be in any of the four rotator cuff muscles listed above. A rotator cuff tear occurs when the tendons of the rotator cuff separate from the bone. Tendons are the ends of the muscles which attach the muscle to the bone. As such, when a muscle pulls too much they can tear this anchor (tendon).
Frozen shoulder, also called adhesive capsulitis. Frozen shoulder is a common condition that leads to stiffness of the joint and sometimes constant pain, or just discomfort when reaching behind your back or head. A true frozen shoulder limits motion so much that even when stretching the joint is very hard or impossible to move.
Bicep tendonitis which usually causes pain that develops gradually at the front of the shoulder that moves down over the biceps muscle. The pain is often worse with repetitive lifting, carrying heavy bags, or overhead activities.
Other causes could be Bicep Tendon Rupture, SLAP Tears (Superior Labrum Anterior Posterior tear), Shoulder Osteoarthritis, AC Arthritis (arthritis of the place where the clavicle meets the acronium, which is the hard, pointy spot on the top of the shoulder), Shoulder Instability, and Shoulder Dislocation.
What this laundry list of possible problems mean is that it’s incredibly hard to diagnose exactly what is going wrong. So, what do you do?
First, did the pain come on gradually or suddenly? If pain came on gradually, especially if performing a task that cause repetitive movements, then that narrows it down. Most commonly, this leads to tendonitis or trigger points in a muscle. Ice will help relieve tendonitis, as it decreases inflammation. Helpful hint: any medical word ending with itis means inflammation. If it’s an overworked or tight muscle, then heat will be helpful. Why? Because when a muscle gets tight, it narrows blood vessels. Heat opens these back up and allows the muscle to get fully nourished again.
If pain came on suddenly, especially after a movement, lifting, or injury, you’re at a higher risk of having a sprain, strain, or even a complete tear.
This is all very overwhelming, I know. So, what should you do? If pain persists then your best option is seeking medical care. The internet is not your friend, as it offers far too much information, causing even more confusion than all the information above.
So, some simple rules:
Pain comes on suddenly = use ice and rest.
Pain comes on slowly, especially after work = use heat and rest.
Pain after a traumatic event, like a slip, fall, or car accident = see your doctor.
To help prevent or reduce pain from all of the above, you can do this: Stabilizing Shoulder Exercises.
Why? When the shoulder is stable and the muscles are strong, your risk of injury or all the problems above go down significantly. Also, many injuries only get better after performing Stabilizing Shoulder Exercises.
So, what are these? Here’s a list of some of the best:
Shoulder circles- Hold arms out at sides like you’re a bird and make small arm circles until the shoulders are tired.
Prone flexion- lay on stomach with arm hanging over edge of bed. Raise arm up to ear like you’re Superman flying.
Prone abduction- lay on stomach with arm hanging over edge of bed. Raise arm up to the side like you’re a bird or an airplane.
Prone extension- lay on stomach with arm hanging over edge of bed. Bring arm backwards towards your hip.
Prone rows- lay on stomach with arm hanging over edge of bed. Keep elbow bent and pull arm up at the side like you’re pulling on a lawnmower cord or rowing.
Wall push ups- with feet away from the wall, and hands up on wall at shoulder’s width apart, lower face towards wall and then push back out.
Many people get obsessed with the ‘show muscles’, which are the muscles that becoming bulky and good looking; but they forget all the other shoulder muscles. What happens when one muscle becomes too strong and one too weak? Well, think of strapping a fridge to a trailer, only you didn’t tighten one side enough, and the other side you tightened as far as it could possibly go. What will happen? Most likely while bouncing down the road, the straps won’t keep the fridge stable and it will tip. The same can be said of the shoulder.
So, what’s causing your shoulder pain? Or should we ask: what started that led to the shoulder pain? Imbalance.
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