Understanding Shoulder Anatomy.

“The shoulder,” sounds like one joint but is actually comprised of four joints despite most symptoms being felt in only one.  The shoulder joints include the connection of the collar bone to the sternum, the connection of the collar bone to the shoulder blade, the relationship, not actual connection, between the shoulder blade and the rib cage and of course the ball and socket where the arm bone meets the shoulder blade.   

Shoulder pain is most commonly felt in the ball and socket.  The ball and socket is often compared to a golf ball on a tee.  However, both the ball and the socket are capable of moving and in all three planes.  Therefore, we prefer the analogy of a seal balancing a beach ball on the end of its nose like you might see at the circus.  This way we describe the key features of the ball being much larger than the socket and that both the ball and the socket are capable of moving. 

What Is The Main Cause Of A Shoulder Injury

The most infamous type of shoulder pain regards the rotator cuff.  Our rotator cuff gets unfairly blamed for a lot of shoulder pain.  The rotator cuff is a group of four small muscles that work to keep the ball centered in the socket while you use it.  When bigger arm muscles create movement, the ball wants to migrate out of or against the top of the socket, which can lead to inflammation and pain. Our rotator cuff constantly works to prevent this.   

Even though your rotator cuff may be inflamed, fraying or torn it may not be the culprit.  The shoulder blade itself needs to move appropriately too. Especially for overhead reaching, lifting, throwing, etc.  When the shoulder blade fails to move properly the rotator cuff tends to pay the price.  The rotator cuff gets the diagnostic label, the imaging, the injecting, etc but oftentimes is the innocent victim. 

Evaluating The Body As A Whole

There is no substitute for a good shoulder exam which will include all the component parts of the shoulder, the neck, the rib cage and breathing at a minimum.  We have treated many people who had shoulder pain due to dysfunction away from the shoulder. 

One favorite example was a man who had pain lifting overhead.  We got his glutes to stabilize his core better from below and pain went away like magic.  Those are always fun.  But they never happen without a complete whole body exam.  

If your shoulder pain is affecting your sleep we recommend using Proze "Nerve."  This topical cream works great and is non narcotic.  Here's a link where our patients can buy it at a discount. 


Shoulder Pain Does Not Mean Shoulder Problems

Just because you have shoulder pain does NOT mean you have a shoulder problem. No matter what your MRI says. Keep in mind many symptom free people have rotator cuff tears visible on MRI.

The percentage goes up as you age such that OVER 50% of SYMPTOMS FREE people 60 years old have cuff tears on MRI.  It’s not about your films it’s about you.  All of you.  Your body works as one whole unit. 

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