With Prom Health Osteopath, Xavier Gresch
Time for a bit of hip and shoulder! The shoulder is arguably one of the most complex regions of the musculoskeletal system. The region is in fact made up for four joints, not one. The shoulder joint is called the ‘glenohumeral joint’ (arm bone to shoulder blade), acromioclavicular joint (shoulder-blade to collar bone), sternoclavicular joint (collar bone to sternum) and scapulothoracic articulation. This last one isn’t actually a joint but simply the movement of the shoulder blade over the rib cage.
The glenohumeral joint has the most range of motion of any joint in the body. It is a ‘ball and socket’ joint, with a large ball from the arm bone and a small socket at the shoulder blade. Think of a golf ball on a tee. To achieve this range, the joint sacrifices stability for mobility, and therefore it’s also the most frequently dislocated part of the body.
There are 19 muscles that attach directly to the area, 7 ligaments, 6 bursa (a cushioning structure) and a plexus of nerves and blood vessels pass through as well. There are smaller, deeper muscles that as a group are called the rotator cuff and larger, more superficial muscles that create more powerful movements. All of the muscles need to work together to achieve ‘dynamic stabilisation’ which means three things: the ball part of the joint needs to stay in the middle of the socket, the tension from all sides needs to stay fairly equal, and the muscles need to be able to move the joint synergistically.
Three of the most common shoulder symptoms that we see in practice are:
- Pinching with reaching – we call this ‘shoulder impingement’. This typically involves soft tissue such as tendons or bursa getting pinched with shoulder movements.
- Numbness and tingling down the arm – typically nerves being compressed in the shoulder region.
- Pain at rest, laying or sitting – usually an inflammatory response to bursa or tendon damage. Lots of causes: e.g. shoulder impingement, over/underuse.
Seven fundamental truths about what we find in clinical practice are:
- Most shoulder issues can be attributed to excessive stiffness or strength in some tissues and weakness in others. The synchronicity has been lost.
- In the older population, underuse of the shoulder causes many tendon issues.
- Osteoarthritis (OA) of the shoulder affects up to 20% of the middle-aged and elderly. OA and symptoms are only weakly related. If symptoms are present, we often achieve significant improvement in function and symptoms.
- Poor posture contributes to shoulder issues. Try slumping and lifting your arms.
- Anti-inflammatories might help with shoulder pain but they won’t address the underlying issue.
- Daily activity isn’t enough to keep shoulders healthy. Being the most mobile part of the body, we rarely use its full-range, resulting in significant stiffness and weakness.
- Resolution of symptoms can be generally gained pretty quickly with the right treatment (typically manual therapy) and home-management. However, long-term health of the shoulder is generally dependent on regular strength training and stretching.
See our website www.promhealth.au for the article, anatomical images and further explanations.
