The shoulder is a complex structure that must simultaneously be mobile and stable enough for the wide range of motion needed during arm and hand movements like pulling, pushing, and lifting. Although a tremendous asset, the broad range of motion provided by the shoulder can also be a drawback since it increases the risk of shoulder injuries.
Anatomy Of The Shoulder
The three main bones of the shoulder are the scapula, humerus, and clavicle. The humerus is the long bone in the upper arm. The scapula, also called the shoulder blade, is the irregularly triangularly-shaped bone that that connects the humerus with the clavicle. The clavicle, also called the collar bone, is the small curved bone that can be felt running crosswise from the base of the neck to the top of the arm.
There are three synovial joints in the shoulder:
1. Glenohumeral joint
This is the synovial ball and socket joint that’s formed by the head of the humerus (ball) and the glenoid fossa surface of the scapula (socket). The socket is deepened by a fibrocartilaginous area called the glenoidal labrum or glenoid ligament. An articular joint capsule envelopes the joint. Inside this capsule, articular cartilage covers the ends of the humerus and scapula to help prevent friction between the bones. There are also a number of bursae sacs inside the joint - subdeltoid bursa, subcoracoid bursa, subacromial bursa, coracobrachial bursa, and subscapular bursa. The bursae help cushion the joint and further help to prevent friction between bones. The coracohumeral ligament; superior, middle and inferior glenohumeral ligaments; and transverse humeral ligament hold the joint together and keep it stable.
2. Acromioclavicular joint
This is the gliding synovial joint at the top of the shoulder that’s formed by the clavicle and the acromion process of the scapula. Like the glenohumeral joint, this joint also has a joint capsule, articular cartilage, and bursae to help prevent friction between the surface of the joint bones. The acromioclavicular ligament, coracoclavicular ligaments, and coracoacromial ligament hold the joint together and keep it stable.
3. Sternoclavicular joint
This is the saddle synovial joint. It connects the clavicle with the sternum (breastbone). This joint is a little different than the other two joints. A fibrocartilagenous articular disc divides the joint into two distinct synovial cavities, each with a separate synovial membrane. The joint is supported by the anterior sternoclavicular ligament, posterior sternoclavicular ligament, interclavicular ligament, and costoclavicular ligament.
The muscles of the shoulder include the following:
* deltoid
* serratus anterior
* subclavius
* pectoralis minor
* sternocleidomastoid
* levator scapulae
* rhomboids
* trapezius
* rotator cuff muscles
Tendons attach muscles to bones. Some of the most important tendons of the shoulder are the tendons of the rotator or rotor cuff. The rotator cuff is comprised of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles and their tendons. This tendon and muscle network forms a covering around the head of the humerus and is instrumental in holding the humerus bone inside the shoulder joint as the arm moves. The rotator cuff muscles and tendons are responsible for raising the arm from the side and rotating the shoulder. The subacromial bursae are situated over the rotator cuff tendons and protect the tendons from the overlying acromion process.
Another important tendon is the biceps tendon that travels from the biceps muscle to the shoulder and inserts at the glenoidal labrum on the glenoid.
The shoulder also has an extensive nerve ( radial, ulnar, and median nerve) and blood supply
What Causes An Injury To The Shoulder?
As should be evidenced by the brief anatomy overview above, the composition of the shoulder is nothing less than complex. The shoulder depends on the ligaments, muscles, bursa, tendons, bones, and so forth working together to keep it stable and provide adequate range of motion to complete hand and arm tasks. Injuries to these structures are common in sport-related activities, but can occur in everyday life as well. Repetitive use, misuse, overuse, degenerative or disease processes, and traumatic injury from falls or car accidents are common sources of shoulder injury and pain. Shoulder issues may also arise after periods of shoulder immobility.
What Are Some Common Shoulder Injuries And Sources Of Shoulder Pain?
Frozen Shoulder / Adhesive Capsulitis
This is a disorder effecting the shoulder capsule of the glenohumeral joint. The joint becomes inflamed, painful, and feels stiff. The condition typically slowly progresses through three stages over a period of months or years:
1. Painful stage - certain movements or jarring of the shoulder causes pain. Range of motion is limited. Pain is usually worse at night and in cold weather conditions.
2. Frozen stage - while pain lessens, stiffness and range of motion limitations worsen.
3. Thawing stage - range of motion slowly begins to improve.
The exact cause of frozen shoulder isn’t known, but certain factors seem to increase the risk of developing frozen shoulder - previous injury or trauma to the shoulder, rheumatoid arthritis, existing diabetes, and previous arm or shoulder surgery that required arm immobilization.
Dislocated Shoulder
A dislocated shoulder happens when a fall or shoulder impact forcibly displaces the head of the humerus from the socket. This occurs at the glenohumeral joint . The dislocation may be in a forward, backward, or downward position and can be a partial or complete dislocation. The majority of shoulder dislocations are anterior, meaning the humerus has been displaced to the front of the joint. This causes shoulder spasms, pain, swelling, bruising, and weakness. Other symptoms may be present if the force of the impact also damages the ligaments, tendons, and nerves of the shoulder.
Shoulder Separation
A shoulder separation occurs at the acromioclavicular joint between the clavicle and acromion. The injury usually occurs from a direct blow or fall that impacts the top of the shoulder. The impact causes the clavicle to be forced away from the acromion. Shoulder separations can involve fracturing of either bone, but is most often a soft tissue injury (sprain) to the ligaments of the joint.
Rotator Cuff Strains
The tendons and muscles making up the rotator cuff may be strained. A strain is the abnormal stretching or tearing of tendon and/or muscle fibers. This may be caused by a forceful, sudden, and violent muscle contraction; a single traumatic impact to the shoulder; or the cumulative effect of a degenerative processes, such as from frequent repetitive overhead motions. Tendinitis, which is tendon inflammation, and bursitis, which is bursa inflammation, are also common rotator cuff injuries and may lead to strains.
Strengthening Exercises
These Shoulder Exercises are ideal to build strength and flexibility.
Massage Treatment
These Shoulder Massage Techniques are of great value in pain relief; circulation stimulation; dispersing blood and fluid accumulations; swelling reduction; and relaxing muscle spasms, especially when used alongside the Sinew Therapeutics liniments, soaks and massage oil.
ACUTE STAGE SYMPTOMS AND TREATMENT
This stage is characterized by swelling, redness, pain, and possibly a local sensation of heat, indicating inflammation. If coolness makes your pain feel better, then the Acute Stage Treatment is recommended.
ACUTE STAGE SYMPTOMS:
The acute stage starts the moment an injury occurs and lasts until the swelling and inflammation are gone. The swelling is the result of the blockage of blood, tissue fluids and circulation in the shoulder because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating; blood and fluids back up behind the injured shoulder, causing pain, inflammation, lumps and swelling.
The sensation of heat is due to the warming action of the blood and fluids overheating in the injured shoulder as they back up and accumulate. Stiffness and decreased mobility are due to spasms in tendons and ligaments that have contracted reflexively beyond their normal range from the impact of the injury.
As ligaments and tendons stretch and tear, blood from ruptured blood vessels becomes trapped in the local tissues. As the trapped blood clots up, it sticks the tissues together creating adhesions. Adhesions cause pain, inflammation and restricted movement because the layers of tissue that used to slide smoothly across one another now adhere and snap which interferes with normal functioning. It is essential to break up clotted blood as quickly as possible to prevent adhesions and scar tissue from forming.
During the acute stage it is very important to restore normal circulation to the shoulder, break up clotted blood and stagnant fluids, reduce swelling, and reduce the redness and heat associated with inflammation. By restoring the flow of blood, fluids, and circulation in the shoulder, then pain is relieved, damaged tissues can regenerate with healthy functional tissue, and the shoulder can strengthen and regain it's mobility.
ACUTE STAGE TREATMENT:
1. Apply the Sinew Herbal Ice on your shoulder to reduce redness, swelling, and inflammation while dispersing accumulated blood and fluids to help restore normal circulation to the shoulder. This first-aid treatment is used in place of ice to significantly speed up the healing process. It reduces the swelling and inflammation more effectively than ice, allowing you to more quickly regain range of motion. Acute Sinew Liniment can be used in-between applications.
Ice is not recommended because it does not help repair damaged tissues and keeps everything in the injured area frozen, causing the stagnation of blood and fluids and the contraction of muscles, tendons and ligaments. In Chinese sports medicine ice is not used and is considered a culprit in injuries that don’t heal well.
2. Massage your shoulder with Acute Sinew Liniment to relieve pain, reduce swelling and inflammation, break up clotted blood and stagnant fluids, and stimulate circulation of blood and fluids to help cells quickly repair damaged tissues. Sinew Herbal Ice can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
CHRONIC STAGE SYMPTOMS AND TREATMENT
This stage begins once the swelling and inflammation are gone, but you still feel pain, stiffness, weakness, and/or sensitivity in cold and damp weather. If heat makes your pain feel better, then the Chronic Stage Treatment is recommended.
CHRONIC STAGE SYMPTOMS:
The chronic stage begins once the swelling and inflammation are gone, but you still feel aching pain and stiffness. This is because there are still accumulations of stagnant blood and fluids in your shoulder that are blocking circulation and blood supply to damaged tissues, creating residual pain, stiffness and weakness. You may actually feel hard nodules like sand in the tissue, indicating accumulation, calcification, and adhesions, which all cause pain, stiffness, and joint instability.
Your shoulder may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. When you move your shoulder you may hear a clicking or popping sound from the tendons and ligaments slipping very slightly in and out of their natural alignment indicating weakness and joint instability, causing chronic pain and a cycle of reinjury. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.
Increasing circulation and blood supply to the damaged tissues is very important in treating chronic injuries because tendons and ligaments do not have an extensive direct supply of blood. That is why chronic injuries can be slow to heal. Increasing local circulation also prevents cold and dampness from penetrating the injured area, preventing pain and stiffness.
During the chronic stage it is very important to break up remaining accumulations of blood and fluids, and increase circulation and blood supply to the damaged tissues. By increasing circulation and blood flow in the shoulder, then pain and stiffness is relieved, and the tendons and ligaments can strengthen to restore stability.
CHRONIC STAGE TREATMENT:
1. Massage your shoulder with Chronic Sinew Liniment to relieve pain and stiffness, strongly stimulate circulation and blood flow to damaged tissues, and promote the healing of overstretched tendons and ligaments. Sinew Injury Poultice can be used in-between applications.
2. Apply the Sinew Injury Poultice on your shoulder to relieve residual pain and stiffness, significantly stimulate circulation and blood flow to damaged tissues, and further promote the healing of overstretched tendons and ligaments. The Sinew Injury Poultice is particularly useful if your shoulder is more painful in cold and damp weather. Chronic Sinew Liniment can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
