The Elegance and Complexity of Our Shoulder

By | May 12, 2021

By: Barbara Fahmy, MS OTR MPA

ClearLight Writing and Editing Services, LLC

Human shoulders are an intricately designed combination of muscles, ligaments, bones and joints. We often take them for granted as they allow us to do amazing things such as pitch a fastball, lift our children up high, fix the overhead fan, and saw wood for the fireplace. Such movements require the strength and mobility of the joints and bones, but also the elasticity and flexibility of many muscles and tendons.

These biomechanical marvels however, are subject to some notable downsides. A myriad of shoulder injuries, both sudden (acute) and cumulative, can rapidly interfere with our daily self-care activities, work tasks, and athletic pursuits.
In this article, the healthcare team at Accelerate Physical Therapy in Arvada Colorado describes several common shoulder injuries that can plague sports enthusiasts, busy parents, and construction workers alike. We also delve into the related anatomical and biomechanical factors that can lead to shoulder problems. In addition, we inform you on PT rehabilitation and what you can do to remain in the best physical shape possible so that you can maintain a busy and active life.

Bones, Joints, Ligaments, and Muscles
The shoulder joint is also called the glenohumeral joint. It is a ball-and-socket joint that attaches the upper arm (humerus) to the shoulder girdle. The bones of the shoulder girdle, the scapula and clavicle, provide a foundation for the glenohumeral joint. The complex combination of related muscles and ligaments allow our shoulders the high status of being the most mobile joints in the human body.1
This is why, under normal circumstances, we can do everything from lifting boxes over our heads, to shoveling snow, to swimming. Sometimes, however, our shoulders do not want to function normally. Pain, stiffness, and disease can come about for a number of reasons. Read on to learn about some common shoulder conditions, causes, and treatment strategies.

Common Shoulder Conditions
Labral Tears
The superior labrum is one of the structures that keeps the humerus safely placed within the shoulder socket when we do our daily activities. With repetitive, high-impact use, it can become frayed, or even tear. Physical therapy includes strengthening the rotator cuff muscles around the shoulder to further protect the labrum.2
If the tear is complete, this would be called a SLAP lesion, standing for: Superior Labrum Anterior-to-Posterior. Although surgery is sometimes recommended for complete tears, levels of success can vary.3 You may be able to avoid surgery though, by tuning into any pain and soreness early on and getting involved in a regular exercise program. It’s also important to keep all of the muscles of the shoulder and upper arm as strong as possible.

Rotator Cuff Disorders
There are four muscles that comprise the rotator cuff: supraspinatus, infraspinatus, teres minor, and subscapularis. All of them originate on the scapula (shoulder blade) and attach to the humerus (upper arm). Injuries to the rotator cuff are undoubtedly the most common of all of the shoulder injuries and can be quite painful. They can be caused by a traumatic event, such as a fall or shoulder dislocation. Injury can also occur due to repetitive issues, for example overhead work, or sports activities. People with diabetes or diseases affecting the connective tissue can also be subject to rotator cuff injuries.

Shoulder Impingement Syndrome
Rotator cuff disease is sometimes accompanied by shoulder impingement syndrome: either as one of the causes or a result. Other culprits may include bone spurs or osteoarthritis. Usually, a fall or excessive high-intensity use of the shoulder can lead to swelling and irritation of the rotator cuff. Bony prominences such as the tip of the shoulder blade (acromion) pinch or impinge upon the rotator cuff muscles. This leads to yet more inflammation and restriction of movement. 5,6 As the cycle of inflammation and decreased movement continues, normally active and healthy individuals experience a progressive decrease in abilities to perform even simple daily tasks, such as putting on overhead shirts and blouses.

Frozen Shoulder
Also known as adhesive capsulitis, frozen shoulder sometimes occurs after periods of immobilization with injuries such as a fracture, stroke, or having to wear a cast. Thick, hard adhesions develop after a period of inflammation that eventually restrict shoulder range of motion. People with diabetes can also be prone to this disorder. Occasionally, frozen shoulder occurs after some surgical procedures.

The knowledgeable, skilled, and caring therapists at Accelerate Physical Therapy are here to help you stay strong and flexible.  We will collaborate with your physician, surgeon and everyone on your health care team to make sure that you receive the best care physical therapy treatment possible.

Contact Accelerate Physical Therapy in Arvada, CO for pre- and post-surgical rehabilitation, prevention, and injury management.  (303)421-2210.

-Barbara Fahmy, MS OTR MPA

ClearLight Writing and Editing Services, LLC

REFERENCES

1) Shoulder Structure, Function, and Problems. Retrieved from:  https://www.healthpages.org/anatomy-function/shoulder-structure-function-and-problems/#:~:text=The%20shoulder%20is%20not%20a%20single%20joint%2C%20but,girdle%20includes%20three%20bones%E2%80%94the%20scapula%2C%20clavicle%20and%20humerus.

2) Sears, B. (2020, May 11). Rehabilitation of a shoulder labrum tear: Physical therapy after a labrum tear in the shoulder. [Blog Post].  Retrieved from: https://www.verywellhealth.com/physical-therapy-after-a-shoulder-labrum-tear-2696539.

3) Familiari, F., Huri, G., Simonetta, R., McFarland, E.G. (2019). SLAP lesions: Current Controversies. Shoulder & Elbow, 4. Retrieved from: Retrieved from: https://online.boneandjoint.org.uk/doi/epub/10.1302/2058-5241.4.180033

4) Aboelmagd, T., Rees, J., Gwilym, S. (n.d.) Rotator Cuff Tears: Pathology and Nonsurgical Management. Retrieved from: https://www.sciencedirect.com/science/article/abs/pii/S1877132718300356.

5) van Rijn, R.M., Huisstede, B.M.A., Koes, B.W., Burdorf, A. (2010). Associations between work-related factors and specific disorders of the shoulder – a systematic review of the literature. Scand J Work Environ Health 2010;36(3):189-201. Retrieved from: https://www.researchgate.net/publication/41112763_Associations_between_work-related_factors_and_specific_disorders_of_the_shoulder-A_systematic_literature_review.

6) (Author). (n.d.) Shoulder Impingement. Retrieved from: https://www.healthline.com/health/shoulder-impingement.

7) Mayo Clinic. Frozen Shoulder. (n.d.).  Retrieved from: https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/diagnosis-treatment/drc-20372690.

8) Konarski, W, Pobozy, T., Hordowicz, M., Pobozy, K., Domanska, J. Current concepts of natural course and in management of frozen shoulder: A clinical overview. Orthopedic Reviews, 12: 8832. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874955/pdf/or-12-4-8832.pdf

9) Shoulder Structure, Function, and Problems. Retrieved from:  https://www.healthpages.org/anatomy-function/shoulder-structure-function-and-problems/#:~:text=The%20shoulder%20is%20not%20a%20single%20joint%2C%20but,girdle%20includes%20three%20bones%E2%80%94the%20scapula%2C%20clavicle%20and%20humerus.

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About Paul O'Brian

CEO, Paul O’Brian founded Accelerate Physical Therapy , P.C. in 1989 in Arvada. Specializing in orthopedic and neurological rehabilitation over a 35-year career, Paul is experienced in shoulder, knee, spine, foot/ankle, elbow, wrist and hand rehabilitation, quadriplegia, hemiplegia, multiple sclerosis, weakness and balance issues, and geriatric conditions, arthritis, functional decline), postural pain an problems, sports injuries, motor vehicle accidents, and workers’ compensation injuries. As a youth sports coach for 20 years in swimming and diving, soccer, football and rugby. Paul has served on the Boards of Directors of three Colorado non-profit Colorado corporations: Colorado Physical Therapy Network (20 years), Rugby Colorado (5 years) and Tigers Rugby Football Club (14 years).