Have you ever had shoulder pain and wondered what is caused it? Have you got shoulder pain right now and want to gain a better understanding? Take a look through our comprehensive guide of the makeup of the shoulder, its functions, common injuries and what you can do to make your shoulders better for the future.
General Anatomy
To understand the complex setup of the shoulder let’s take a simple look through all of the shoulders components to make it understandable.
Bones – the bones that make up the shoulder include the humerus, clavicle and scapula – put simply the upper arm, collar bone and shoulder blade.
Joints – there are 4 joints within the shoulder and they are:
- Sternoclavicular – where the sternum meets the clavicle
- Scapulothoracic – where the scapula sits on the upper back
- Acromioclavicular – the acromion (end of the scapula) meets the collar bone to form the edge of the shoulder
- Glenohumeral – the main shoulder joint comprising of the upper arm bone fitting into the glenoid of the scapula. This is a shallow ball and socket joint, unlike the hip which has a deep secure socket.
Muscles and Tendons
This is by the far the most important part of the anatomy as the shoulder needs a good balance of strength to make it secure and functional. This is due to the aforementioned shallow ball and socket of the glenohumeral joint.
Instead of relying on a secure socket for its stability – the shoulder is heavily dependent on its muscles and tendons, particularly the rotator cuff. The rotator cuff is a set of 4 muscles and tendons which are vital to your shoulder movement:
- Supraspinatus – takes the arm away from your side (abduction)
- Infraspinatus – externally rotates the humerus
- Subscapularis – internally rotates the humerus
- Teres Minor – externally rotates the humerus
Other parts of the anatomy of the shoulder which deserve to be mentioned are the ligaments which hold the bones together and also the long head of biceps which acts similarly to the rotator cuff and gives further security to the shoulder.
The cartilage of the shoulder is the labrum – a small disc of cartilage that sits in the shoulder socket which helps to absorb shock and make the shoulder secure.
Symptoms
Shoulder pain symptoms can vary in location across the whole shoulder complex. Commonly shoulder pain will be felt deep within the glenohumeral joint which is at the top of the humerus where it meets the collar bone and scapula.
However, pain can radiate into the front of the chest, into the neck, down into the arm as far as elbow level and also into the shoulder blade region on the upper back.
Pain also causes dysfunction – simple tasks such as washing and dressing may become difficult as you struggle with the strength and range of movement.
The ability to wash our face/hair and fastening our bra strap are typical problems with function. Pain causes us to hold our shoulder in comfortable positions – much like limping when we have a sore leg, it’s an adaptive reaction which helps us through a painful period.
Due to the shoulder being so reliant on having a good balance of muscular control, failure to address this adjusted posture can impede on the shoulder function.
A good way to address this is to look at your shoulders in a mirror with you top off to see if there is an imbalance happening.
Another symptom which can come from an adjusted posture of the shoulder is nerve and circulatory pain. If the shoulder becomes too protracted or closed, it compresses the nerve supply that feeds our arm.
Heaviness and aches in the arm are commonly described and also tingling can be felt in all fingers and the hand.
Causes
Impingement
This is a term that means the shoulder tendons become trapped and sore between the joints of the shoulder. This can commonly occur from poor posture and positioning over a prolonged period.
An example of this would be poor working position using a computer mouse and leaving the shoulder in a forward position for a long time. Other examples include one-handed work on production lines or manual labour such as a plasterer.
The shoulder becomes weak at the back if not well maintained and this leads to an imbalance with a closing of the joint space in the shoulder which ‘impinges’ the tendon. Look to strengthen the scapulae and surrounding muscles to prevent this.
Whiplash
Typically whiplash will affect the neck and head region but shoulder pain is also a common symptom. The shoulder muscles which merge with the neck can often become overstretched and strained with the joints of the shoulder suffering trauma – commonly from the car seatbelt tightening over the shoulder and collarbone area.
Sprains and strains
Overexertion of the shoulder can lead to injury and shoulder pain. If we perform movements or lift weights we are not used to then this can cause the shoulder to become aggravated.
Examples of how you could strain your shoulder include – decorating when you haven’t done this is a while, gardening after not having done it for months or lifting a heavy weight, which your shoulder isn’t used. The joints of the shoulder can become sprained but also the soft tissues like muscles and tendons can suffer strains.
Sleeping
Sleeping directly on your shoulder causes a lot of pressure to be exerted on the glenohumeral joint. If we habitually sleep on one shoulder rather than the other it can compress the joints, tendons and muscles which over time can lead to aggravation of the tissues.
It is often hard to vary your sleeping position as we have poor control of how our body moved when we are sleep. A good tip is to try and use pillows to keep us in a better position.
Tendon Rupture
Rotator cuff tendon rupture is more common over 60 years of age when tendons aren’t as strong as they used to be. When we get to over 70 the amount of rotator cuff ruptures increase again.
Rotator cuff tendon rupture results in severe loss of movement, high pain levels and need to be managed appropriately in a time-sensitive fashion. If you have an accident with your shoulder and you are severely restricted, you should go to your doctor or emergency room.
Frozen shoulder
This occurs in people in their mid-40’s to 50’s commonly. There is no definitive cause of this problem but it occurs in people who use their shoulder repetitively for many years.
Frozen shoulders can last 1-2 years in total and start with a painful stiffening of the shoulder which sees a severe restriction of the shoulder joint and very limited movement.
Following a few months, the pain will decrease but you will be left with a stiff shoulder. Physiotherapy and exercises will be needed intensively to help this problem. In worst cases, surgery is needed to release the shoulder.
Dislocation & labrum Injury
These injuries are common with injuries such as falling on to your shoulder or outstretched hand and impact and forced external rotation. Dislocation of the shoulder commonly involved a part of the shoulder joint becoming separated or the humerus is forced out of its socket. It can go back in to place by itself, but typically medical attention is needed to ‘relocate’ the shoulder.
In worse cases, surgery is needed to stabilise the injury to prevent it happening again. Accompanying dislocation is often a labral tear. These can heal on their own but surgery is common.
Supplements
Fish Oils – there are many health benefits to be had from fish oils which are rich in omega 3 fatty acids. Key benefits that help fish oil to protect your shoulder include reducing inflammation and improving the body’s ability to maintain healthy joint tissue.
You should take fish oils for around 12 weeks to see the best benefit for your shoulder pain. They also have other great benefits such as improving blood flow, reducing cholesterol and managing gout symptoms.
Magnesium, Potassium and Calcium – this combination can help you prevent and manage shoulder pain, cramp and stiffness.
Magnesium helps to improve nerve pain and maintains normal muscle and nerve function, potassium helps to maintain a restful sleep which helps you repair and calcium helps to aid bone density and muscle growth.
Combined, they are great at reducing shoulder cramps or stiffness. All of these 3 things can be found in the food we eat but are also available in many supplement forms including tablets but also in bath salts and sprays which can be easily absorbed through the skin.
Zinc, Vitamin C and Chlorophyll – these are found in things such as seafood, green vegetables and fruit. These supplements are important for your shoulder health as they support the production of collagen in tendons.
Due to a lot of shoulder pain issues occurring due to tendon related issues, then supporting healthy tendon maintenance would be advised. Zinc, vitamin C and chlorophyll are available in supplement form if you are unable to include certain foods in your diet.
Exercises
The shoulder heavily relies on its muscles and tendons to keep it secure, pain-free and functioning well. As we age, our lean muscle mass and strength reduces (sarcopenia), so our shoulders can become especially vulnerable as they rely heavily on the rotator cuff tendons to operate the shoulder.
Exercise for the shoulders should focus on mobility to ensure the shoulder is as capable as possible as well as strengthening the shoulder to maintain muscle mass and ensure tendons remain in good condition.
Using weight and resistance is recommended for the shoulders as it helps strengthen muscle and tendon tissue. You may need to buy some weights if you don’t go to a gym or some elastic bands which are a great form of training at a cheap cost that will ensure your shoulder health for years to come.
Shoulder mobility circles
Maintaining all of your shoulders range is important. In a controlled motion forwards or back, swing your arms in circles. A full range of movement helps your shoulder joint remain healthy and allows muscles and tendons to be to work to their full capacity.
Scapula squeezes
Maintaining the strength of the posterior shoulder muscles is essential. Rounding of the shoulders, hunching and poor posture can cause problems such as impingement.
Strengthen the rhomboids and traps to pull the shoulders back into their optimal position. The exercise is simple – squeeze and pinch your shoulder blades together for 5-10 seconds and repeat until tired.
Dumbbell lateral raises
Strengthening the smaller muscles of the shoulder that sit on the outside of the shoulder compliments the strengthening of the larger muscles and also the tendons of the shoulder that sit inside.
If you have strong deltoids it can protect the rotator cuff, especially the supraspinatus which performs the same movement. Holding dumbbells by your side and slowly raising them out to the side, just below shoulder level and then control back down to your side.
Shoulder elastic exercises
There are many different exercises using elastic bands to do. A popular exercise is external rotation of the shoulder.
Tie the band to a fixed point, hold the band in one hand with your elbow bent at a 90-degree angle, keeping your elbow close to your ribs, twist the band out over to perform latera rotation. This exercise is great for your rotator cuff tendons.
Military Press
This movement is commonplace in all gym routines. It is a simple exercise but also an extremely effective one.
Use a barbell ideally, or dumbbells, or any object you can hold with your hands. Start with the bar in front of you at chest height resting on your shoulders – press the weight forcefully above your head and then return it in a controlled manner.
We’ve reached the end of our guide to shoulder pain! We really enjoyed putting it together for you and hope you found it useful. Stay healthy!