Shoulder pain? You don’t have to live with it.
St. Joseph’s/Candler Physician Dr. Steven Greer explains the anatomy of the shoulder and ways you can treat common shoulder injuries
We rely heavily on our shoulders to do a number of activities – throwing a ball, paddling a kayak, lifting boxes, pushing a lawn mower and even walking.
The shoulder is the most mobile joint in the body because of its wide range of motion. But because of this flexibility and how often we use our shoulders, it’s also not very stable and is easily injured.
So much so that Dr. Steven Greer with St. Joseph’s/Candler Physician Network – Bone, Joint & Muscle Care treats shoulder injuries every day.
“The shoulder can do more things than other joints but that’s why it’s easier to injure,” Dr. Greer says. “There’s a lot of misconceptions about the shoulders that are interesting to me. It’s really my favorite joint in the body.”
One misconception is that the shoulder is one joint made up of two main bones – the end of the upper arm bone (humerus) and the shoulder blade (scapula). Actually, the shoulder is made up of four bones, four separate joints and 20 muscles supporting those joints. These are all held together by a group of ligaments and tendons making up the shoulder.
The glenohumeral joint is the ball and socket. The AC joint connects the collarbone to the shoulder blade. The SC joint connects the sternum to the collarbone – this is the joint that moves when you shrug your shoulders. The scapulothoracic joint connects the shoulder blade to the back - it increases the shoulder’s ability to rotate up, down, forward and back.
In addition, there’s even more involved with making the shoulder function properly. You’ve most likely heard of the rotator cuff, which is a group of muscles and tendons that attach the arm bone to the shoulder blade and help the shoulder move. However, your rotator cuff’s job isn’t to rotate anything, Dr. Greer says. Your rotator cuff holds the arm bone in place while the big muscles rotate it.
That’s a lot of anatomy that can easily be damaged.
Shoulder injuries can occur for a variety of reasons. One we can’t control is age. As we age, our rotator cuff naturally gets weaker, Dr. Greer says. Also, if you are over 40, there’s a good chance you have some type of tear – whether big or small, painful or not – to the cartilage in your shoulders from natural use over the years.
You can also injure your shoulder doing overhead activities – for example, playing tennis – and overuse activities – such as repeated lifting on the job. Dr. Greer sees a lot of shoulder injuries in athletes, but also in certain occupations such as mechanics.
The thing about musculoskeletal injuries, Dr. Greer says, is that most are not emergencies, and nearly 80 percent of them don’t require surgery. However, that doesn’t mean you should live in pain. Shoulder injury pain varies from person to person depending on the degree of injury.
“A lot of times patients will have shoulder pain for years and don’t come see me until it keeps them from sleeping at night,” Dr. Greer says. “When it interferes with your sleep or overall quality of life, that’s when a lot of patients come in so we can help.”
Treating shoulder pain
Treating shoulder pain starts with a shoulder maintenance program. It involves exercising the small muscles around the shoulder, not just the big muscles. There’s also exercise you can do to keep your shoulder blade muscles healthy.
That’s where it actually begins, Dr. Greer says. Even if your injury is another muscle or the rotator cuff, you first begin by strengthening the shoulder blade muscles.
“It’s a progression,” Dr. Greer says. “First, you need to strengthen the muscles that control and stabilize your shoulder blade, and that’s going to be two to four weeks. It may not alleviate your shoulder pain if the injury is your rotator cuff, but if your shoulder blade isn’t stabilized, there’s anatomy that can dig into your rotator cuff because the shoulder blade isn’t stabilized, and that won’t help the healing process.”
After several weeks of physical therapy focused on exercises to stabilize the shoulder blade, then you will progress to exercises designed to strengthen your rotator cuff muscles.
“We’ll send them to physical therapy if they are injured to get them to do that progression of exercises,” Dr. Greer says. “They should be progressing, changing their exercises if not every week, then every other week, to progress through these things and feel better.”
Related Article: How physical therapy can help with your shoulder pain
If the pain is so severe that it makes it hard or impossible to do physical therapy, then Dr. Greer can give them a steroid shot to the shoulder. But, a steroid shot is not a cure, he emphasizes. You must still participate in physical therapy.
If the injury is so severe that it requires surgery – again only about 20 percent of the time – then your healthcare team will still most likely recommend physical therapy before surgery. This will make recovery after surgery less painful and faster, Dr. Greer says.
Preventing shoulder injuries
While there’s no guarantee that you won’t experience shoulder pain at some point in your life, there are small things you can do to improve the health of your shoulder muscles. One thing we can all do is practice good posture. That includes making sure you have an ergonomic-friendly work environment.
Another thing is simple arm exercises, like using resistance bands, or if you don’t want to spend money at all, grab some tuna or soup cans out of the cabinet and simply lift those in multiple directions, working all the shoulder muscles.
Walking also can help. You don’t have to crazily swing your arms, but just the natural flow of arm and shoulder movement in walking works all areas of the deltoid muscles, Dr. Greer says.
If you experience shoulder pain, or any discomfort with any bone, joint or muscle, Dr. Greer can help. Request an appointment online now.