Hey this is Dr. Gangemi and welcome to our newest Sock Doc video. Today
we're going to talk about the shoulder and the shoulder joint in general.
Helping out today is [Madison McCarroll]. Thanks for joining. Madison's a
great rower in the area.
The shoulder you know most people think about the shoulder as just like a
certain area which it obviously is but it's really combined of three joints
and three bones. So it's a very dynamic area that's used to, you know, we
use our shoulder all day long. We use it to support things, we use it to
lift things, we use it to carry.
It's actually one of the most common areas that people injure and you can
injure your shoulder, the shoulder area, in so many different ways. A lot
of times people will tear their rotator cuff or sprain or strain their
rotator cuff. They will get stuff like tendonitis, bursitis, or perhaps a
frozen shoulder is also very common. So these are some of the things we're
going to talk about.
So the three joints of the shoulder pretty much we have a sternoclavicular
joint. Our clavicle is here. That's that bone running across the top.
People know it as their collarbone. And the joint here where it hits your
sternum which is your breast bone, not going to talk about really today
because there's not a whole lot going on there. The two other joints are
going to be our major function, or our major focus, because that's where a
lot of the injuries occur.
First one we're going to talk about is your AC joint which is also known as
your acromioclavicular joint and that's if you trace your collarbone to the
outside here you're going to hit a little bump which is the acromion of
your scapula which is your shoulder blade. And then that's where it
attaches to your clavicle which is your collarbone.
Now if you come down just on the inside there, so you find that dip on the
end of your collarbone and then dip right down, you have what's called your
coracoid process. Now this AC joint is very, very important to understand
because it's where people get things like a frozen shoulder. And they can
also get generalized shoulder pain if this joint is not moving properly.
So a frozen shoulder is basically if you cannot lift your arm, a lot of
people can't lift it at all, or especially above parallel. So if you can't
lift your arm anywhere over your shoulder or if you can't do it freely
without pain a lot of people are diagnosed as a frozen shoulder. But again,
especially if you can't even just move it at all. Typically it's because
the AC joint is locking up.
Three major muscles going there. You've got one of your pec muscles, your
pec minor, which comes up from your chest and inserts into that coracoid
process. We also have your biceps, one of your biceps, the short heavier
biceps that has to do with this, obviously curling, flexion of the arm.
That pec minor is more of an across the body, especially with your palm up,
type motion. It supports a lot of the rib muscles.
And then also a very important muscle called your coracobrachialis. Now
this muscle we kind of associate when someone has pain if they say are
washing or combing your hair, like so. And your shoulder hurts even just
doing that, not necessarily if you have a frozen shoulder but if just you
get shoulder pain while you're doing this that's probably this
coracobrachialis muscle.
So you're going to look for a trigger point right in that coracoid. Again,
come down from the end of that clavicle, your collarbone, dip right down,
and right in the divot of your shoulder in there, right where your pec
comes into your shoulder joint, look for a tender area, rub that out.
That's right on your coracoid process. And you could hold that if she was
having a shoulder issue she could put some pressure in there and see if
she's having more of a free movement in her arm with whatever direction she
might be having trouble with, okay? So that's the AC joint.
Let's talk about the major joint of your muscle though which is your
glenohumeral joint which has to do with what we all know or most of us know
as the ball and socket joint of the shoulder. That's what allows you to
really move your shoulder in pretty much every direction and it has to do
with your scapula which is your shoulder blade and your humerus, your upper
arm bone, okay? So that's the whole ball and socket motion of the shoulder.
What supports it is actually rotator cuffs. Remember the rotator cuffs,
first of all, there's four of them. A lot of people think there's one or
two. And your rotator cuffs are not very powerful muscles. These muscles
are used to keep the arm in the socket so a lot of people they injure them
or they tear their rotator cuffs because the other muscles, the big muscles
supporting the shoulder like your lats and your rhomboids and your serratus
muscles that we're going to talk about are not working efficiently so now
you're trying to use more of these supportive muscles for strength and for
power. So you end up getting them injured. Of course you can, you know,
injure them other ways like in traumatic accidents.
But the four rotator cuff muscles are your supraspinatus which is if you
lift your arm out about 30 degrees that's really your supraspinatus. It's
about just from here to here. When you get past that then you start using
your actual deltoid which a lot of people think of as their shoulder
muscle, the meaty part of their shoulder. Let's have you turn just a little
bit here, Maddy. So your supraspinatus comes down from sort of deep in your
trap here on top of your scapula, which is most people where they get sore,
and inserts right into top of the humerus here. So if you have a problem
with the supraspinatus and you have problems doing this, look for a trigger
point in the top here and see if it's easier to move that.
Remember a lot of times there's a muscle/organ relationship with injuries
and with pain. We talk about this a lot on the Sock Doc videos. The one for
this is actually excitotoxins. MSG can really affect this muscle. So can
Nutrasweet which is aspartame. Any of these excitotoxin type chemicals. I
talk about those on both drgangemi.com and sock-doc.com. So you can read
about them there. But also high insulin levels and high stress hormones
will also cause supraspinatus problems. This is the most common rotator
cuff that's injured. Actually, people fall, say you were climbing on a
ladder or you just fell off something and you landed there, a lot of times
someone's going to rupture, you'll rupture the supraspinatus.
The other three, we have our teres minor which turns your arm out like
this. This is external rotation of the arm, turning it out. And your
infraspinatus is similar but it's more when your arm is actually in this
position and coming back like that. And then the last one is your
subscapularis which is pushing down. So infraspinatus is back like that and
subscap is that throwing forward motion which is on the front of your
scapula.
I'm going to have you stand and turn here. So if you have problems with
your elbow in and as you're turning out like this - let's do that motion
like that, so that's your teres minor. That muscle comes from your arm into
your scapula like this. So you're going to look for trigger points in here.
And you can actually as you, go ahead, do that a couple times, you can feel
that muscle right there moving. Now a little bit lower if you do it this
way is that infraspinatus and that's going to be about right here. Go
ahead. It's a much wider broad muscle, all right? Really huge span. A lot
of fascia connective tissue in there. You can put your arm down.
So don't worry about exactly where they are. If you have any problems with
that rotation out like that look for those trigger points here coming from
the back of the arm and coming into the shoulder blade here. And look for
trigger points right up to where you feel your shoulder blades stick out,
your scapula, that spine of the scapula there. All in here, okay? Turn back
around.
And the other muscle for your subscapularis, this is the one that comes
down like this. So if she was to push against my hand like that and if she
had pain in here that muscle is deep in the armpit because it's actually in
the front of your scapula. This is a tender one even if it's not bothering
you, because the way to get that is to actually come up into the armpit
area and get in the front of the shoulder blade, the scapula. So you end up
digging in here.
If you're going to do it on yourself lay down so your arm is relaxed and
push up within that scapula there so it's not fighting against you at the
same time. A lot of times you've got to get way up there if you're having
problems with that, way up to the ribs. Tender, isn't it? But it's fun.
So those are your four rotator cuff muscles. So we have our teres minor, we
have our infraspinatus, our subscap pushing back down, and then this
supraspinatus coming out, okay?
Now another muscle that comes up and comes down in your ribs here on the
side, let's turn a little bit again, are these like finger-like muscles
called your serratus that come over the ribs. And they're actually going to
go up and help stabilize your scapula with that subscapularis muscle. So
your serratus muscle is any type of holding and supporting like that as
well as pushing. It's a really important muscle to stabilize your scapula.
Doing a push up, any hanging, climbing type motion, think of the serratus
as that type of motion.
So I'm going to have you turn to the side again one more time. That'll be
good. So the serratus if you have problems holding, if she had problems
holding her arm like that out as in a push up move look for those trigger
points all the way down on these ribs and they wrap around right to the
back, to the sides of her body here. The serratus muscle, right down in
line with basically the side of the body. You don't have to go too far
forward, typically to find where the majority of the trigger points are,
and you don't have to go too far back. But they will come up and attach,
connect with the connective tissue of that subscapularis that is going to
help to push down. Again big shoulder blade stabilizing muscles.
Another really important muscle to stabilize that shoulder blade, turn
around to the back again, stand up, are your rhomboids. These muscles
attach the inner part of your shoulder blade to your spine. So the trigger
points, that's where people get like they say, you know, "I have pain
between my shoulder blades." That's going to be more the rhomboid. And you
could have pain anywhere in your shoulder blade as you move it but
especially if it's out as you do like that type of motion, look in between
these rhomboids. All the way down, that one or two inches you have between
the spine.
And a lot of times if this one's hurting the problem's coming from the
other side. These muscles have to balance each other left to right and
they're very similar to how the piriformis muscles balance each other in
the hips and I talk about that in the Lower Back Sciatica video. If say the
right one is bothering you, the weakness might actually be on the other
side causing that one that's bothering you to spasm. So she might have
let's say a shoulder issue on this right side. This one's really tight
because this one's the problem and you want to treat the trigger points on
that opposite side, okay?
We also have the lats coming from here attaching to the arm which raises
your arm up and helps you pull things down, your latissimus muscles. So
again a shoulder problem, don't just look towards the shoulder. Some of
those points can come all the way down here to your lumbar spine. Your
latissimus muscles come up and help you with shoulder motion and shoulder
power.
These are your big muscles now, your rhomboids, your latissimus and your
trap muscles which are above these lower fibers, medial fibers, and top
fibers/upper fibers of the trapezius muscles. Most people know about their
traps here but the traps come down like this. That's like this type of
motion as you pull back to support the shoulder.
So you could have any type of shoulder muscle pain, shoulder pain, rotator
cuff problem and it could be coming from those lats down there on your
lower back. So you have to look for trigger points in your lower back. You
have to look for trigger points in the mid part of your back around your
traps and then going up to your shoulder blade towards the spine for your
rhomboids. And even up here if her upper traps were a problem then it's not
going to help support and stabilize her shoulder blade from the top. So any
motion she was doing could actually affect the shoulder blade.
I'm going to talk about a little bit more in the elbow video how the biceps
and the triceps also affect the shoulder and you can also get elbow pain
from that because the biceps help elevate the shoulder and the triceps can
actually help bring the shoulder back. So a little bit more on that there
and where to get those trigger points.
If you're having trouble getting the trigger points in the back you can
roll on a ball or something like that or if someone can't get in there. And
I'm also going to show a few little climbing and crawling exercises to help
with stabilizing the shoulder joint and proper rehabilitation to help that
stuff out. So that should do it. Thanks for helping out. Good shoulder
muscles. And that's the end.
Okay so there's a muscle that I forgot to talk about when we talked about
frozen shoulder and that AC joint and it's your subclavius muscle. It's
really a very important muscle when it comes to frozen shoulder and being
unable to lift your shoulder up.
So your subclavius muscle attaches your first rib underneath your
collarbone here, your clavicle, to your clavicle. So it's a very tender
area anyway underneath your collarbone there, but I want you to look for
tender areas. You have to dig up and underneath that collarbone there
looking for really tender sore spots, okay? So if you find them, hold them,
you can work them out, and then raise your arm up a little bit. If it
releases you're on the right spot. Again, it's going to be tender
anyway but with a frozen shoulder or shoulder issue it'll be even more
tender.
The other one is your deltoid muscle, your actual shoulder muscle that
people consider to be because you think about that with your shoulder as
weight lifting, strength and conditioning type of issues. Look for the trigger
points here if you have trouble ab-ducting your arm like that. We talked
about this with the rhomboid. It could be locking your scapula, but if you
have trouble coming out like this if it's not really moving look for a
middle deltoid trigger point right about where it inserts into your humerus
here, your upper arm.
The interior fibers of the deltoid come like this bringing your arm pushing
up and forward. So they're going to be a little bit more towards the front
and the posterior fibers more towards the back here if you're going like
that. It has to do with that long head of the tricep too like I'll mention
in the elbow video. So look for those deltoid ones for that type of
movement.