Shoulder Pain Treatment & Prevention: Rotator Cuff & Frozen Shoulder – Sock Doc


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.

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