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The shoulder is a complex ball-and-socket joint that is made up of the humeral head and its contact with the glenoid fossa of the shoulder blade or scapula.  The shoulder is designed to move the arm and position the hand in space and completes this task with extreme accuracy through an intricate system of ligaments and muscles that restrain and provide motion.  Because the shoulder must accommodate such a wide range of motion, it gives up a degree of stability and is more susceptible to injuries.  This can be contrasted against the hip, which is also a ball-and-socket joint, but offers much more stability and less mobility through a deeper joint socket, stronger ligaments and more powerful muscles.

Joint stability at the shoulder is dependent on the strength of the rotator cuff muscles and the muscles that surround the scapula and the integrity of all surrounding ligaments.  Since we can not strengthen our ligaments, this article will focus on improving performance of the muscles and their corresponding tendons.

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As a physical therapist, a great deal of my time is spent educating people on the importance of proper body alignment, symmetry and posture.  I would be willing to bet that most of us have been told since an early age that correct posture is important, but how many people can actually explain why this is true.

As I have mentioned in previous posts, most humans fall into a few typical movement or postural patterns and it is these patterns that are responsible for the majority of musculoskeletal complaints.  Now take a minute and think about what I am saying…imagine that on average you are awake 16 hours per day and that a large percentage of those hours are spent in a gravity dependent position such as standing or sitting, whether at school or at work.  Both school and work, in most cases, involve prolonged periods in which we are not moving a whole lot and even sitting for extended amounts of time.  I realize this does not count for everyone, but trust me this scenario is true for most.  While you are sitting or standing in place, your postural muscles are active in an effort to fight the effects of gravity and keep you upright.  This is where the problem occurs.  Most of us give in to the effects of gravity and begin to slouch either out of habit, muscle weakness or fatigue.

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Shoulder instability refers to a condition in which laxity of the shoulder joint is present and can be classified as either traumatic or atraumatic (multidirectional).  Increased laxity of the shoulder can lead to dislocations, which are events in which the shoulder joint comes completely “out of socket” or subluxations (anything less than full dislocation).  Laxity and subsequent dislocations or subluxations can lead to damage to other joint structures such as the joint capsule, labrum, cartilage and rotator cuff muscles and possibly result in the need for surgery.

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The next several posts will cover the three most common shoulder problems encountered in orthopedic physical therapy. We will start with impingement syndrome, which is probably the most common shoulder issue addressed in physical therapy and can lead to other conditions including bursitis, bone spurs and rotator cuff tears.

Impingement syndrome basically describes a state in which a superior or upward migration of the humerus occurs causing compression of structures that are located in the subacromial space. The subacromial space is located between the ball portion of the humerus and the acromion, which is the bony structure on the shoulder blade that can be felt at the very top of the shoulder. Within this space one can find the subacromial bursa, which is a fluid filled sac designed to absorb shock and reduce friction and one of the rotator cuff muscles called the supraspinatus. Symptoms of shoulder impingement are usually described as a sharp pain at the top of the shoulder that may radiate down the lateral upper arm during positions that compromise the subacromial space. These positions usually include overhead movements such as lifting above shoulder level, throwing or performing a tennis serve to name a few.

So, what can you do to prevent impingement? As stated earlier, impingement often results from an imbalance of the stabilizing muscles of the shoulder complex and/or poor alignment secondary to postural dysfunction. Listed below are several strengthening and stretching exercises that have been shown to decrease impingement symptoms by improving muscle balance, shoulder mobility and alignment. The following exercise should not cause pain and should be adjusted or discontinued if pain is experienced.

Strengthening/Postural Exercise #1

Strengthening Exercise #2

Strengthening Exercise #3

Strengthening Exercise #4

Stretching Exercise #1

Stretching Exercise #2

Stretching Exercise #3