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 their 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? So 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 dig 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 spinous. 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 really 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 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.
Shoulder pain is a major complaint in many people, not just athletes, and to successfully correct the problem one must look far beyond the shoulder itself. In this video I discuss the majority of the muscles that make up the shoulder joint and their relationship to common injuries that occur in the shoulder girdle area.
Common injuries to the rotator cuff are described in detail, as well as how to assess each muscle and perform basic trigger point therapies. Frozen shoulder problems are also discussed in this video, as many people suffer from this common injury in which the shoulder cannot freely move in the manner in which it is designed.
At the end of this video I demonstrate two easy rehabilitation exercises you can do to help regain the strength and mobility back in your shoulder!
Please check out the Trigger Point Therapy article and video if you need more information regarding this subject.
Also please read the Sock Doc First Aid For Injuries series to understand why it is often disadvantageous to ice, heat, stretch, or take NSAIDs for this, or any, injury.
Bill P says
Great article Doc!! It seems that everybody has a shoulder problem, so its good to get that trigger point info along with the exercises.
Greg Slatner says
I’m going to throw this out there that Dr Gangemi is a badass! That hanging shoulder exercise is crazy hard and he made it look so easy in the video. I’m sticking to my crawling and climbing for shoulder excercise for now.
Good video Doc
Sock Doc says
Thanks Greg. Yeah, that one takes practice.
Dave, RN says
I have deltoid pain when I use my shoulders, in both L and R delts. I’ve tried EVERYTHING and it persists. Prolotherapy, hanging, OT, nothing works. It looks like in that last segment you started to touch on it. Where my delts insert, it is VERY tender on both sides. I just don’t know how to fix it.
Could it be refered pain from bilateral bone spurs?
Sock Doc says
Hi Dave. Can’t show everything on the videos due to length and there is just so much that can go wrong. There has to be some muscle imbalance in the area. Bone spurs are most likely there because of the shoulder ROM problems. Sometimes the delts lock up because of diaphragm (breathing) problems.
As I often say to people – “Sometimes you just gotta be treated by a doc or therapist who looks at the entire body from a structural, nutritional, and emotional perspective and understands how everything is interrelated and attributing to a health issue or injury.” Although there’s not a lot of “us” out there, that’s your best bet. A good doc will be able to get you back in a very short period of time and if not, at least explain why it may take longer.
hey doc I was dianosed with biceps tendonitis of the long head in my left shoulder. I have been resting completely for a month now. The tendonitis seems to have gotten better, but about 2 weeks into my rest I began to feel light aches and pain in my right shoulder (healthy one). Sometimes its in the anterior deltoid, but sometimes it can travel to the medial deltoid or on in other locations of the shoulder. NOW, I have anterior deltoid aches in the anterior deltoids of both shoulders. Do you think this could be from lack of use and possible tightness?
Any help would be great
Sock Doc says
Doubt it is from lack of use. Most likely some other imbalance that hasn’t been recognized yet. First place I’d look is in the rhomboids and lats as I show in the video.
Emily Michaud says
Hey doc! Thank you so much for making these videos. I’ve been suffering with Bursitis in my shoulder for months! I’m not even sure how it happened, but I do know I tend to sleep on that side in awkward positions and I also do yoga and had been doing it on carpeted areas, which is likely unsafe. I was put on steroids, but after I came off from them the shoulder pain has been getting incrementally worse, and now it’s far worse than it was before the steroids. I’m very confused about how diet can help with this, as you mentioned that an acidic diet would help with calcium deposits? I’ve also read that reducing acid can help treat inflammation. I’ve also been taking fish oil and a natural medicine called zyflammed, for the past week. It still feels like it’s getting worse. I was considering getting a shot into the bursa, but I don’t have the money to go to the doctors for this treatment and I’m also afraid that more steroids will just make it worse! Please help, as it feels like it’s spreading and it hurts all down my upper arm now when I lift it.
Sock Doc says
Please read this; thanks!
Terry H. says
Great informative video and I will try working on these trigger points. I am a very active 50 year old woman with a shoulder which appears to be in the ‘freezing’ stage (pretty sure due to repetitive stress at work) and I want to do everything I can to forestall it! Your last slide about dynamic natural motions being a good rehab was intriguing to me. Do you think paddle sports like rowing and kayaking would be beneficial to regaining mobility? What if there is pain in the motion – is it a bad idea to ‘push the pain’ a little (or a lot?)
Sock Doc says
Those are good sports but not sure if they’d be best for mobility rehab. A lot of people row/paddle more with their arms rather than the back/scapula.
Some mild discomfort is okay as long as you continue to heal and progress. More pain, especially one that hinders motion, would be a bad thing to push through.
I suffered a shoulder injury 4 months back.But ignored it and continued to box.Now it has worsened so last week doctor told me to get MRI and Xray done.And what the doctor told is that i suffer from hyper laxativity joint whch is genetic.This was the MRi report:
Mild fluid noted in subacromial and subcoracoid bursa and bicep tendon’
Mild shoulder effusion
Can u give me specific exercises to fix this.any supplement recomended.Videos wil b helpful
Sock Doc says
Please read this; thanks!
This video showed me why I’ve been having shoulder pain. I started really trigger pointing it on my own and doing lots of foam rolling and slowly it’s getting better. Thanks for the video!
This is helpful. Great site. I’ve had some rotator cuff problems over the years and have been given conflicting advice from my ortho and physical therapists. The PT people showed me good ways to do push-ups for strengthening the shoulders. My ortho doc said never to do push-ups after age 40 because they put too much pressure on the rotator cuff. Who is right?
Sock Doc says
Seriously? This is an April Fools Joke early, right? Does he even know anatomy or correct form of exercises?
When do we (humans) stop doing pull-ups – age 30? And no squatting after age 50? That’s an embarrassing statement for humans by your ortho doc.
David Allen Young says
The doctors operated on my left shoulder earlier in 2015 and I still have the same problem when i move my arm a certain way. I think I have a torn ligament, because the operation of cleaning out my rotator cuff did not help and the Military Dr Sullivan at Eglin AFB, Florida left the stitches in too long for a deep scar on top of my shoulder area and I think they left some of the stitches embedded into the skin. My shoulder is not frozen but pains me when moving my arm. What is your advice?
Sock Doc says
See if the points in the video help. If not, then find a doc/therapist who can help you with the mobility in that area.
Thanks for posting this vid. I have shoulder issues, especially the right one, but suspect they’re coming from root canalled teeth which I cannot afford to deal with. My chiropractor does some trigger point work but it does not last. Knowledge is power; the more we know that’s truthful, the better decisions we can make in caring for ourselves. My first steps and, indeed, most that follow, lead me to the so-called alternative practitioners because they first do no harm and, for the most part, are continually searching for answers that support, nourish, and heal.
I noticed a comment under this vid on youtube from today (Nov 28, 2016) that was obviously written by a troll for the allopaths. He/she accuses you of being a “homeopathic quack” and what’s needed is a “real specialist, an orthopedic surgeon to diagnose and treat your problems.” …..LOL!
Dr. Stephen Gangemi "Sock Doc" says
Yeah, after a while I just don’t pay attention to those comments anymore. 🙂
Sir my dislocated above 8 times from last 4 years.from last 10 months I am dislocated.my resent MRI shows. Small hill Sachs lesion,focal suggestion of mild marrow edema,tendon with rim rent tear. My doctor said no need surgery,do physiotherapy ,please suggest me sir,I seen urs video all symptoms I have
Dr. Stephen Gangemi "Sock Doc" says
Hi – other than the free things I show in the video, I’d have to see you to give you any personalized advice. I hope the video has helped some!