The shoulder is truly an amazing piece of design. Consider the joint itself, which is called a ball and socket. To visualize it, make a fist with one hand and cup your other palm overtop. In that position, the clenched fist can rotate in nearly every plane in space! When functioning as a well-oiled machine, the joint lets our arms and hands work in so many different ways around our bodies, from delicate movements to heavy lifting.
What makes the shoulder so mobile is having a large ball and a small socket – think of a golf ball on a tee. Unfortunately, this also makes it unstable without some serious support. To be so mobile but also secure, our shoulders require muscles and tendons to surround them (tendons are like ropes that connect our muscles to our bones). These connections make up what we call the rotator cuff.
The rotator cuff is not just one, but four muscles that all wrap over the ball at the top of your upper arm, called the head of the humerus.
When our arm hangs by our side, the rotator cuff holds it securely into the socket (like your hand holding on to your clenched fist). When you want to move your arm across, to the side, in front, or behind you, it is those four muscles that are doing the work.
Sounds a bit complicated, doesn’t it? As with all intricate pieces of machinery, components may wear out over time, but can also strain and tear suddenly during activity, no matter how reliable. At the rotator cuff, we can tear any one of those muscles just a little bit (partial tear) or completely (full-thickness tear) and we can also aggravate those tendons with years and years of use, developing what we doctors call a “tendinopathy”.
Tears and tendinopathies occur most often with overhead movements. When our arms are over our head, the muscles are most unstable, and those tendons are sliding and sometimes pinched between bones. So, even if you’re not a swimmer, tennis player, or construction worker, your decades of placing objects up on to shelves, cleaning the gutters and hanging Christmas lights can lead to painful problems.
Unfortunately, we often don’t realize how much we use a part of our body until we experience pain there. Whether it is a sudden injury or chronic wear and tear, those aches and twinges make us all too aware of each movement we took for granted, and the shoulder is no exception. Studies have shown that nearly 70% of people will experience significant shoulder pain within their lifetime.
Fortunately for rotator cuff disease, surgery can often be avoided. A regimen of home exercises & stretches or physical therapy is often at the center of treatment, and a little bit of routine work on your part can go a very long way in reducing pain and strengthening your shoulders against more injury.
Rotator cuff issues are only one of many things that can cause shoulder pain. We can also get arthritis, where bones begin to rub bones, strain ligaments (ropes that hold bones onto other bones) or damage the socket of the joint.
So where do we begin? In gathering a history of your pain and performing a good physical exam, we can begin pinpointing if you have had a rotator cuff problem or another cause for your shoulder pain. From there, we can create a plan together for more investigation such as ultrasound, X-ray or MRI if needed, and begin managing your pain and placing you on the road to recovery.
The body is a beautiful thing, and the fact that we have so many pieces working in tandem is truly impressive. Although doctors are like the mechanics at the auto shop, you’re the owner! You may find comfort in holding some knowledge when a problem arises. I hope these posts I write will empower you should you visit the office with pain, like in the shoulder as I’ve described today.