The Hand to Shoulder Solution
Your new resource for hand, shoulder, and elbow pain. Together, we are giving pain the middle finger and gaining knowledge to live a better, pain-free life!
Discover what might be causing pain in your fingers, pain in your hand, pain in your wrist, pain in your arm, pain in your elbow, pain in your shoulder.
Learn about your body, arthritis, tendinitis, tennis elbow, fractures, golfer's elbow, and carpal tunnel syndrome.
Hosted by Carl Petitto, OT, CHT, and Certified Hand Therapist specializing in orthopedic conditions of the hand to shoulder. Also an expert in fabricating custom orthotics.
The Hand to Shoulder Solution
Ep 14 - Secrets to a Pain-Free Shoulder: Understanding Anatomy, Impingement, and Posture
This episode provides listeners with an in-depth look at shoulder pain, its anatomy, and how various components interact to create both mobility and stability. Understanding these elements helps listeners identify pain sources and recognize the importance of seeking timely professional care.
• Examining the importance of timely healthcare interventions
• Overview of shoulder anatomy and mechanics
• Exploring the dynamics of mobility and stability in the shoulder
• Understanding the role and function of rotator cuff muscles
• Insights into scapulothoracic rhythm and its significance
• Discussing the implications of biceps tendon injuries
• Emphasizing the benefits of early intervention and rehabilitation
• Practical recommendations for managing shoulder pain
Hello and welcome to the new show, The Hand to Shoulder Solution, with me, Carl Petitto.
If you are experiencing pain in your arms and hands, this is your resource.
Subscribe, listen, and share to help us give pain the middle finger for good!
This is a resource to help you mitigate pain at home and become more educated on what to ask your doctors and therapists. No medical advice will be given, and you should always see your medical professional for any questions.
Thank you, and welcome to the show!
Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. I'm your host, carl Petito. I'm an occupational therapist and a board-certified hand therapist. I specialize in the rehabilitation of orthopedic conditions that are affecting the fingertips through the shoulder. So anything that has to do with the bones, the muscles, the tendons which connect muscle to bone, the ligaments which connect bone to bone, the nerves which control the muscles and also send signals of sensation to the brain basically, the whole anatomy of the fingertips through the shoulder.
Speaker 1:I want to start by mentioning that this video is meant for the general public. I'm bringing this podcast to you because I want you to understand the fundamentals of how your body works. I want you to recognize what you need, when you need it, meaning if something in my arm, my wrist or my hand is causing pain, what do I need to do, who do I need to talk to, etc. In healthcare in general, what you obtain and when you obtain it is very important. So, of course, you have to obtain the correct service, but timing is everything and I really want to get across to the public that anytime we as providers can get to a condition sooner versus later, it's easier to fix for everyone, especially for the patient. This is not treatment or advice. This is information sharing that you may be empowered to make decisions for yourself, in partnership with your health care provider. In partnership with your healthcare provider, it's really important to go in, go into the office, get a thorough evaluation, get a thorough exam, because every condition is different in many, many ways. It's also different within the same person. Meaning, for example, if I have a shoulder problem on my right and let's say it's the exact type of problem that I have in my other side as well, it's going to be different left versus right and everybody responds differently, and that's why they call it practice, and we discussed that in some previous episodes.
Speaker 1:So, speaking of the shoulder, I want to talk about the shoulder today, and I have a lot of people come in the office and I spend time with them so that they understand why are they hurting? Where's the pain coming from? What are the basic mechanics of the shoulder? There's a lot of details as far as how do you use your arm? What kind of work do you do? What kind of hobbies do you do? Why does it hurt when I do this? It doesn't hurt when I do that. What is the rotator cuff when someone is told they have a rotator cuff tear. What does that mean? So I want to talk about the basic anatomy and what these structures are, so that you can be armed with the knowledge of this. These structures are so that you can be armed with the knowledge of this, and I'm hoping that folks can just anyone who's dealing with shoulder pain. They can look up these videos and maybe do a search and say, okay, this is shoulder pain, carl is talking about it, let's see what I can learn about my shoulder. So I want to go through it and I want to talk about the basic mechanics. I want to talk about the basic structures. I want people to know how it's set up so they have an understanding again of how the shoulder works.
Speaker 1:Before I start talking about the shoulder, I always like to compare it to the wrist, because the wrist and the shoulder, they both are required to do two contradicting things. To do two contradicting things. So in the wrist there's a lot of moving parts which we talked about in previous episodes. We talked about the carpal bones. There's eight of those the metacarpals in the back of your hand and through the palm, these long bones right here, and then the radius and the ulna and the forearm In the wrist area. Those all come, come together and there's 15 bones, there's 24 contact surfaces, 24 ligaments that connect all the bones together, etc. So there's a lot of moving parts. That gives us ability to have so much movement.
Speaker 1:However, the contradictory side is it all also has be stable. We have to be able to strike with our hand. We have to be able to grip tight and have stability. We have to be able to lean on our hand. We have to be able to pull ourselves up to save our own life, for example, to save someone else. It has to be strong, it has to be stable and mobile at the same time and mobile at the same time. So usually something is strong and stable or solid, but not very mobile. So that makes me think about the hip. The hip joint is a very deep socket and you can't very easily put your foot behind your head right, so the hip sacrifices mobility for stability. The hip is very stable, but the hip is not very mobile.
Speaker 1:Now let's talk about the shoulder. The shoulder is very mobile. You put the hand behind the head, the hand behind the back, across the body out to the, the back, cross the body, out to the side, up to the front, up to the side a lot of movements. The shoulder does sacrifice stability for mobility, so opposite of the hip, so the hip sacrifices mobility for stability. It's very stable but it's not very mobile. Right, the shoulder is very mobile, but it occasionally gets dislocated, it gets subluxed. We'll talk about some of these terms.
Speaker 1:However, we do require of our shoulders that they be very stable and mobile at the same time. Of our shoulders that they'd be very stable and mobile at the same time. The way we use them, the way we have to use them. So the shoulder will position the arm where we need it to be, and then that, combined with the elbow and the forearm and the wrist, positioning this amazing tool, the hand, where it needs to be, in space. And all of these muscles around the shoulder have to contract at the same time to hold it really solid. Same with the muscles that control the elbow and the forearm and the wrist. It has to contract and they all have to work together in unison, which is called you guessed it coordination. So it all has to coordinate and work together.
Speaker 1:So another excellent analogy when talking about the shoulder is a golf ball and a golf tee. One of the main reasons why we can have so much movement of the shoulder is because it's a very shallow ball and socket. And when you're talking about the ball and socket of the shoulder, the tee, the golf tee, will serve as the socket and the golf ball will serve as the ball which is the head of the humerus. So your humerus bone, or your upper arm bone, some people call it. That ball will ride on that very shallow, very small socket and it's sort of like this Now, when the ball moves around on that socket, it not only spins on the socket but also glides back and forth and up and down and all around. So how does this stay centered? How does the golf ball stay centered on the golf tee or the ball stay centered on the socket, the rotator cuff, c-u-f-f, the rotator cuff it's a group of four muscles, very important, and that keeps the ball centered around on the socket.
Speaker 1:So let's talk about when we talk about anatomy. Anatomy is the parts. So you can have the anatomy of a car engine. You have the block and you can list all the parts. You have the pistons and where are they? And that's what I want to do with the arm, the shoulder, talk about the anatomy and we all have heard about the ball and socket.
Speaker 1:There's two main joints in the shoulder. They have to work together. So we have the ball and socket, we have the shoulder blade on the rib cage. It's very important to note that these have to work together. So here's the ribs would normally be in the front of this shoulder blade. So the shoulder blade first rides on the back of the rib cage. Back here the humerus rises up and meets the socket which is called the glenoid fossa. Let's just call it the socket for now. That sits in there. And if the shoulder blade would not move on the back of the rib cage, then the top of this bone would hit that bone. So the top of the humerus would strike part of the shoulder blade if the shoulder blade didn't move itself out of the way.
Speaker 1:That's called rhythm of the humerus and the shoulder blade. So when the arm comes up to the side, at the same time the shoulder blade has to raise up too. So when I'm raising my arm up to the side, my shoulder blade is gliding on the rib cage. Sometimes the shoulder blade can get stuck on the back of the rib cage and get tethered by muscles and get stuck with some adhesions. It has to be physically freed so it can work normally again. So it can work normally again and that's when your therapist has to really restore the normal mechanics of the rhythm between the shoulder blade and the humerus.
Speaker 1:So the humerus is the ball on the ball and socket and the shoulder blade is the socket. Now one structure that makes the socket a little bit deeper is called the labrum. So this socket very shallow socket there's a lip that goes around it, made out of cartilage, and that cartilage lip I just want you to have an awareness that it does exist there's a lip around that makes the socket a little bit deeper. And what's nice about having a cartilage lip around it to deepen that socket a little bit is that the cartilage is a little bit flexible. But there's a drawback, and everything of the drawback with this is that that cartilage lip sometimes tears, so that's called the labrum tear and that can be very, very painful. We can also get into that in a later episode.
Speaker 1:Now let's stay with the ball and socket. So you have the ball in the socket. So if you take that ball and socket and you take a big roll of saran wrap and you wrap that saran wrap around the ball and socket. It is really thick and strong. It's called the capsule. So most joints have a capsule around them. The capsule around the shoulder, the ball and socket. That is very, very thick. Sometimes that becomes tight and that often creates significant problem. So I just want you to have an awareness of that.
Speaker 1:The shoulder blade there's very specific parts on the shoulder blade. So if you, if I, were to turn around, this is the right shoulder blade. So if I were to turn around, there's a structure on the shoulder blade called the spine. You see that bony ridge right there and that spine of the shoulder blade separates a couple of muscles of the rotator cuff. So right on the top here we have a muscle called supraspinatus, super means above spinatus, the spine of the scapula, so that supraspinatus muscle lays right up there and it travels underneath this roof of bone called the acromion. So that supraspinatus muscle lays right in here, it travels underneath the acromion and inserts on the outside part of the ball. So when that, remember, muscles only contract, they don't push. So when this contracts, that initiates raising the arm up to the side. That's one of the main motions that that muscle does and that's one of the most commonly torn muscles of the rotator cuff, the supraspinatus, and that's right up here, and that's right up here.
Speaker 1:Now there's another muscle, infraspinatus infra, for below, and that lays right here underneath the spine of the scapula or the shoulder blade and that also goes under the acromion and that inserts on top of the ball, the outside part of the ball as well, front of the ball as well, and that muscle does this. It brings the arm away from the body. If you touch, your, lay, your hand on your stomach and then bring it out the opposite direction, that's that muscle right now. That's the second muscle of the rotator cuff. Another muscle lays between the shoulder blade and the rib cage and that muscle inserts on the front of the ball. So that muscle brings it in. So if you press your stomach into your excuse me, press your hand into your stomach, that is activating that muscle called subscapularis. It's called sub because it's below, it's between the scapula or the shoulder blade and when that contracts, that very strongly brings that in your hand, in toward your stomach, right? So when you go to the doctor's office, when you go to the therapist's office, right? So when you go to the doctor's office, when you go to the therapist's office, and they might be resisting your movements. What we're doing is we're testing all those different muscles and finding out what muscles might cause pain when they're resisted, and that helps us figure out what muscles are involved.
Speaker 1:There's another muscle called teres minor. So the teres minor muscle lies within the back of your shoulder and that muscle does what we call external rotation, brings the hand away from the body. It also helps with bringing the arm down to the side of your body and pulling your elbow straight back. So there's really four main muscles to think of your body and pulling your elbow straight back. So there's really four main muscles to think of. When we talk about the rotator cuff C-U-F-F, it's a cuff of muscles that really stabilizes the shoulder and keeps the ball centered on the socket. Again, this is the back of the shoulder blade. So sits S-I-T-S. Supraspinatus on the top of that spine of the scapula, infraspinatus on the bottom of the spine, teres minor, right back here in the back, and subscapularis, the muscle in the front that lies between the shoulder blade and the rib cage. Now, as mentioned earlier, each one of these muscles has a specific job to do and the most important role is keeping that ball centered on the socket Remember the golf ball and the golf tee as the shoulder is moving, as the ball is moving on the socket.
Speaker 1:Now there's this other bone that's kind of sticking out right here out in the way, that's the collarbone or the clavicle. So what I want to point out here is where the collarbone meets the scapula or the shoulder blade, and that joint right there is frequently affected by osteoarthritis and the arthritis sometimes it'll cause some crunching. But you know certainly pain when all of this is moving, because it has to be, you know, rubbery there, it has to. That thick white lump around it. That's the ligament which is connecting the bones together and keeping that solid.
Speaker 1:There's another structure on the front of the shoulder blade. So this is the front of the shoulder blade. The ribs are lying against this called called the coracoid, and that's an attachment to one muscle that lies below pectoralis major. So push-ups, bench press, people talk about their pecs. Pectoralis that's, excuse me, the big one that lies on the surface Below, that is pectoralis minor and that travels from the coracoid down to ribs 3, 4, and 5. So basically, when that gets tight, that pulls the shoulder blade forward.
Speaker 1:And now look at this roof of bone, the acromion that we talked about, where those muscles of the rotator cuff travel underneath. Now when that gets rocked forward, now that acromion muscle excuse me, acromion bone the bone is now pinching the muscles. So one stretch that I really have I have to do often on a lot of folks because the shoulder blades tend to get a rounded posture, because if, for example, the keyboard board is too far forward on the desk and the person has to reach for their keyboard and now their shoulder blades, their shoulders, are adopting a forward rounded posture. That muscle now is in a shortened position so that shrinks up, gets very, very tight. It starts causing problems with the rotator cuff, problems with the subacromial bursa, which we'll talk about later, causing bursitis. Problems with the long head of the biceps tendon, which will cause biceps tendonitis, which, with the long head of the biceps tendon, which will cause biceps tendonitis, which we'll talk about later. If we restore the posture by changing the ergonomics of the workstation and then also in the clinic push this back and stretch that pectoralis minor, that brings that acromion back up and removes that pinching sensation which we call impingement syndrome, impingement for pinching. That impingement syndrome just needs to be corrected mechanically most of the time.
Speaker 1:Now we did talk about the scapulothoracic glenohumeral rhythm. So the rhythm we talked about is with the shoulder blade of the rib cage and the ball and socket. So this is the back of the shoulder blade. When the arm comes up to the side, that shoulder blade has to rotate with it. When that gets stuck on the rib cage and this arm is coming up and the shoulder blade is not moving, you see where this bone is hitting that bone. You see where the top of the ball is hitting the roof of bone, the acromion, and that is causing pinching of tendons that connect the rotator cuff muscles to the bone. And again, that's also impingement syndrome.
Speaker 1:So another stretch that I do often as a therapist, another stretch that I do often as a therapist, aside from pushing that shoulder blade back to reverse that forward rounded posture, is I have to get back here and physically push that shoulder blade, force that shoulder blade to rotate upward, and that usually feels very good. That's not painful. It feels very good on folks to get back there, push that shoulder blade up, rock it up as they're moving. So I have one hand underneath their arm. I bring it up like this I have my other hand on the shoulder blade, just forcing that shoulder blade to go up. I also move it forward on the rib cage, move it back on the rib cage and loosen that up. Once that's loosened up, that'll have a person sit up from their sideline position where I have, where I'm moving them and say, okay, now don't think about it, just raise your arm up. You know they raise their arm up and now it's going twice as far and guess what, it doesn't hurt. Restore the normal mechanics of the two joints the shoulder blade on the rib cage and the ball on the socket all working together now in coordination. That really takes away a lot of the pain immediately.
Speaker 1:So one last thing the biceps tendon. So the biceps and on a future video we'll use the muscled anatomy model so I can show some of these muscles to you better. But see that groove right there. That groove is called the bicipital groove on the humerus and biceps is called biceps by meaning two. So there's two heads of the muscle and the one head is called the, the long head, and that tendon that connects the muscle to the bone goes right up through that groove over the top of the ball and, believe it or not, inserts on the top of the socket so the tendon actually goes through the joint. That becomes a problem.
Speaker 1:You get tendonitis, which we talked about in previous episodes. Itis means inflammation. Tendonitis meaning inflammation of. Talked about in previous episodes. Itis means inflammation. Tendonitis meaning inflammation of the tendon. Remember, tendons connect muscle to bone. Sometimes it also turns into tendinosis, where the tendon will start to fray, like a piece of yarn will start to fray. We'll talk about some of the treatments for these things in future episodes. So that's a little bit of the basics. That's a introduction of some of the parts of the shoulder and let's get into it a little bit more detail in future episodes. Thank you.