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 15 - Shoulder Secrets: Anatomy Insights, Pain Relief, Therapy Tips, and Injury Prevention
Shoulder pain is often the result of imbalances in muscle strength and coordination, making it crucial to understand the anatomy and mechanics of this complex joint. We explore the relationship between shoulder structure and function, common injuries, and the importance of patient involvement in overcoming pain.
• Overview of shoulder anatomy with emphasis on the rotator cuff
• Discussion of common shoulder conditions like bursitis and tendonitis
• Importance of muscle balance in shoulder function
• Impact of ergonomics on shoulder health during daily activities
• Emphasis on patient involvement in therapy and healing
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.
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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 affecting the fingertips through the shoulder. I want to talk to the general public about basic structure and function and mechanics of the fingertips through the shoulder. Today I'm primarily talking about the shoulder and common conditions that cause pain within the shoulder. I'll do a little bit of review from a previous episode about the basic anatomy and then get into some basic conditions.
Speaker 1:I'm bringing this to you because I want you to understand the fundamentals of how your body works and to recognize what your body needs so you can obtain what you need when you need it. As with most things in life, the sooner we can address a problem, the easier it is to fix. Now, this is not treatment advice. It's really crucial that you get into your doctor, your therapist, that you be seen and evaluated with a thorough exam. This is for information purposes only. I really want to reiterate that this is not treatment advice. This is information so you can be empowered to have a better conversation with your healthcare provider and make the best decisions as part of the healthcare team for yourself. That will get you well in minimal time. So let's get right into it.
Speaker 1:In a previous episode we were talking about the skeleton and some of the muscles. Today I want to actually show you some of the muscles on the model, and let's start first with the bones. So when you're looking at the shoulder, this is the right arm and this is the humerus. The humerus has the ball. The shoulder blade, or the scapula, has the socket and it's a very shallow socket. The ball and socket has a lot of movement. You can put your hand behind your head, behind your back. You can go across your chest and go out to the side. You can go up to the side, you go up to the front. You'll wait, wait to the back, and sometimes all of this reaching gets us into trouble because it over, it overexerts and over lengthens, over stresses the tendons which connect muscles to bone. Sometimes those tear, sometimes the muscle tears. There's also a lot of ligaments in the shoulder area that connect bone to bone and sometimes those get overstretched, those tear.
Speaker 1:I mentioned just now that it's a very shallow socket, but one thing that adds depth and stability is the labrum. So the labrum is a cartilaginous or just cartilage. It's made up of cartilage lip that extends the socket a little bit and that cartilage is flexible. That cartilage can tear and that's called a labrum tear. So that happens. Cartilage can tear and that's called a labrum tear. So that happens. Sometimes folks will feel a lot of very significantly deep pain within their shoulder and there's specific tests that we can do right in the office to test the labrum and see if it's looking mechanically like there might be a tear on that.
Speaker 1:Now, what keeps it's such a shallow, shallow socket. So what keeps the ball centered on the socket is the rotator r-o-t-a-t-o-r. Rotator cuff, c-u-f-f. It's a cuff of muscles. There's some muscles that attach in the front and on the side and in the back and that keeps the ball centered on the socket during movement, and there's a lot of movements where the ball is. Is is spinning, it's is rising, uh, the ball is also gliding on the surface of the socket and it's the job of the rotator cuff to keep that ball centered on the socket.
Speaker 1:So four main muscles let's review that sits s, sits S-I-T-S. Supraspinatus, which goes right on the top of that spine of the shoulder blade. Infraspinatus goes right below the spine of that shoulder blade. Teres minor, which is in the back. Again, this is the right side, so let's turn it around. This is the back Teres minor, which is is the back teres minor, which is the back of the shoulder, and subscapularis, which lives between the front side of the shoulder blade and the rib cage. So this here, if we x-ray right through the front of my right shoulder, right chest, you have the front of the ribs, you have the back of the ribs and then there's chest, you have the front of the ribs, you have the back of the ribs and then there's subscapularis and then there's the scapula, or the shoulder blade, and those main muscles, those four keep that ball centered on the socket during movement.
Speaker 1:So let's take a look at these muscles and if we take this now, we have the left arm. Right here is the deltoid, so let's take that off. Here is the front of the shoulder blade, so the front of the shoulder blade, there is subscapularis and that muscle comes around the front and it inserts on the front of the ball. So you remember muscles, muscles only contract, they don't push. So when this contracts, that pulls the hand in like this. So the ball is spinning inward and if we look at I'm going to use a golf ball and a golf tee, because that's a really good comparison for the shoulder. So that ball is spinning inward like this, bringing the hand in toward your stomach. So if you press your palm onto your stomach, that is strongly using not only the pectoralis muscle, the big muscle in front of your chest, also the subscapularis that I just showed you right here. So these muscle fibers contract and rotate the ball inward.
Speaker 1:Okay, now let's take a look at those other muscles on the back. So remember, this is the left arm. So if we go like this, here's the back Supraspinatus. So remember, this is the spine of the shoulder blade. Super, meaning above, super spinatus. You see that muscle. It goes underneath this roof of bone which we talked about earlier, the acromion. It goes underneath and inserts on top of the ball. So you can imagine, with that muscle is traveling underneath that roof of bone and now you got the ball socket the ball and socket down here. That's a pinch point that could be pinched in there. We'll get to that in a minute.
Speaker 1:Below the spine of the shoulder blade is the infraspinatus. So it means below that comes around. Now that also goes part of the muscle travels underneath that acromion bone and that also inserts on the ball of the ball and socket. So if you feel the top of your shoulder and there's a hard, flat area, that's the acromion right here. And when you step off the edge right off the side, you're on supraspinatus tendon, which connects the supraspinatus muscle to the ball, top of the ball, and then if you go back a little bit you're on the infraspinatus tendon. Sometimes tendonitis occurs right there and I have people just use an ice cube and ice that area to reduce the inflammation and take away the tendonitis on that spot. Sometimes you can also use ultrasound, but I found the best thing is just direct icing ice on the skin until it's deeply cold 10 to 20 seconds, which is better than ice pack for 10 minutes. And on the shoulder ice pack is way too broad, it covers too much area and I'll explain why that's a problem later on. So anyway, just have an awareness of now.
Speaker 1:Here's two more muscles of your rotator cuff and they travel underneath that roof of bone which is called the acromion. You know, some people are born with different types of acromions. Where the edge of this is a little bit hooked, hooked down, you start getting a type two, type three, aquarium, we call it. And if that's hooked down then you start getting a type 2, type 3 acromion, we call it. And if that's hooked down, then guess what? Now that acromion bone is pressing into that really hard, sawing into it, and then as we get older sometimes that gets more hooked. Then also bone spurs form underneath. Then that really turns into a sawing action where some of these bone spurs will actually cause a rotator cuff tear. You know. So I'm 50 years old. I have a 50% chance of having a rotator cuff tear. If I'm having shoulder pain and if they, you know, if I'm undergoing an exam and pushing on certain muscles and seeing what hurts, and if I'm having pain within my rotator cuff, I have a 50% chance of having a tear. If I were 70 years old I'd have a 70% chance of having a rotator cuff tear. So from use, from wear and tear, we can over the years really wear into this rotator cuff muscles and they start getting torn, they start getting damaged a little bit. So just have a basic awareness of that right now.
Speaker 1:So we talked about subscapularis, being between the shoulder blade and the rib cage and being a strong muscle of what we call internal rotation pulls a hand in toward the stomach. These muscles here, the muscle on the top, this supraspinatus muscle, above the spine of the shoulder blade, that muscle starts to raise your arm up to the side. So in the first 10 to 30 degrees of movement, raise your arm up to the side. That's this muscle right there. Pretty interesting. Now, below this, here, this muscle. So if this muscle on this side brings your hand in toward your stomach, this muscle on this side, infraspinatus, we're bringing your hand away from your stomach. Now we have another muscle, pteros minor, right under here, the back of the shoulder, and that muscle helps bring it away from your stomach and it helps bring your arm down and it brings your arm back as well. So these muscles, it's important to understand that they have opposing actions and when they're all working together they cause a stabilizing effect within the shoulder.
Speaker 1:I want to talk about a little flat water balloon called the bursa sac. So we were talking about the acromion bone, that bone that if you put your fingertips on the top of your shoulder and you feel that flat, hard bone, that's your acromion. Between this is the back of the shoulder blade. So between that acromion bone and the ball of the ball of the socket there's a little shock absorber. It's a little flat water balloon that resides right underneath that acromion bone, that roof of bone, and the balloon part of the water balloon If we can use that analogy the balloon part is living tissue and then there's fluid inside. So that's called the subacromial bursa.
Speaker 1:And remember, when we're talking about tendonitis, itis means inflammation, tendonitis is inflammation of the tendon. This is called bursitis. So that can get really inflamed and aggravated. If a person is doing a lot of leaning on their arm or if the shoulder blade is stuck on the back of the rib cage is not moving right. There's a lot of impingement, which we talked about in a previous episode. There's a lot of pinching up here that will get really inflamed.
Speaker 1:So if that stays underneath that roof of bone, how can I check that in the clinic to see if somebody has bursitis? Well, one very effective way is I'll have the patient put their hand behind their back. So picture the ball of the ball in the socket. As I put my hand behind my back, the ball is rolling forward. What that does is that pulls that subacromial bursa, that flat water balloon. It exposes it. It pulls it forward, that subacromial bursa, that flat water balloon. It exposes it, it pulls it forward. So now it's exposed. So with the patient's hand behind their back I can come over and touch the front of their shoulder blade and see if that's really really tender and if it is most likely they have bursitis or subacromial bursitis, and that is treated very effectively with ultrasound and again with ice. I'll have people put their hand behind their back and take an ice cube. It just barely touches the skin of the front round bony part of the shoulder until it's deeply cold, which should take 10 to 20 seconds and that reduces the inflammation and pain very nicely. It eventually gets it to go away. So again, if I can get to the patient where they've been experiencing symptoms for maybe a few weeks or a month, it's not going to take that long to go away. If it might take a couple of weeks sometimes to fully go away, if they've been experiencing symptoms for three months, six months, it's going to take longer. It's going to take several weeks to go away. So if you're experiencing shoulder pain, get into your doctor sooner rather than later.
Speaker 1:Let's get this figured out Now. Let's talk about biceps, tendonitis, the biceps. Let's look at the muscles again. So bi for two. Bi means two right. So if you have the biceps heads here, there's a short head, one head that goes to the what's called the coracoid. See that funny hook shape bone right here. That's on the front of the shoulder blade. So the ribs are removed we're looking at the front of the shoulder blade, we're not looking at the back Goes up to there. The long head of the biceps travels up the tendon, goes through the groove and goes over the top of the ball and inserts on the top of the socket and inserts on the top of the socket. It's pretty amazing that it goes that far. One job of that is to help keep the head of the humerus or the ball down when you're raising your arm up. However, it's a problem because now we have a tendon Remember, tendons connect muscle to ball.
Speaker 1:We have a tendon that's going through a joint, a joint area, and that is an area where there's close tolerances. There's a lot going on in there, there's not any room for error and it often gets pinched. So that gets very inflamed. When that goes on for a long time and continues without treatment, it can start to fray and that turns into a tendinosis, which is sort of you know you've seen yarn or thread that starts to fray and it gets scraggly. That tendon gets pretty diseased. Sometimes it ruptures. And if that ruptures, if it's an older person and it ruptures and you know the person's older, they're not doing a lot of heavy work outside, they're not, perhaps they're retired. There's a total of three muscles that bends the elbow, three main muscles, and so now if that ruptures, they have two and a half muscles. That is flexing or bending the elbow. So that means it doesn't have to be repaired.
Speaker 1:When it gets repaired, what the surgeon will do is drill a little hole in the in the shaft of the bone of the humerus, put a bone anchor in there and now, instead of that tendon traveling up through over the top of the ball and inserting on top of the socket, now that tendon is pulled out of there and it's anchored into the bone and that's a nice procedure that works really well. And you know it's something that's interesting is called the Popeye sign. So if you remember the cartoon Popeye, big biceps, big forearms. So if that tendon is broken now, the muscle is going to shrink and ball up because that tendon is going to pull down and there might be a ball in there where the biceps muscle is and that will look very prominent on that spot. That's called Popeye's sign.
Speaker 1:Now let's talk about we talked about the rotator cuff being pinched underneath that roof of bone called the acromion we talked about. Sometimes the acromion gets hooked we talked about. Sometimes bone spurs form under the acromion there's a really big muscle called the deltoid and that deltoid everybody knows about the side of the shoulder, that big, heavy muscle that's a deltoid. The job of the deltoid is to raise the head of the humerus or the ball on the socket. So sometimes when muscles are out of balance and that deltoid is stronger than the rest of them. And by the way, the deltoid muscle we're really going to get to some mechanics here the deltoid muscle has the strongest moment arm of force, meaning it's the strongest leverage for pulling that ball of the ball and socket.
Speaker 1:North up up there's other muscles of the rotator cuff and shoulder girdle that have the opposite effect. They work to pull the ball down. There's a reason for the competing forces. So if there's competing forces, that allows, that provides stability. So if this hand is moving to my right, my right hand is moving to my left and they press together, that's really stable and solid. If everything's going in the same direction, it's just going to continue on and fly apart, fall apart. So if there's competing forces, that makes it press together and stay very solid.
Speaker 1:Now I'm sure you're thinking well, if you use these competing forces and some forces are now stronger than others it's going to have a tug-of-war effect and one side is going to win, the other side is going to lose, and then what happens is structures slam into each other. So let's go back to the deltoid. All right. So if this deltoid muscle on the side of the shoulder is now way too strong compared to the other muscles and it's raising the ball of the ball and socket up high and it's hitting the acromion, that roof of bone, and now it's pinching off those muscles of the rotator cuff even more, even, even harder, and that also that causes spurring, that causes the that acromion bone, that roof of bone, to become a little more hooked and that leads to more wear and tear on the rotator cuff tendons that connect the muscles to the bone. So sometimes you can have a partial tear in the muscle, sometimes it's a full tear.
Speaker 1:Now I want to mention something very interesting that studies have shown that upwards of 20% of people who have a rotator cuff tear don't know that they have a tear. What does that mean? That just simply meaning that they don't have any symptoms. That also means that if 20% of people with a tear don't know they have a tear, that means the person doesn't always, 100% of the time, need surgery. So usually, so usually, whenever we can get away with it, we do therapy first to see if we can strengthen the rotator cuff and strengthen specific muscles that raise the acromion higher and lower the ball of the ball and socket to widen this space underneath the roof of bone and the ball to relieve pressure from those tendons of the rotator cuff. So yes, by strengthening the correct groups of muscles we can have the effect on the skeleton that we want to have, that we need to have in order to relieve pressure or pinching or impingement on that area.
Speaker 1:Now, will will the tears of the rotator cuff heal themselves? And the answer is no. Often what your doctor will do is an MRI to see the severity of the tear. But again, even if the tear is very severe, if we can get the pain to fully reduce, get the range of motion restored, restore full functional use of the arm, full functional use of the arm, full functional use of the shoulder, then more often than not, surgery isn't needed in those cases. So there's always, there's always other details, there's always other situations With the mechanics of the shoulder, with really with anything. We can't make blanket statements, because a blanket statement for everything just isn't true.
Speaker 1:I'll hear a lot of people say things. You know that some patients will come into the offices and be very nervous. Usually what they're thinking is therapy is going to be really painful, it's going to be extremely difficult, et cetera, et cetera. At the initial visit I always explain to patients that therapy shouldn't be extremely painful. This is not going to be a painful therapy. This is going to be restoring the mechanics, strengthening proper muscles, stretching certain structures, and stretches should be. You should feel a pulling sensation, not pain.
Speaker 1:If you're feeling pain, the stretching is too aggressive. Sure, occasionally there's some discomfort, there's some pain, but if pain is getting, you know, with maximal pain being 10, 10 out of 10, and a pain during a stretch is, you know, 5, 6, 7 out of 10, that's too much, it's a too intense stretch. So at home I educate patients to proper stretches to lengthen or restore flexibility to muscles that are very, very tight and stretching should be done not intensely but frequently. So stretching usually every one to two hours, but it should only take four or five minutes the shoulder really, frequency is the key to do the stretching four to six to eight times per day, depending on the condition that we're treating. But nothing should be aggressive or terribly forceful. So at that point patients really relax for a bit when they realize that this should not be a painful therapy.
Speaker 1:Talking about stretching when patients are in my office, I want to do things for them that they can't do for themselves at home. So let's talk about the structures a little bit more. You see this bone right here, sort of a c-shape that's called the coracoid, and there's a, a muscle called pectoralis minor. It attaches to that, this hook-shaped bone right here, and it attaches down lower to ribs three, four and five. So when that gets tight, what it does is it rocks that shoulder blade forward and the thing to pay attention to again is the crummy on that roof of bone. So when the shoulder blade rocks forward, such as when we're using poor posture and leaning forward, one thing I always think of is what a lot of people want to do is put the keyboard for their computer really way forward on the desk and have the papers in front of them. So what that does is that makes a person reach for the keyboard. They're looking down at the papers, their shoulder is in a forward rounded position. That means the shoulder blade is cocked forward, that roof of bone, that roof of bone called the acromion, is cocked forward and what that's doing is pinching off the muscles, the tendons. That subacromial bursa, that flat water balloon we talked about, is pinching that, causing inflammation and pain. If we bring the computer keyboard close to the edge of the desk, that brings the body up. It brings the shoulders back.
Speaker 1:Now I have patients take an ergonomic break once in a while, patients who work at a desk. And what's the opposite of this? All forward rounded Up like this, bringing the arms back. I call it a big yawn stretch, just like taking a big yawn and bringing the arms back like this. This really restores the nice mechanics of the shoulder. Even if you just hold that for three seconds, you relax and just do a few of those and it looks natural too right. Just this looks like, oh, a person's trashing and they're just taking a big yawn and that really does wonders. That brings us back. So in the office what I'll do is sometimes I'll just have a person stand, put their back against the wall, I'll fold up a towel, put it on the bottom part of the shoulder blade, right there, and then I'll get in the front. I do an upward and back angle and push that back and that stretches that pectoralis minor muscle, lengthens that muscle and opens that right up and really makes a world of difference and takes the pressure off here. Then they'll go home and do the icing like we talked about a few minutes ago. Now watch this. This is really interesting.
Speaker 1:When this arm comes up to the side and we talked about this on a previous episode this shoulder blade cannot stay still. The shoulder blade on the back of the rib cage is one of the main joints of the shoulder. So again we have the shoulder blade on the rib cage. We have a ball in the socket. They both have to work in tandem. They have to coordinate with each other. So that's called rhythm between the two. There has to be a rhythm between the two so as the arm comes up, the shoulder blade also has to rotate. See how that shoulder blade is turning. The shoulder blade is spinning on the back of the rib cage, so that's called upward rotation of the shoulder blade.
Speaker 1:So in the office I'll have a patient stand in front of me and with both arms by their side and I'll say, okay, shrug your shoulders, pull your shoulder blades back together, glide them forward, raise both arms up to the front. I want to see how that shoulder blade is rotating. Raise both arms up to the side. I want to see how that shoulder blade is rotating. And I'm comparing it to the opposite side. All my hands ran on it and I'll feel where is that? This is called the interior angle. So where is that angle of the shoulder blade? On the left side it's way up there. When their arm is up, hands are up over their head, and then on the other side it's a lot lower, lower. That tells me that these muscles over here, the rhomboid muscles and other muscles, are the ones that keep it down. They're too tight.
Speaker 1:So easy, I'll assist that shoulder blade and I'll literally push on that shoulder blade into a nice stretch and that feels so relieving to people, and then we'll just get that lengthened out. Take about five minutes, do some stretches. I'll push the shoulder blade forward, push it back, tilt it back, do the upward rotation and really mobilize that shoulder blade on the rib cage. And then what does that do? That's going to relieve the pressure between that roof of bone and the top of the ball and take the pressure off those tendons that travel through there and it's going to restore the normal mechanics of the skeleton. So we meet that goal and immediately most of their pain quite often fully goes away at that visit when we restore it. So we might have to do that once a week, probably for a few weeks, sometimes in severe cases twice a week for a few weeks.
Speaker 1:Then on top of it, I'll give patients exercise bands to use at home, because again, if they're going to just come into the office and they're just going to stand there and do a bunch of exercises, they can do that at home. And then I'll use the patient's cell phone to take a video of the patient doing exercises. So here you watch this at home, spend five minutes once a day, twice a day maybe, doing these strengthening exercises and then maybe every three hours, every two hours, do these basic stretches. Super easy, doesn't take very long, and then they can watch the video on their own phone and then just follow along. It typically takes about four minutes, five minutes maybe, max, to go through everything each session. So it is very, very important that at the exam.
Speaker 1:So I'm going to determine several things. I'm going to determine what is the skeleton doing, what muscles are being pinched, maybe, or what muscles are too tight, what muscles are causing compromised mechanics of the shoulder, are some muscles too weak? Are some muscles too short? Also, when muscles are too short, one of the causes might be trigger points. So a trigger point is a knot in a muscle. So if that knot can be worked out, that really does wonders. But how do you massage your own shoulders? Especially, how do you get back there?
Speaker 1:So here's something I'll put a link to this on the bottom of the screen, but this is called a ferrocane, so you can. It has handles to where you can hold this. This knobby will go back here within these muscles. And if there's and I'll show the patients where the, where the trigger points are in the muscles, and if the, if you take a rope, a length of rope, and you tie a knot in the length of rope, now your length from point A to point B is shorter. So a tight knot in the muscle is going to shorten the muscle and that really throws off the mechanics within the shoulder. So, for example, if there's a knot in this muscle right here that's really, really tender, then they can come back. That muscle, by the way, is supraspinatus, remember, it's above the spine of the shoulder blade. If you can reach back and you feel that bony ridge back there, that's the spine of the shoulder blade. So most of us, especially in the muscles that go from the neck down to the shoulder blade, upper trapezius, levator scapula, the ones that raises the shoulder blade up, you know we carry our attention there, we always have these up and they get really, really tight. You can get that knobby part of this theracane back here and find that tender area and just hold it, pull into it until it feels a little sore and just keep it there and then, when the soreness goes down, when it feels a little bit better, go in a little bit deeper. This is called ischemic compression.
Speaker 1:Ischemia means lack of oxygen. So what you're literally doing is pushing and again, this is not treatment advice. I'm not telling you to do this. You really have to get evaluated by your therapist, by your doctor. But in cases like this, I just want you to have an awareness.
Speaker 1:This is what I have. Some people do and they push into this and then, as the pain decreases, that means the muscles relaxing. Because I'm starving the muscle of oxygen, I'm pushing the blood out. So if you push the blood out because you're putting pressure, that's pushing the oxygen is in the blood. So if you're pushing the blood out, you're starving the muscle of oxygen is forcing the muscle to relax. So now it's feeling a little bit better. So now I'm going to pull in there a little bit deeper. And okay, that relaxed a lot. So now I'm going to find another point and sure enough there's another one. You know I haven't been using this enough. My wife and I each have one at home. We'll use the heating pad for 10 or 15 minutes and then get into it a little bit, and with this this can even be taken into the shower with nice warm water on there and get, get into those tight muscles. So this is very, very handy.
Speaker 1:And again, I just want you to have an awareness of of these things. So we talked about tendonitis, we talked about tight muscles, of the rotator cuff, and aside from the rotator cuff is the shoulder girdle. So the muscles that go down your back, latissimus, they go all the way down your back and they help control your shoulder, they help control the shoulder blade, and all of these things put together is quite a combination of a lot of different structures, a lot of different mechanics, and that's why you need a thorough examination, a thorough evaluation of what's going on. What can you do at home? Here's what we should do in the clinic. And again, I'm only going to do things in the clinic that the patient can't do for themselves at home. And then also I'm going to modify as the patient gets better and they can do different things. I'm going to modify the home program.
Speaker 1:So it's all about efficiency. Of course, we want the patients to get well in minimal time. That's the key. Let's get rid of this pain, let's restore the function of the shoulder and the arm. And how do we do that? With efficiency. I'm going to give certain treatments in the office, things that can't be done by the patient in their home, and then I'm going to have the patient do what's optimal for themselves at home and working together. And again the patient has to come in with an attitude of I'm going to participate, I'm going to give this some some dedication and we're going to get this better.
Speaker 1:And it's really teamwork. The most important part of the team always is the patient. The patient is the most important because of the patient is just coming into therapy once a week, even twice a week. Patient is just coming into therapy once a week, even twice a week. That's not going to do it. It's. You know, one of my main roles is a coach, basically, and all right, now we're going to change things up, do this at home instead, and then, when you're in the office, I'm going to give you a tune-up and I'm going to do things for you that are specific, that you're not able to do for yourself at home. That's called skilled treatment. Bringing it all together makes it primarily efficient, so that way you can get well in minimal time.
Speaker 1:So one last thing is osteoarthritis. So arthritis affects these joints you have on the front. You might be wondering what's this bone sticking out here? That's the collarbone, so that. Or the clavicle, so that clavicle attaches to the sternum, so you have your sternoclavicular or sc joint. So where that comes and meets, that is quite a place for arthritis. I'm actually dealing with that right now and I'm giving myself some treatment to fix that. What's happening with my collarbone is it's moving forward. So it's actually you can see on my left side without my shirt, on the skin is being pushed forward but I'm bringing that back. I actually have a strap that I wear around my shoulder sometimes to bring this back where it needs to be and it's feeling much, much better.
Speaker 1:But that's another discussion about posture. I've been leaning on my arm when I'm treating patients. I've been leaning on my desk and looking at the computer screen etc. Now on the other end of the shoulder of the collarbone, the clavicle, is the AC joint, the acromial clavicular joint, the acromion, that roof of bone. This collarbone meets that roof of bone on the front of it and that has to move. So it's pretty interesting if you feel your collarbone and you follow it to the center of your chest. Your sternum is that breastplate. If you follow that over and you move your arm around, there's a little bit of movement there. Also, when you follow it over toward your shoulder where that meets right there at the acromion, there's a lot of movement on that area. As a therapist I'll mobilize those joints a little bit, loosen them up, educate patients where to put direct ice to reduce inflammation. And, again, restoring posture, restoring strength to specific muscles will all help all of that structure. So you remember, arthritis is inflammation of the joint, arthro means joint and itis means inflammation. Let's end it with that. That gives you a basic understanding of the mechanics of the shoulder.
Speaker 1:In another video I want to talk about ergonomics and how to best position our arm when lifting things, what not to do, what to do, safe exercises. All of that Because wellness versus sick care. So if I wait for you to be injured and now we have to fix something, that's sick care. There's already a problem. Now we have to fix it. Let's prevent the problem. That's wellness. There's already a problem, now we have to fix it. Let's prevent the problem. That's wellness. So, preventing the problem and optimizing the mechanics of the shoulder and keeping the shoulder safe, that's wellness and let's do that. Let's do that instead of getting injured. And there's a lot of easy, basic things a person can do and habits to not fall into to really maintain the best health of the shoulder. Thanks for listening. I'll talk to you again soon.