Does a day of yard work, a tennis game or a quick house project leave your shoulder aching for days?  Shoulder pain can range from a constant, dull ache to a sudden sharp pain with movement.  Whatever symptoms you are experiencing and no-matter how short-lived they are, they are a warning sign and you should pay attention to them.

The ‘shoulder’ is actually made up of four joints.  The shoulder joint itself is made up from the ‘ball’ of the upper arm (humerus) fitting into the shallow ‘socket’ of the shoulder blade (scapula).  The shallow socket is more properly known as the glenoid fossa and this joint is called the gleno-humeral joint.

The gleno-humeral joint has a shallow socket that is deepened by a soft, cartilage rim, called the labrum.  By contrast, the hip joint is also a ball and socket-type joint but it has a deep, boney socket that provides much more stability.  You may have heard the term ‘labral tear’ which is a tear in the labrum itself or when the labrum tears away from the boney socket.  This injury can cause pain, instability (shifting or slipping) and catching or ‘locking.’  The shoulder is designed for maximum mobility, however, this also means that it gives up some stability and is more prone to injury.  Not only does the gleno-humeral joint offer more mobility, the other three joints allow the shoulder blade to move on the rib cage, providing even more movement.

Movement at the ball and socket joint results from a force couple - two muscles or muscle groups produce forces in different directions that create a rotation.  In order for a rotation to occur at the ball and socket joint, one force must create a movement in a particular direction while the other force provides stability to keep the ball in the socket.  If the stabilizer muscle (rotator cuff) is not working or is overpowered by the mover muscle(s), the ball slides upward in the socket, pinching the rotator cuff and bicep tendon.  These tendons pass through the very small space above the ball and beneath the bony ‘roof’ of the shoulder, the acromion process of the scapula. 

Whether this pinching happens once in a traumatic event or repeatedly over time, the result is swelling (inflammation) and, if severe enough, scarring, fraying or tearing of the tendon(s).  What might start as something mild, such as a tendonitis, that might respond to anti-inflammatory medicine can easily progress to a rotator cuff tear that will require surgery and extensive rehabilitation. 

Most people are conditioned to respond to the pain, not the cause of the pain.  That is, when their shoulder hurts, they take medicine to get rid of the pain, get a cortisone shot to ‘blast out’ the inflammation or worse, avoid using the arm in a normal manner due to pain.  The problem is that the pain is your body’s way of telling you that something is wrong.  Fixing a problem will prevent it from becoming worse while masking the pain will create a bigger problem later on!  Listen to your body and take care of the problem, not just the symptoms.

If you are planning on starting an activity (or new job) that involves using your arms a lot, especially overhead, then you should prepare yourself by working on the mobility, flexibility and strength beforehand…it’s much easier doing it as PreHab than as ReHab!  A list of typical rotator cuff exercises can be found in our rotator cuff rehabilitation article here.