The shoulder joint consists of three different bones, the humerus or upper arm bone, collar bone or clavicle and the shoulder blade or scapula. All of these bones affect the shoulder. Until I got a shoulder injury, I thought of my shoulder blade as a simple triangle of bone that sat on my back and stuck out whenever I pushed my elbows forward.
The shoulder joint contains three different bones, the upper arm bone or humerus, collar bone or clavicle and the scapula or shoulder blade. All of these bones make up the shoulder. Until I got a shoulder injury, I thought of my shoulder blade as a triangle of bone that was located on my back and stuck out if I pushed my elbows forward. I had not really thought about its design or purpose.
Actually, it is quite a complex piece of human architecture. At the top outer corner it has a cup of bone called the glenoid which forms the ball of the shoulder ball and socket joint. It also attaches to the clavicle at the top. This part of the shoulder blade is a hook of bone that curves over at the top called the Acromion.
In addition to the the bones of the joint there are seventeen different muscles which work the shoulder as well as ligaments and cartilage that all make up and hold together this complex joint.
The cuff is a group of four muscles that all fix to the shoulder blade at one end and the humerus at the other, surrounding the joint in a cuff of muscle . They all pull the ball at the head of the upper arm bone into the socket of the shoulder joint. Because the socket of the shoulder is very shallow these muscles are necessary to hold the arm in place and stabilize the joint. Without them our shoulders could become easily dislocated.
One of these muscles, the supraspinatus runs through the hook of the acromion before attaching to the upper arm bone. Try to imagine a thin tendon running through a channel of bone. If the channel narrows or the tendon gets inflamed it can start to rub on the bone damaging the tendon leaving it vulnerable to tearing or fraying. You could compare it to an old rope being rubbed against something hard, after time the rope would begin to fray and if left long enough could actually snap.
The causes of rotator cuff impingement are similar to other injuries. Any injury or trauma to this particular tendon, that causes swelling, can trigger a rotator cuff impingement. Arthritis can cause the channel to narrow and as we age some of us actually grow bony spurs on the acromion that will narrow the channel and cause a potential impingement.
The symptoms of an impingement are shoulder pain especially when raising the arm above shoulder height or reaching out for something coupled with trouble sleeping at night. A simple test that your doctor may do for a shoulder impingement is to ask you to straighten your arm with the palm facing out and then to raise it up. If this causes pain then you almost certainly have a rotator cuff impingement.
Don't ignore a shoulder impingement as this can cause more serious problems. Therapy is rest and anti-inflammatory drugs to reduce the inflammation. Do Make sure that you avoid any overhead movements. If you work at something like plastering or painting you will need to change how you work to avoid these movements. When the muscles are rested and have started to recover you can start physical therapy to strengthen the muscles of the rotator cuff to prevent future injuries.
If symptoms persist or if the bone has changed shape then you are almost certainly looking at surgery to repair it. This will involve keyhole surgery called a sub-acromial decompression where the surgeon shaves away a piece of bone to release the tendon.
Most rotator cuff impingements are solved without surgery but it is vital to take this injury seriously and rest it, avoiding overhead movements. The pain you feel is an indicator that more damage is being done so listen to your body and let it heal.
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