Recently a ballet dancer came into the office stating she was having a hard time pointing her arm toward the ceiling. She was also having some pinching in the shoulder. She also complained of tightness around the ribcage. Sound familiar. Shoulder injuries are very common and can result from excessive use or repetitive strain. They can also be caused by micro injuries that continue to build and build until a tear or impingement occur.
The goal of the next few posts will be to discuss the anatomy of the shoulder, common injuries of muscles of the shoulder and ways to prevent and stretch the ROTATOR CUFF MUSCLES.
There are many muscles in the shoulder. The 4 that make up the rotator cuff are the 1) Supraspinatus 2) Infraspinatus, 3) Teres Minor and 4) Subscapularis. Dysfunction in one or multiple ones can cause a myriad of symptoms from inability to lift arm, pinching feeling, elbow pain and numbness or tingling in the arm or hand.
This post will discuss the SUBSCAPULARIS.
The Subscapularis is located on the inner surface of the scapula. (You cannot feel it unless you dig your fingers into your armpit). It attaches to the anterior aspect of your humerus or arm.
The actions of the Subscap are internal rotation and adduction of the arm. It also helps to secure the head of the humerus in the glenoid fossa and in this way assists in abduction of the arm.
Symptoms of progressive painful restriction of abduction and external rotation of the arm are mostly due to trigger points in the Subscap and can cause the dreaded FROZEN SHOULDER.
Symptoms of Subscap trigger points or spasm can cause pain to the posterior shoulder area, down the back of the arm and possibly around the wrists.
IMPORTANT- WEAKNESS IN THE SUBSCAP CAN CAUSE THE HUMERUS OR ARM TO MOVE UP AND PINCH THE SUPRASPINATUS TENDON, THEREBY CAUSING PAIN IN THE FRONT OF THE SHOULDER.
Many people are diagnosed with “Impingement Syndrome”, the pinching of the Supraspinatus tendon. Sometimes it caused by bony abnormalities, but sometime by the weak Subscap.
It is important in any shoulder exam to examine the Subscap for spasm, shortening, contracture or weakness. If you eliminate the trigger points, stretch and strengthen the muscle, the pinching and discomfort will disappear.
Back to our ballet dancer. We treated her with some Electric stimulation followed by Active Release Technique to the Subscapularis. Results: Immediate increase in motion. No pinching and decreased stiffness and pain.
Here is a simple test to see if the Subscapularis is tight or dysfunctional.
Lift one arm and try to touch the top of your opposite scapula then try to touch the bottom of the opposite scapula. Inability to do these tests to full range can mean there is a problem with the Subscap.
Stretches- Important to be careful if you have pain. Use a towel and do this on both sides.
Be careful with all stretches. Consult a Doctor if you feel something wrong in your shoulder. We will continue with a different rotator cuff muscle next post.
Candice Thompson
I love this post. Totally have this problem and love learning more about the anatomy!
Thanks!
Best,
candice
Feb 18, 2009 @ 18:54
Renee Rothman
This couldn’t be more timely. Even cortizone isn’t helping my shoulder. I wonder if there is an easier stretch to begin with? I’m not young and have lost a lot of flexibility. Look forward to part 2.
Feb 18, 2009 @ 19:33
Dr. Michael Weber
In 2002 I discovered Active Release Techniques, ART, a medically patented technique developed by Dr. Michael Leahy. I was amazed at the ART treatment I personally received which immediately resolved my chronic shoulder, knee, and ankle problems that had responded minimally to other types of care. ART gave me my life back. I got my “game” back, I began running, cycling, swimming, etc.. I give all the credit to ART.
May 31, 2010 @ 23:04
Deirdre
Thanks for the post. As a massage therapist, and person in consderation of grad. studies for OT work, I always love to see ROM tests and stretches easy to explain to clients. Very appreciated!
May 30, 2011 @ 03:38
Jim Laliberte
Dr. David,
Could you recommend a good chiropractor in the Sacramento area who does active release, etc., as you do?
I am seeing someone now and they crack your neck, back…and that seems to be the extent of their expertise. I am a bit disappointed. Thought good chiropractors would be much more knowledgeable.
Your advise would be much appreciated. I am a frustrated bodybuilder with shoulder problems stemming from a labral repair operation.
I think I have some subscalp/biceps tendon issues. Thank you.
Jim Laliberte
916-346-4571
Jun 10, 2011 @ 00:11
Per
I can´t see how you can address a tight subscapularis by doing movements that internally rotates your glenohumeral joint. Otherwise, a good post. A release of a thight subscapularis will often aid good outcomes.
Feb 01, 2012 @ 20:14
Donna Summers
I have been a Pharmacy Technician for 7 years. Doing this kind of work is repetitive. I am 52 years old and started having this problem in mid January 2012. I was telling myself it was arthritis and was a fact of life. It got worse…Two weeks ago I had an x-ray of shoulder/neck areas. An MRI was ordered as the x-rays were inconclusive. Just received the findings of the MRI. My Dr. decided to make an appt. for me to a Bone and Joint Clinic without discussing it with me. This was unexceptable. I refuse to think I will have to have shots in my left shoulder for a better quality of life for who knows how long. I read and printed a copy of your article, as it was like reading my own story. I would appreciate any suggestions ie. exercises, strenthening, adjusting, to what seems to be a long term unwelcomed enemy to my body. Thanks so much for writing your findings.
Apr 21, 2012 @ 22:56