Welcome to Revive Spine and Sport Physiotherapy Clinic's patient resource about Shoulder problems.
The shoulder is an elegant piece of machinery. It has the greatest range of motion of any joint in the body. However, this large range of motion can lead to joint problems.
Understanding how the different layers of the shoulder are built and connected can help you understand how the shoulder works, how it can be injured, and how challenging recovery can be when the shoulder is injured. The deepest layer of the shoulder includes the bones and the joints. The next layer is made up of the ligaments of the joint capsule. The tendons and the muscles come next.
This article will help you understand:
what parts make up the shoulder
how these parts work together
Hear from some of our patients who we treated for Shoulder Pain
“
I came to Revive Spine & Sport Physiotherapy in so much pain with my shoulder. I couldn't even lift my arm up over my head. They have worked their expertise on me and I can now move my arm freely... ”
“ I came to Revive Spine & Sport Physiotherapy in so much pain with my shoulder. I couldn't even lift my arm up over my head. They have worked their expertise on me and I can now move my arm freely without pain. The staff are fantastic, very easy to talk to, very caring. I would highly recommend anyone needing any physiotherapy.
Great job everyone, especially Siv. ”
“
Enjoying my walk today due to my pain-free shoulders. Who knew swaggering harder could relieve the tension? Now I'm looking good and feeling better. Thank you Morgan. ”
“ Enjoying my walk today due to my pain-free shoulders. Who knew swaggering harder could relieve the tension? Now I'm looking good and feeling better. Thank you Morgan. ”
“
The best physiotherapy, Siva has help me recover my shoulder and hands I’m so grateful to finding Siva 100% guaranteed with best results.
Thank you for your great service. ”
“ The best physiotherapy, Siva has help me recover my shoulder and hands I’m so grateful to finding Siva 100% guaranteed with best results.
Thank you for your great service. ”
“
The best physiotherapy, Siva has help me recover my shoulder and hands I’m so grateful to finding Siva 100% guaranteed with best results. Thank you for your great service. ”
“ The best physiotherapy, Siva has help me recover my shoulder and hands I’m so grateful to finding Siva 100% guaranteed with best results. Thank you for your great service. ”
“
Revive Spine and Sport Physiotherapy Clinic, Albany, has an excellent staff of professionals - from the front desk to the therapists. Their experience, knowledge, professionalism, thoroughness, and... ”
“ Revive Spine and Sport Physiotherapy Clinic, Albany, has an excellent staff of professionals - from the front desk to the therapists. Their experience, knowledge, professionalism, thoroughness, and friendliness, supported by advanced technologies and state-of-the-art treatment modalities, provided me with a great experience. Impressive! The clinic has been extra vigilant about sanitizing equipment and surfaces, having patients and staff wear masks, stagger appointment times, and limiting the number of people in waiting rooms. Mr. Paul, my physiotherapist, intently listened to me and validated my concerns, evaluated my shoulder/neck strain, prescribed a treatment plan, explained everything while putting my mind at ease. He professionally guided me through therapy that significantly improved my ability to participate in day-to-day activities. In addition to the in-clinic treatment, Mr. Paul also provided me with a personalized home exercise program that also expedited the healing process. I look forward to continuing my therapy sessions with Mr. Paul. No doubt, Revive Spine and Sport Physiotherapy Clinic is where I'll go when I need physiotherapy again. And, I highly recommend that you visit the clinic. I guarantee that you will be exceptionally pleased with your results! Thank you, Brooklyn and Mr. Paul, for providing me with outstanding service. I can't emphasize enough how grateful I am for the care I have received. ”
“
I love this clinic! Staff is friendly and professional. Facility is clean and well designed. But most importantly I was looked very well by Siva (one of the physiotherapist). I initially went there... ”
“ I love this clinic! Staff is friendly and professional. Facility is clean and well designed. But most importantly I was looked very well by Siva (one of the physiotherapist). I initially went there due to dizziness from a past concussion but was so pleased that I also asked for advice for a long recurring problem I have with my back (slipped disc). Siva took the time to explain me what was going wrong in both cases and how we would solve the problem. He gave me clear exercises that have been very effective over time. Siva is extremely knowledgeable. After my second visit I was already convinced and referred my spouse for he frozen shoulder. She has seen improvement too. I would absolutely recommend that you give the clinic a try! ”
“
I came here to rehabilitate my shoulder after a fall. After 6 weeks it feels like it did before. The staff here are friendly, professional, and helpful. COVID-19 protocols are in place and the place... ”
“ I came here to rehabilitate my shoulder after a fall. After 6 weeks it feels like it did before. The staff here are friendly, professional, and helpful. COVID-19 protocols are in place and the place is clean and tidy. I would come here again in the future if needed. ”
“
The therapist at this location are stellar, I had a neck/trap injury so bad I had a chiropractor tell me I wasn’t going to be able to do shoulder workouts going forward. I came to revive and I... ”
“ The therapist at this location are stellar, I had a neck/trap injury so bad I had a chiropractor tell me I wasn’t going to be able to do shoulder workouts going forward. I came to revive and I haven’t felt this good since before my injury. ”
“
Revive has been amazing! I initially went here in 2019 for a pinched nerve in my shoulder, and most recently in 2021 for a knee injury. The Physiotherapists here are so well-informed, and they... ”
“ Revive has been amazing! I initially went here in 2019 for a pinched nerve in my shoulder, and most recently in 2021 for a knee injury. The Physiotherapists here are so well-informed, and they provide you with videos to remind you about your homework and the proper way to practice the exercises and stretches. It’s fantastic! Paul is amazing, and he took me from limping, to being able to practice balancing exercises on a BOSU—teaching my body muscle memory to rehab and prevent another injury from happening. Here, they don’t just rehab and ensure you heal properly and safely, they also set you up with the knowledge and exercises to prevent future injuries! I’m leaving here transformed, and I feel so much more stable and awate of my balance now. The difference now is pretty incredible, really. ”
“
Revive Spine and Sport Physiotherapy Clinic, Albany, has an excellent staff of professionals - from the front desk to the therapists. Their experience, knowledge, professionalism, thoroughness, and... ”
“ Revive Spine and Sport Physiotherapy Clinic, Albany, has an excellent staff of professionals - from the front desk to the therapists. Their experience, knowledge, professionalism, thoroughness, and friendliness, supported by advanced technologies and state-of-the-art treatment modalities, provided me with a great experience. Impressive!
The clinic has been extra vigilant about sanitizing equipment and surfaces, having patients and staff wear masks, stagger appointment times, and limiting the number of people in waiting rooms.
Mr. Paul, my physiotherapist, intently listened to me and validated my concerns, evaluated my shoulder/neck strain, prescribed a treatment plan, explained everything while putting my mind at ease. He professionally guided me through therapy that significantly improved my ability to participate in day-to-day activities. In addition to the in-clinic treatment, Mr. Paul also provided me with a personalized home exercise program that also expedited the healing process.
I look forward to continuing my therapy sessions with Mr. Paul. No doubt, Revive Spine and Sport Physiotherapy Clinic is where I'll go when I need physiotherapy again. And, I highly recommend that you visit the clinic. I guarantee that you will be exceptionally pleased with your results!
Thank you, Brooklyn and Mr. Paul, for providing me with outstanding service. I can't emphasize enough how grateful I am for the care I have received. ”
“
First of all would like to Thank you to The Team of Rivive Spine and Sport Physiotherapy Clinic. Specially to Paul, Arghese for assisting me and helping me to get through to the healing process of my... ”
“ First of all would like to Thank you to The Team of Rivive Spine and Sport Physiotherapy Clinic. Specially to Paul, Arghese for assisting me and helping me to get through to the healing process of my injury. After my car accident last May 30, 2020. i suffered pain on my eye, head, neck, shoulder, arm and back. That moments my physian Dr. steer recommended me to the clinic. And I am so greatful that all the staff are very respectfull, nice, happy and friendly to assist me. After I got into a car accident I usually had head ache, soar and stift neck that continue to give me pain on my shoulder, arm, and back. I can't sleep, can't move my arm or can't do any activity on my daily living witch is a huge impact in my life. Now there is a big difference since I am attending the therapy and doing the home exercise that helps me to be back on where I was before. Now I'm still in the process of recovery with leser pain on my back and i can move more on arm and neck without having a lot of pain. There is always a saying No Pain, No gain. Again thank you for all the support that you have made for me. Wishing you all the best and you may all continue to help people like me. Happy and satisfied clients, Lodilyn Sumagpang ”
“
Honestly the best Physio clinic in the city! I have been dealing with a work injury for a while now and this clinic has helped me so much. I went to a few physiotherapists before finding Siva at... ”
“ Honestly the best Physio clinic in the city! I have been dealing with a work injury for a while now and this clinic has helped me so much. I went to a few physiotherapists before finding Siva at Revive and I'm glad because Revive is the best. I have worked with Siva and Paul and both are fantastic physiotherapists. Siva has helped me maintain good range of motion to my shoulders and continues to advocate for me in regards to dealing with WCB and physicians. I value his guidance and expertise and have nothing but good things to say about Siva and his team. The front end and all around awesome workers are always friendly and willing to help out. The clinic is spotlessly clean. They have been following all the covid precautions as set out by Alberta Health and their are multiple places to wash your hands or to hand sanitize. They work hard to maintain strict disinfecting between clients but also leave out the cleaners so that you can clean the equipment as well. I haven't had a problem finding appointment times that work with my schedule and they are always accommodating. I also appreciate the email reminders for appointments. There location is great as well with lots of stores near by (banks, walmart, restaurants, dollarama) and plenty of parking. If you are looking for a physiotherapy clinic look no further! I highly recommend Revive! ”
“
In my second session of treatment, I felt improvement in my shoulders mobility and it got better with a couple more sessions. Siva and his team are really good in what their doing, very professional,... ”
“ In my second session of treatment, I felt improvement in my shoulders mobility and it got better with a couple more sessions. Siva and his team are really good in what their doing, very professional, friendly and most of all, they do their best to make you feel better and back to a healthy and active YOU in no time. I would recommend this clinic to anyone. ”
The important structures of the shoulder can be divided into several categories.
These include:
bones and joints
ligaments and tendons
muscles
nerves
blood vessels
bursae
Bones and Joints
The bones of the shoulder are the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone). The roof of the shoulder is formed by a part of the scapula called the acromion.
Shoulder Bones
There are actually four joints that make up the shoulder. The main shoulder joint, called the glenohumeral joint, is formed where the ball of the humerus fits into a shallow socket on the scapula. This shallow socket is called the glenoid.
The acromioclavicular (AC) joint is where the clavicle meets the acromion.
Acromioclavicular and Glenohumarel Joints
The sternoclavicular (SC) joint supports the connection of the arms and shoulders to the main skeleton on the front of the chest.
Sternoclavicular and Scapulothroacic Joints
A false joint is formed where the shoulder blade glides against the thorax (the rib cage). This joint, called the scapulothroacic joint, is important because it requires that the muscles surrounding the shoulder blade work together to keep the socket lined up during shoulder movements.
Articular cartilage is the material that covers the ends of the bones of any joint. Articular cartilage is about one-quarter of an inch thick in most large, weight-bearing joints. It is a bit thinner in joints such as the shoulder, which don't normally support weight. Articular cartilage is white and shiny and has a rubbery consistency. It is slippery, which allows the joint surfaces to slide against one another without causing any damage. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to make motion easier. We have articular cartilage essentially everywhere that two bony surfaces move against one another, or articulate. In the shoulder, articular cartilage covers the end of the humerus and socket area of the glenoid on the scapula.
Ligaments and Tendons
There are several important ligaments in the shoulder. Ligaments are soft tissue structures that connect bones to bones. A joint capsule is a watertight sac that surrounds a joint. In the shoulder, the joint capsule is formed by a group of ligaments that connect the humerus to the glenoid. These ligaments are the main source of stability for the shoulder. They help hold the shoulder in place and keep it from dislocating.
Ligaments attach the clavicle to the acromion in the AC joint. Two ligaments connect the clavicle to the scapula by attaching to the coracoid process, a bony knob that sticks out of the scapula in the front of the shoulder.
A special type of ligament forms a unique structure inside the shoulder called the labrum. The labrum is attached almost completely around the edge of the glenoid. When viewed in cross section, the labrum is wedge-shaped. The shape and the way the labrum is attached create a deeper cup for the glenoid socket. This is important because the glenoid socket is so flat and shallow that the ball of the humerus does not fit tightly. The labrum creates a deeper cup for the ball of the humerus to fit into.
The labrum is also where the biceps tendon attaches to the glenoid. Tendons are much like ligaments, except that tendons attach muscles to bones. Muscles move the bones by pulling on the tendons. The biceps tendon runs from the biceps muscle, across the front of the shoulder, to the glenoid. At the very top of the glenoid, the biceps tendon attaches to the bone and actually becomes part of the labrum. This connection can be a source of problems when the biceps tendon is damaged and pulls away from its attachment to the glenoid.
Labrum
The tendons of the rotator cuff are the next layer in the shoulder joint. Four rotator cuff tendons connect the deepest layer of muscles to the humerus.
Muscles
The rotator cuff tendons attach to the deep rotator cuff muscles. This group of muscles lies just outside the shoulder joint. These muscles help raise the arm from the side and rotate the shoulder in the many directions. They are involved in many day-to-day activities. The rotator cuff muscles and tendons also help keep the shoulder joint stable by holding the humeral head in the glenoid socket.
Rotator Cuff Tendons
The large deltoid muscle is the outer layer of shoulder muscle. The deltoid is the largest, strongest muscle of the shoulder. The deltoid muscle takes over lifting the arm once the arm is away from the side.
Deltoid Muscle
Nerves
All of the nerves that travel down the arm pass through the axilla (the armpit) just under the shoulder joint. Three main nerves begin together at the shoulder: the radial nerve, the ulnar nerve, and the median nerve. These nerves carry the signals from the brain to the muscles that move the arm. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature.
Blood Vessels
Traveling along with the nerves are the large vessels that supply the arm with blood. The large axillary artery travels through the axilla. If you place your hand in your armpit, you may be able to feel the pulsing of this large artery. The axillary artery has many smaller branches that supply blood to different parts of the shoulder. The shoulder has a very rich blood supply.
Bursae
Sandwiched between the rotator cuff muscles and the outer layer of large bulky shoulder muscles are structures known as bursae. Bursae are everywhere in the body. They are found wherever two body parts move against one another and there is no joint to reduce the friction. A single bursa is simply a sac between two moving surfaces that contains a small amount of lubricating fluid.
Think of a bursa like this: If you press your hands together and slide them against one another, you produce some friction. In fact, when your hands are cold you may rub them together briskly to create heat from the friction. Now imagine that you hold in your hands a small plastic sack that contains a few drops of salad oil. This sack would let your hands glide freely against each other without a lot of friction.
Summary
As you can see, the shoulder is extremely complex, with a design that provides maximum mobility and range of motion. Besides big lifting jobs, the shoulder joint is also responsible for getting the hand in the right position for any function. When you realize all the different ways and positions we use our hands every day, it is easy to understand how hard daily life can be when the shoulder isn't working well.
These include:
