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Why Shoulders Are So Susceptible To Injury
Most Mobile Joint In The Body

The shoulder has a wide range of motion, making it the most  
mobile joint in the body. Because of this flexibility, however,  
it is not very stable and is easily injured!
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.
Anatomy of the Shoulder  
The shoulder is made up of bones and joints, ligaments and tendons, muscles, nerves, blood vessels, and bursae.
  • Bones & Joints - The bones of the shoulder are the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone), which make up four joints total. 
  • Ligaments & Tendons - Ligaments are soft fibrous connective tissues 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 socket. These ligaments are the main source of stability for the shoulder. They help hold the shoulder in place and keep it from dislocating.
  • Muscles - This rotator cuff muscles are attached to the rotator cuff tendons and lie just outside the shoulder joint. These muscles are involved in many day-to-day activities and help raise the arm from the side and rotate the shoulder in the many directions. The rotator cuff muscles and tendons also help keep the shoulder joint stable by holding the humeral head in the glenoid socket.
  • Nerves - Three main nerves begin together at the shoulder: the radial nerve, the ulnar nerve, and the median nerve, and travel down the arm  through the armpit. These nerves carry the signals from the brain to the muscles that move the arm. 
  • Blood Vessels - Traveling along with the nerves are the large vessels that supply the arm with blood. 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 - Bursaes are small fluid filled sacs that are sandwiched between the rotator cuff muscles. They are found wherever two body parts move against one another and there is no joint to reduce the friction. 
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.
Typical Shoulder Injuries
Dislocated Shoulder: Top arm bone pops out of shoulder socket.
AC Joint Sprain: Separation of the acromion from the clavicle. 
Rotator Cuff Injury: Muscles damage by strain or tear. 
Frozen Shoulder: Extreme stiffness, occurs in 2% of Americans.
Impingement: Misaligned tissue/bone that rubs or chafes
Muscle Strain: Extensive stress on shoulders leading to inflexibility.
Sternoclavicular Dislocation: Ligament trauma to the joint.
Winged Scapula: Muscle injury forces blade to protrudes on back.

Number One Shoulder Injury:
Rotator Cuff Tear
The weakening of the rotator cuff tendon can lead to a rotator cuff tear. Symptoms of a torn rotator cuff include tenderness and soreness in the shoulder during an activity that uses the shoulder. Acute rotator cuff injuries occasionally occur in younger people, and chronic rotator cuff injuries happen mostly to middle-aged or older adults who already have shoulder problems.
A chronic rotator cuff injury usually occurs at or near the tendon, as a result of the tendon rubbing against the bone and is often asociated with an impingement syndrome. Symptoms are usually seen on the dominant or stronger shoulder and more often effect athletes over 40 years of age.

An acute rotator cuff injury tends to happen as a result of a sudden, powerful movement such falling onto an outstretched hand, making a sudden thrust of the arm and shoulder like a powerful pitch or throw. Symptoms of a torn rotator cuff will usually consist of sudden shoulder pain with a tearing feeling in the shoulder, followed by severe pain through the arm.
Dr. Sullivan's Recommendations 
For should injuries that I see in the office, I tend to do a combination of Active Release Techniques and Graston Technique on the injured areas. They work well because they are movement-based muscle techniques, and the patient actually participates in the treatment by actively moving their arm and/or neck.  In my experience, when treating shoulder injuries, I also recommend rehabilitative shoulder exercises to perform in the gym with very light weights to re-establish normal movement and retrain the mind-muscle connection to default to normal movement patterns.  In some cases where the patient has a frozen shoulder or has a labral tear, laser therapy is very effective in providing pain relief and increasing range of motion. 
Here is a video showing some of the shoulder exercises I recommend for a rotator cuff injury and shoulder mobility. 
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Note: The material provided in this newsletter is for informational purposes only. The opinions expressed herein may not always reflect the views of the NOVA Chiropractic, nor do they imply an endorsement. 
In This Issue
Most Mobile Joint In The Body
Anatomy of the Shoulder
Typical Shoulder Injuries
Dr. Sullivan's Recommendations
NOVA Chiropractic Blog Article
Additional Articles
Help Dr. Sullivan Spread the Word!
Laser Therapy
Updated HIPPA Notice of Privacy Practices
2014 Office Policy Updates
Healthy Recipes
Natural Remedies
The Healthy Alternative
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