Shoulder Pain and Dysfunction: The Scapula Forms the Foundation

by Specialized Orthopedics August 31, 2020
Shoulder Pain and Dysfunction

Shoulder pain is one of the most common afflictions that affect overhead athletes and active adults 30+ years old.  It is commonly characterized by pain in the front or side of the shoulder that is often exacerbated by lifting the arm out to the side, overhead, or behind the back.  Pain can also be elicited by lifting weights or even sleeping on the same side of the shoulder.  Typically, a visit to the doctors will land you the diagnosis of rotator cuff tendonitis, rotator cuff impingement, shoulder bursitis, as well as many other common diagnoses.  However regardless of the formal diagnosis a thorough evaluation must be performed by a skilled and experienced Physical Therapist to determine the true root cause of the painful syndrome that is present.

Most of you have heard of the group of muscles lying deep within and crossing the shoulder joint known as the rotator cuff.  The rotator cuff is comprised of 4 muscles:

Subscapularis (on the front or anterior portion of the humeral head)

Supraspinatus (on the top or superior portion of the humeral head)

Infraspinatus (back or posterior portion of the humeral head)

Teres Minor (back and lower or posterior and inferior portion of humeral head)

These 4 tiny muscles are in charge of keeping the head of the humerus (ball) in the correct position in the glenoid fossa (socket) and stability during dynamic movement of the arm and shoulder.  Due to its very delicate structure, the rotator cuff is oftentimes the site of irritation, pain, and ultimately dysfunction.

As you can see in the following illustration, all 4 of these muscles start at (or originate) from a common bony structure called the scapula (or shoulder blade).

Rotator Cuff Anterior and Posterior Views

It would make sense that an efficient rotator cuff has to have a solid base or foundation to be anchored to in order to function properly.  As we all know the scapula is a relatively loosely connected and mobile bone to the rest of the skeletal system.  This furthers the notion that a properly positioned and stabilized scapula is paramount for proper shoulder function.  Scapular stabilization also prevents and limits the rotator cuff from being irritated, strained, or torn!

In order for the scapula to maintain proper positioning and stability, the muscles that are connected to it from the spine and thorax have to be in tip/top shape!  These are the muscles that are often overlooked but of the utmost importance when evaluating shoulder dysfunction.

The following illustration clearly shows us the numerous muscles that all have to work together to maintain the scapula in the correct position for the arm and shoulder to move fluidly and efficiently.

Shoulder Blade Muscle

As you can see there are many muscles pulling on the scapula together to keep it stable and typically weakness within all of these muscles results in the scapula being poorly positioned to allow the rotator cuff to work properly.  The most common muscles to exhibit weakness are the rhomboids, middle trap, lower trap, and serratus anterior.  Special attention must be paid to evaluating the strength of these muscles as well as prescribing strengthening exercises by your Physical Therapist to address the assessed weaknesses.

There are a wide variety of exercises that help to strengthen the scapular stabilizers, here are a couple of our favorites:

Prone T

Prone W

Wall Protractions

We recommend performing 2 sets of 12 repetitions of these exercise ONLY if it is pain free!  If you have pain while performing these exercises or your shoulder pain does not decrease, then call our Warwick (401-384-6490) or North Kingstown (401-329-0051) office today to make an appointment with one of our highly trained Physical Therapists!

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