5 Places to Look for Pain When Assessing the Shoulder
Guest Blog Post by Perry Nickelston DC, NKT, FMS, SFMA
The shoulder is one of the most complex joints in the human body. So much activity happens here and so does a lot of chaos. Next to the lower back it’s the most common area of the body to suffer from pain, discomfort and injury. Why? It’s supposed to be a very mobile joint moving freely and easily. It’s also supposed to be stable and able to resist movement. Every joint in the body should be both mobile and stable. If that balance is compromised, the body suffers inefficient movement patterns and compensations occur. The most common compensations are tightness, stiffness, fascial restrictions, trigger points (muscle knots), decreased mobility, and pain.
Here are 5 key places to focus on when assessing the shoulder:
1. Bicep tendon
The bicep acts as a functional flexor of the humerus. It often moves medially out of the bicipital groove of the humerus causing anterior shoulder pain. You can feel popping or grinding when the tendon pops in and out of the groove. A simple test to assess if the biceps tendon is vulnerable is to bring the arm up in front of the body level with the floor and palm up. Lightly press down on the wrist and see if the arm drops from pain or weakness. If so, it indicates a subluxated bicep tendon.
Laser Treatment Tip: Laser the anterior shoulder with approximately 1,000 joules of energy at 9-10 watts.
2. Supraspinatus tendon/muscle
The supraspinatus is a functional abductor of the arm working with the lateral deltoid. It does the first 35 degrees of shoulder abduction. If the lateral deltoid is weak or inhibited, the supraspinatus must take over the role and it works too hard. This overuse causes tendinitis and eventual tearing when the tendon cannot take the repetitive force loads. Palpate the muscle deep to the upper trapezius as the arm is taken across the midline of the body to expose the muscle. The patient may jump or grimace if the muscle is inflamed.
Laser Treatment Tip: Laser the belly of the muscle and down the lateral aspect of the arm with approximately 2,000 J of energy at 9-12 W.
3. Pectoralis minor
The pec minor muscle is a very busy player in scapular stability. It depresses the scapula, protracts it, and downward rotates it. That’s a lot of work. The pec minor is usually over active because of the rounded posture of today’s lifestyle with cellular phones. Forward flexion of the torso and lack of extension feed the tightness. Pain in the anterior shoulder and bicep are classic signs of pec minor over activity. Weakness of the middle trapezius and rhomboids in scapular retraction cause dominance in the anterior pectorals. The pec minor will almost always be a culprit in shoulder pain.
Laser Treatment Tip: Laser the anterior Pectoralis structures with 1,000 J at 9-12 W using the massage ball. Do both sides!
An external rotator of the arm is often loaded with fascial adhesions and muscle knots. It overworks for larger prime mover muscles in the posterior shoulder, such as the rear deltoid, latissimus dorsi, and middle trapezius. When this muscle is dysfunctional, it refers pain to the anterior shoulder so it’s an elusive culprit in pain. The glenohumeral joint gets pulled anterior, leading to impingement. Palpate the Infraspinatus and the client will usually display the ‘jump sign’ (where they do a side-take jump from the pain).
Laser Treatment Tip: Laser the Infraspinatus and entire middle back with 2,000 J of energy at 9-15 W of power.
5. The cervical spine
The neck has a direct correlation to shoulder dysfunction. Nerves from the neck pass through the shoulder complex and they also control the shoulder via neural input. Shoulder muscles like the levator scapula and trapezius influence scapular control and affect the neck. Every upper extremity musculoskeletal condition should be treated in conjunction with the neck.
Laser Treatment Tip: Laser the cervical spine with 2,000 J at 7-10 W of power.
It’s highly recommended to treat each one of these areas with shoulder dysfunction. There is never just one culprit in shoulder pain. Treating the non-painful shoulder can improve function of the other due to fascial connectivity and force generation.
To watch a treatment video demonstrating how to use RockTape and laser therapy to optimize outcomes when treating shoulder injuries, click here.