Rotating Shoulders - The Anatomy Blog.

A photo of an illustration depicting
the back muscles. 

There have been a couple of occasions over the past week that have allowed me to revisit a part of the shoulder that can cause a bit of confusions, pain and general bother; The Rotator Cuff.

This part of the shoulder held me in amazed wonder when I worked on a project with two fellow therapists in St Andrews University at the Integral Anatomy week I attended with Gil Hedley in July. During that week a Physiotherapist student also shared his work on the shoulder with me, clearly showing the muscle and fascia relationship within the joint. Over the past weekend I had a great time looking at the text book theory of Painful Arch Syndrome when a colleague asked a couple of questions that I wanted read up on. So this blog comes from quite an intense look at the shoulder area in general!

Clients will often come and visit me with grumpy shoulders and there is a general sense that the shoulder isn't working so well. The range at which they can move their arms can be sticky, pain can be felt when the arm is moved in different directions, or when I ask them to resist pressure on movement. Also, clients can feel as if they are suffering from pain around the wrist, elbow and deep into the upper arm or across the shoulder blade, and after looking their symptoms up on the internet often self prescribe problems such as 'Frozen Shoulder' or 'Carpel Tunnel Syndrome'. In this blog I want to really break the pain that can be felt by the four muscles that make up the Rotator Cuff and see what we do to help lift some of the confusion that it has.

So let's get going! 

The Rotator Cuff is made up of four muscles; Supraspinatus, Infraspinatus, Subscapularis and Teres Minor. All hook into your shoulder blade (Scapula) and into the upper portion of your arm (Humerus). They are all deep muscles, sitting under the topical deltoid and trapezius. 

Supraspinatus gives the head of the Humerus bone stability and also gives you movement of the arm. When you take your arm out to the side, it helps to initiate the movement and then raise it above your head after your deltoid muscle has got you to about 90 degrees. You can find Supraspinatus lying deep in the top of the shoulder blade in it's own little groove called the Supraspinatus Fossa, flowing under a bridge of bone called the Acromium to then attach to the arm. 

Trigger points can often be felt if Supraspinatus gets grumpy and the pain is commonly at the back of the arm near the top (Posterior Deltoid) and then it goes across the shoulder blade (Scapula). It can also go down the back of the arm and can then skip the elbow reappearing in the wrist. 

An example in External Rotation

Infraspinatus lies deep in the dell of the shoulder blade called the Infraspinatus Fossa. It's thin and wide and the main job it has is to externally rotate the arm, as well as stabilize the shoulder joint (Glenohumeral Joint). Because of it's shape, if you are to place your hands over a shoulder blade you are guaranteed to be on it, but your intention has to be deep to the superficial muscles. 

This time the Trigger Points will be felt going down the outside of the upper arm along the humerus and you may also notice them right at the edge of the shoulder blade near the spine (the spine of scapula). Many people report that the pain is worse when they are sleeping on the other side when this muscle gets grumpy as well as pain rearing it's ugly head down the thumb side (radial aspect) of the hand. 

Teres Minor is small and often forgotten about, lying as it does on the side of the shoulder blade, jammed in between it's bigger neighbors. However, it may be little but it is powerful working right along side Infraspinatus when you externally rotate your arm. 

The Trigger Point pathway for Teres Minor is very localized and sits just into the back of the arm and can be a very deep ache. It will often be worse if there are trigger points in the Infraspinatus, so the two not only work together but should also be treated together to enable you to regain ease of movement. 

An example if Internal Rotation 

Subscapularis is one of my favorite muscles! It's tucked away, only peeking out when the arm is moved in certain ways and in massage I find it a very satisfying area to treat. It sits in the front of your shoulder blade and this anterior aspect means that it is sandwiched between  the ribs and the shoulder blade. It's the opposing force to Teres Minor and Infraspinatus, enabling your arm to internally rotate whilst still maintaining the integrity of the shoulder joint. It's not often looked at or treated, so don't be surprised if your Body-Work Therapist takes their time over a few sessions to release it all out for you. 

The Trigger Points spring up around the back of the shoulder blade and the back of the wrist and you may be having problems in taking your arm away from the body (Abduction) as well as external rotation. Unfortunately trigger points can cause such a problem that some clients can experience a subluxation when the head of the humerus comes away from the shoulder joint (Glenohumeral joint). 

There is your anatomy and I hope you have enjoyed it and it's clear for you to understand! I'm sorry that I could get any photos of the muscles, but I am going to work on getting that together for next time so you can see it all in context. 

Next time I'll take you on a tour of movement and I hope that will start to really fit all the dots together for you so that we can start working out how you can work on the area safely at home and what you can expect from your Massage Therapist during your treatments. 

As always with the blogs that I put together for anatomy and massage the information is aimed for clients to understand, not therapists! I want to make it clear that these posting are in no way a diagnostic tool and should not be used as such. If you are in pain and need help, always consult your general medical practitioner. I would also direct you to the blog posting Pain Patterns Explained as it will tell you how I approach soft tissue and the theory of muscle based pain pathways.

No part of these blogs can be used or quoted without written permission from the author.

Reference book used for this blog: 

Trigger Point Therapy for Myofascial Pain; The Practice of Informed Touch. By Finando, Finando. Published by Healing Arts Press, 2005