Shoulder Girdle
What is the shoulder girdle?
The shoulder girdle consists of the clavicle (collar bone), scapula (shoulder blade) and humerus (arm bone). It is made up of 4 articulating joints; Sternoclavicular (SC), Acromioclavicular (AC), Glenohumeral (GH) and Scapulothoracic (ST). The shoulder joint sacrifices its stability for mobility, making us unfortunately more susceptible to joint pain/injury, according to Artus et al (2017) 66.7% of us will experience shoulder pain in our lifetime.
What are the most common injuries?
As we’ve established, shoulder injuries are common so let’s get a bit more specific…just what injuries do we see regularly?
Rotator Cuff injuries – Normally referring to pain and/or weakness of the rotator cuff complex (supraspinatus, infraspinatus, subscapularis and teres minor), these injuries are typically a consequence of excessive loading, change in activity levels and repetitive movements the muscles aren’t conditioned for. Symptoms include; pain, especially in overhead and external rotation movements (Lewis et al, 2015)
Subacromial impingement Syndrome– This is where the rotator cuff is inflamed/irritated when they pass through the subacromial space. Many factors have been proposed as contributors with mechanisms including; inflammation of the tendons/bursae (fluid filled sacs), degeneration of the tendons, weak/dysfunctional scapular musculature and postural dysfunctions. Symptoms include; pain – particularly in overhead movements, painful arc of movement around 90 degrees, stiffness and weakness of the rotator cuff muscles. (Michener et al, 2015)
Clavicle Dysfunction – This can refer to 2 entirely different conditions, one located at the AC (Acromioclavicular) joint where the joint becomes inflamed, this can happen in a variety of tasks (there might be a trend happening) in particular, overhead and heavy-lifting activities. Symptoms would include pain at the highest point of the shoulder and moving your arm across the body.
The second condition would be located at the SC (Sternoclavicular) joint and can affect the AC joint. Injuries to this joint are more likely to be the result of road traffic accidents or collisions in sport, additionally degeneration of the joint can take place over time which can also aggravate it. Symptoms include; medial clavicle pain on abduction, flexion and rotation of the shoulder, stiffness and joint swelling (Edwin, 2018).
Rehabilitation: –
Phase 1 – The acute phase:
• Decrease pain and inflammation
• Increase your Range of Motion
Phase 2 – Intermediate phase:
• Progress your range of motion (ROM) – aiming to achieve 90⁰ abduction (pain-free)
• Initiate strengthening – paying particular attention to your scapula thoracic rhythm and external rotation
• Initiate proprioceptive and stabilisation exercises
Phase 3 – Late Phase:
• Progressing to resistance strength training
• Progressing to neuromuscular control drills
• Endurance training – increasing the length of an exercise: > reps and sets
• Plyometric training introduced: – increasing strength and power of shoulder
Phase 4 – Return to physical activity
• Continue to progress phase 3 exercises
• Initiate sports specific training drills
• Initiate gradual return to play
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