Shoulder

Put your head on my shoulder…ow.  Sound familiar? I want to take you on a journey of the shoulder and see what is inside and what can go wrong.

First we will have to look at the anatomy to better understand what is happening with the bones, ligaments, tendons, and cartilage.

First we can see the scapula or wing blade is a wide broad bone with a lot of space for muscle attachments. The ball and socket itself is a shallow cup that is not constrained at all and which relies on ligaments to hold it in place versus a rigid bony surrounding.

The acromion is above the humerus and can be a source of impingement where it can dig into the muscles of the rotator cuff which lie below it. This can occur after age 40 and is rare before that. The clavicle forms a joint with the acromion which can give weightlifters problems. It can sometimes break down and sometimes have arthritis in it. Arthritis is when the joint cushion wears down over time.

Ligaments hold the bones together. The clavicle has several ligament that keep it place and the glenohumeral joint or shoulder joint also has ligaments that make up the capsule.  If the ligaments tear then the shoulder can become loose or unstable resulting in a dislocation.

The muscles of the shoulder attach to the bones with tendons which are a gritty material at the end of the muscle. The tendons actually grow into the bone and are subject to tearing in life as wear and tear accumulates.  This is what happens with a rotator cuff tear. Each muscle around the shoulder is responsible for certain motions like elevation to the side or rotating in and out.  Other muscle like biceps and triceps are responsible for moving the elbow and forearm in space.

The labrum is a fibrocartilaginous structure that acts as a shock absorber cushion for the joint. It can act as a suction cup like device holding the humeral head or ball in place. It acts as a stabilizer because the ligaments attach to the labrum which then attaches to the glenoid or cup. It can tear more easily as an athlete gets older and the tissue dehydrates compared to softer more spongy tissue that is seen into adolescence and early adulthood

37 Comments

  1. Possibilities include reinjury to the repair . Different labral tear (was mri with contrast in joint?), exam would be helpful to give accurate diagnosis. Sean

  2. I have a shoulder issue that has been going on for 18 weeks now and I need some advice. I had a slap tear repaired on dec 10th 2012 and recovered great. The summer of 2013 I was great. could do pullups, burpees, pushups, row, ect. ALL pain free. On Sept 5 th I was showing some athletes how to complete a KB swing and in the middle of the demo I felt a pop / tweak in my post delt. later that day– (Not the smartest thing to do) but the pain was not that bad– I did some butterfly pullups and presses with light weight for my workout. the next few days I had lots of tightness in the traps and my shoulder was painful in the rear delt and near the ac joint. When they did my surgery they also decompressed the shoulder and reattached the biceps tend. Since that bad day in Sept. I have taken it really easy. for 10 weeks I did nothing. then added some running, and light mobility work with kneeling pushups and lat pull downs. I have had an MRI on my shoulder (looked clear to the doc) had an MRI on my Neck – also check clear. Had a nerve test that checked clear. I have had 2 cortison shots and been on anti-inflammatory pills for 18 weeks. I see very little improvement and not sure what to do for the next step back to recovery. The pain is both in the shoulder, scapula, and trap. I have knots in my right pec that I stretch out daily with little improvement. I can move my shoulder with no sharp pain. the pain is more dull and constant — light but annoying. Any advice?

  3. Hi Jodie I should probably check you. It should not be in agony after a wod. Happy to see you, Sean

  4. Hey Sean, I wanted to get in touch with you after you did a seminar at our place. My shoulder has been acting up again. My chiro says that it’s out of place (slightly anterior by a couple milimeters) and keeps pushing it back, but as always in crossfit, it just takes the next day to become painful again. Yesterday’s wod had toes to bar in it and last night I was in agony. How long should I let this go before I seek additional help? Thanks for your help. Appreciate it.

    Might be seeing you soon!

    Jodie

  5. Hi Phil first off I would be happy to see you. 6175275040. If it is truly a grqde 4 that is surgical . Grade 3 is where the controversy lies. I honestly have seen everything. Grade 3 s can do fine without surgery but I have seen people have pain as a result. Of the people I have operated on they have been truly happy they did have the surgery. I hope this helps and if you are around I should see you and your xrays for real advice.

  6. I just listened to a podcast of yours from January. I have a grade 3-4 AC separation, and I’m 3 weeks out of the injury. I am a crossfit and kettlebell enthusiast, and I’m not sure whether or not I should get surgery. The decision is controversial and I’ve seen two orthopedic surgeons, neither or which gave an official reccomendation (one leaned towards a conservative approach and the other towards surgery).

    The surgeons I spoke with don’t really understand crossfit and can’t offer any idea of whether or not I would be able to get back to a full recovery with or without surgery. I don’t know what to do and I was hoping your perspective as someone who can relate to how I like to train may shed light on what I should decide to do. I understand that there are potential complications, and pros and cons for both paths. What I want to eventually be able to do is perform dips, snatches, and turkish get-ups.

    When i try and touch my opposite shoulder I feel a click (one doctor told me that’s the clavicle rubbing against the top of the acromion). one of the doctors said surgery would include shortening of the clavicle and the other did not- is there a superior method? I’m 23 years old, and am willing to undergo a long recovery period if it means having a better shoulder for the rest of my life.

  7. I was just told I have a 20% tear in the intra-atricular portion of the long head of my bicepes. This was found incidentally during a scope for decompression. I’ve been doing Crossfit since 2005, so I’m not entirely surprised. I have a few questions.
    1. What types of movements should I avoid in order to avoid further injury to this tendon? Should I change my pull-up grip? Should I decrease the ROM of my push-ups?
    2. Are there any mobility exercises that might lessen the strain on this portion of the tendon?

    • Hi Jonathan all good questions. Hopefully the decompression will help relieve some of the pressure on the biceps in this area also known as impingement. I don’t know of any study showing benefit to changing a pullup grip or decreasing ROM. Not to sound like a broken record but the most important thing is to avoid pain as tendinosis can lead to degeneration of the tendon and tearing. As far as mobility posterior capsule stretches like the sleeper stretch as seen in SLAP tear prevention post can help. Good luck, Sean

  8. Hi Sean,

    I’m a 49 year old CrossFitter (for 6 months) who recently had an MRI on my right shoulder (I’m right handed) which revealed osteo arthritis of the AC joint. The pain has been bothersome over the last month when doing overhead WoDs, but I want to keep CrossFitting. I’m going to meet with a Physical Therapist, but do you have any advice to keep me in the game?

    Thx,

    Brad

    • Hi Brad, number one issue is whether the AC arthritis is what is causing pain. Many MRIs will be read in someone over age 35 as having AC arthritis. Other causes of shoulder pain exist that may not be evident on an MRI without contrast. There is impingment, labral issues, biceps issues also. To answer your question stop doing what hurts. If it is a little tendonitis then that will improve on its own if you let it. Do everything else that doesn’t hurt, just avoid the painful things. If that does not help then I would be happy to see you if you are in the area.

      • Thanks, Sean! I’ve given it nearly 2 weeks rest and it does feel better, although not 100% yet. I am in the Boston area and will give it to the end of the week.

        Thx,

        Brad

  9. Good question. This decision is an intraoperative decision that is made and depends on a few variables. The age of the patient is a very important one, younger people do better with repairs. The type of SLAP tear also dictates what procedure is performed, biceps tenodesis or SLAP repair.

  10. What is your advice on slap tear surgery options? Fix it where it goes or reattach the bicep tend?

  11. There are lots of things it could be. I would start with an xray to rule out some diagnoses, then a physical exam can narrow the field. Sometimes it is just tightness which can be picked up on a physical but other things like SLAP come to mind. I would be happy to see you 617 527 5040

  12. I believe I have bursitis and shoulder Impingment in my right shoulder and a milder version in the left shoulder. I have had one cortisone shot in right shoulder without much relief. Reaching behind me overhead or holding something straight out in front with my right arm are all painful. I have slowed down with crossfit particularly with anything involving overhead pressing. However this pain is lingering over 3 months. Any advice?
    Thanks
    Anthony

  13. Hi Sean,
    I have just been diagnosed with an anterior and anterior-inferior labral tear (via MRI arthrogram). Just got my results. I don’t remember any recent trauma but I know when I was a kid my shoulder would sublux anteriorly now and then. I began having shoulder pain with overhead lifts and pushups about 3-4 months ago and pushed through it, until it became very clear that something other than a tendinitis was happening. Anyway, my question is–if this is a degenerative thing from years of fraying since I was such a hypermobile kid..does that necessarily make it more difficult to fix? I am so worried that I won’t be able to get back to crossfit fully. I haven’t even talked with my ortho yet, but even when I do I would like to get a second opinion from you, since you know what I want to get back to (heavy overhead lifting, pushups, pull-ups..you know!). Thanks for having this Q&A site–I am so happy to be getting my question out there even though it’s early on a Saturday!

    • Kerstin, It sounds like you had a tear in the past that caused your shoulder to be loose. When you do overhead things, a loose shoulder can become painful and people experience apprehension where they feel like something bad is going to happen. I would be happy to see you. Call 617 527-5040 for visit.

  14. Jonathan, please call the office 617 5275040 or email through the website orthopedicsne.com so I know which Jonathan you are.

  15. Hi Sean,
    I was in to see you last week about my shoulder. I think the CF training has helped a bit but I am still experiencing pain. I meant to ask you if I am a candidate for a cortisone injection? Let me know if you think that might help?

    Thank you!

  16. Hi Sean,

    A friend of mine has worked with you at CFNE and recently saw you for his shoulder issue. I’d like to see you to have my shoulders looked at. I hurt them awhile ago, but was on the mend, but I think I’ve reinjured at least one. My concern to come see you is insurance. We have HP Primary Choice through the GIC. Do you accept that?

    Thanks!

    • My secretaries would know if you call they will let you know, 6175275040 or go to website http://www.orthopedicsne.com and email via the request appointment online tab at top of page

  17. I have had pain off and on in my shoulder for about 2 years. I grew up playing baseball and as I got older that transitioned to softball. The pain is posterior on my right shoulder and really only effects me when throwing a ball. It does not usually hurt any other time unless I sleep on my side for an extended period. Based on the photo above, it seems to be right where the white of the “Infraspinatus” meets the bone. Thoughts?

    • Read some of the other blogs in here on SLAP tears. Throwing is that abduction external rotation maneuver that can hurt anywhere in the shoulder anteriorly superiorly or posteriorly. If you want a real diagnosis, I should see you 6175275040

  18. Hello Doctor Sean. JK here from BHS here. I would love to see you, I have a partial rotator cuff tear plus a few other ortho injuries. Cam you reply to my email address so I can give you a better picture. Looking forward to seeing you!!

    • Just give the office a call and they will get you in 6175275040

  19. I’ve had pain in my right shoulder for 4 months and now I’m experiencing numbness in my right arm, hand and fingers. The pain is worst when lying down and releasing or putting down heavy weight. I was hoping it would heal on its own. At what point should I consider seeing a doctor?

    • Not to be facetious, but …now

  20. I’ve been diagnosed with writer’s cramp in my right arm. I joined Crossfit about 6 months ago and am realizing how tight and beat up my back and shoulders are as I struggle to gain mobility. Can shoulder problems translate to writer’s cramp/hand issues? I have seen a hand specialist and neurologist for Botox injections in my forearm, but would rather not continue if it is curable.

    • I would say they are separate entities.

  21. I hurt my shoulder doing powercleans. This was about 2.5 weeks ago. I can still barely lift any weight overhead with my right arm. Even hanging off a pullup bar causes pain. I don’t have any issues with holding weight such as deadlifts just when I try and oush weight overhead. Any idea what might have happened?

    • It could be alot of things, it depends on position of your arm, your age, location of pain. Biceps and cuff are common culprits. If it is more than just a tweak that is not getting better with typical rest period, I would be happy to see you.

  22. If the tenderness is right over the groove in the front of the shouldler, it could be a biceps tendonitis. If modifying is not helping and you are having pain with actvities of daily living that are not getting better, I would be happy to see you.

  23. I’ve been working out/ lifting weights for about 4 months. My right shoulder consistently bothers me when I do ring dips or anything bearing weight in front of me. (even when I push the vacuum cleaner forward but not backward). Should I be stretching differently or could this be something I should have checked out?

  24. I can usually tell with a history and physical exam. An MRI can be used to confirm the diagnosis. I am happy to see you, Sean

    • Background: Last Wednesday, I had just been doing angled leg psreses (basically weighted squats), going all the way down and noticeably stressing my knees. Later that day, I was playing rugby when I came to a sudden halt. It bent my tibia to the right on my straight right leg, causing a painless pop on that knee. There was minimal swelling, mostly tenderness. Symptoms: Now when I try to bend my right leg all the way, I encounter an intense pain under the kneecap (patella) at a ~90 degrees angle, and a horizontal piece length of tissue (tendon-like) shifts out from beneath the left (inner) side of the patella to down below it. It seems like the pressure from bending that knee forces it out from underneath the patella. It’s painless when I straighten my leg, and the tissue returns to underneath the patella once fully straight, otherwise it seems motion is painless with the tissue pushed out. I go through the same pain though every time I bend that knee at ~90 degrees after straightening. It’s painless after the tissue is pushed out (>90 degrees), and painless when the knee is bent at <80 degrees. I can push and pull lots of weight when the knee is not bent at these zones, but due to the tissue under the patella, it's very painful, after straightening the leg, to support any weight when it's bent at the ~90 degrees zone.Questions: If anyone's got any ideas as of toward what this might be or what solutions I could try, it would be greatly appreciated. It's been a week and a half since the rugby practice, so I know swelling isn't the problem; my doctor tells me it's not a meniscus tear because there wasn't a lot of swelling, but is otherwise clueless. I'll add any details you need.

      • Could be a loose body if you feel something shifting and moving that you never had before. Go back to your doc and show him what you told us.

  25. My shoulder has been sore for several months, especially after overhead work. I am concerned it may be a torn labrum.
    What is the quickest way for me to rule this out?
    Thanks

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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