Pain in the shoulder is one of the main reasons for consultation. While inflammation may be present, as it is usually the case for bursitis and tendinitis, the cause of pain remains a lack of mobility in the joints surrounding the shoulder. In the next two articles we will investigate the relationship between the joints and the shoulder pain. The main goal of the osteopathic approach is to give the shoulder mobility by increasing the amplitude in each of the following structures:

  • The thorax
  • The shoulder blades

A lack of spinal mobility of the chest and the shoulder blade can be the cause of shoulder pain. Today we see how the shoulder, the collarbone, the neck and the head are interrelated. First, the clavicle is an important muscle relay for the muscles of the upper limbs attaching to the chest, shoulder blade, neck and skull. 

Restriction mobility of the clavicle can cause numbness, especially at night, causing a restriction of mobility of the nerves and blood vessels of the arms, thoracic outlet syndrome. Pain shoulder tendonitis or bursitis occur such as the tendons of the rotator cuff from under the clavicle are frustrated and stuck. Cervical mobility is important because there are many nerves that pass from the neck and head to the shoulder and arm. 

The origin of shoulder pain is mostly caused by the irritation of certain nerves in the neck directly innervating the shoulder. Finally, several muscles focusing on the head influence the mobility of the shoulder. Figuratively, the skull is a puzzle shaped ball where several bone pieces fit together. 

All the muscles attaching to the shoulder blade, the neck, the clavicle, the head and the arms should be mobile because a muscle has two mobile ends. For instance, a person who falls on the head could develop shoulder pain. Additionally, the heart and lung ligaments are fixed to the thoracic cage which attaches to the neck and skull, demonstrating the connection between the head, the skull and the chest.

It’s important that the thorax be mobile because many shoulder muscles are attached to it. The thorax consists of ribs, vertebrae, heart and lungs. Inside the thorax are organs that are also attached and reduce the amplitude of the rib cage.

First of all, in order to assure the necessary amplitude in the thorax, it is fundamental that the diaphragm be mobile. Also, a special attention should be paid to the joint mobility of the first two ribs because of their innervation, their vascularization and their roles in the mechanics of the shoulder.

The maximum mobility of the scapula is also essential because its movement is twice that of the arm. The muscles of the rotator cuff focusing on the scapula are intended to stabilize the arm. In addition, the rotator cuff ensures fluidity in the movement of the scapula and arm during elevation. We also evaluate some muscles from the neck, head and chest. So the scapula is important in shoulder pain. In the next article, we will see the relationship of the shoulder with the clavicle, head and neck.