Sharon - Shoulder Questions ( - Anatomy Lesson)#2

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This is a second attempt resend.

Sharon wrote:

ANy ideas for a chronically and severely dislcaoting shoulder and

collarbone/rib (my shoulder is dislocating subclavicularly and is

getting " stuck " under my collarbone and pushing it and my ac etc out

as well making my shoulder, forarm, neck and collarone etc areas

EXTREMELY painful so that my med's MsContin and liquid Codiene

aren't helping with the pain and I am left shaking, neauseous (sp?)

and with my body setting off into fasciculations and myoclonus (NOT

FUN with the shoulder etc out). HELP !!!!

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To begin with, I need to know EXACTLY which bone you mean when you

say your " shoulder " dislocates subclavicularly. The " true " shoulder

joint is the glenohumoral joint - the ball and socket joint holding

the head of the humorus (the upper arm bone)in the glenoid fossa by

the rotator cuff muscles (supraspinatus, infraspinatus, teres minor,

and subscapularis). The " shoulder " bone is the scapula. The top is

called the spine of the scapula. Out at the shoulder, it takes a

little dog-leg toward the front. That flat " dog-leg " is called the

acromion process. The clavicle connects with the acromion process

and forms a joint called the acromioclavicular joint, or a-c joint

for short. In addition, there is another protrusion from the spine

of the scapula called the coracoid process. It also points forward

like the acromion process but comes in under the clavicle and is a

couple of fingers medial to the acromion. It is an important muscle

and ligament attachment point.

So, in terms of bones, we have three: scapula, clavicle, and

humorous. When most people say they have a dislocated shoulder,

they are referring to the humorus coming out of the glenoid fossa.

If the bones are still making contact, it is a subluxed shoulder.

If it is completely out, it is dislocated. The other case is a

separation of the clavicle at the acromion process. Again, if the

two bones are still in contact, but out of proper position, it is

technically subluxed. If they are not making contact at all, it is

a dislocation, although the technical term normally used is an AC

separation.

Given the above technicalities and comparing them to your

description, it SOUNDS like your scapula is rotating forward such

that the acromion process is sliding under the end of the clavicle.

And it can't just rotate forward by itself - it has to be pulled out

of position by a contracted muscle.

So let's talk a bit about muscles and muscle actions. The true

shoulder, being a ball and socket joint, allows eight possible

movements OF THE UPPER ARM. These include flexion, extension,

horizontal abduction, horizontal adduction, abduction, adduction,

medial rotation and lateral rotation. The specific muscles involved

for each action are listed below. For the most part, these actions

occur because one end of the muscle is attached at some point on the

humorus while the other is attached at some point on the scapula (in

back) or on ribs (in front).

Flexion:

Deltoid - anterior fibers

Pectoralis major - upper fibers

Biceps brachii

Coracobrachialis

Extension:

Deltoid - posterior fibers

Latissimus dorsi

Teres major

Infraspinatus

Teres minor

Pectoralis major - lower fibers

Horizontal Abduction:

Deltoid (posterior fibers

Infraspinatus

Teres minor

Horizontal Adduction:

Deltoid - anterior fibers

Pectoralis major - upper fibers

Abduction:

Deltoid - all fibers

Supraspinatus

Adduction:

Latissimus dorsi

Teres major

Infraspinatus

Teres minor

Pectoralis major

Triceps brachii - long head

Coracobrachialis

Medial Rotation:

Deltoid - anterior fibers

Latissimus dorsi

Teres major

Subscapularis

Pectoralis major

Lateral Rotation:

Deltoid - posterior fibers

Infraspinatus

Teres minor

The scapula is called the scapulothoracic joint although it is not

in fact a true joint. There are six possible motions that the

scapula can perform: elevation, depression, abduction, adduction,

upward rotation, and downward rotation. The involved muscles are:

Elevation:

Trapezius - upper fibers

Rhomboid major

Rhomboid minor

Levator scapula

Depression:

Trapezius - lower fibers

Serratus anterior

Pectoralis minor

Abduction:

Serratus anterior

Pectoralis minor

Adduction:

Trapezius - middle fibers

Rhomboid major

Rhomboid minor

Upward Rotation:

Trapezius - upper and lower fibers

Downward Rotation:

Rhomboid major

Rhomboid minor

Levator scapula

All I listed up above are the muscle actions and specific muscles

involved in performing those actions. I did not list origin and

insertion points for each muscle because of the amount of space

required to do so. If you want that information, let me know. I

have a very detailed set of notes I worked up when I was in school

that I can send you off list my email attachment. The main point of

all this is that bones don't do anything by themselves – whatever

they do is done by muscle contraction. And if you are having a

problem with a bone doing something it shouldn't, you need to

identify which muscle is involved with making it do whatever it is

that it is doing.

If you are talking a true shoulder dislocation, the NORMAL action or

direction that the humorus will do/take is to drop out and down. In

other words, it is going to move away from the scapula/clavicle. In

general, this will be because of a weakness in one or more of the

muscles (usually the rotator cuff muscles) that help hold it

securely in the socket. The only ways that it can move out and up

would be either from trauma (an impact forced it into that position)

or there is a severely contracted muscle that pulls the humorus up

and out. You aren't talking trauma here. You are talking – oh, I'm

just minding my business, going about my daily routine, and it

decides all by itself to ruin my day.

That's part of why I don't think it is the humorus. The other

reason is your description of going under the clavicle. That sounds

like an AC separation or sublux. Again, we are not talking specific

trauma to cause it – it just does it to you. That is suggestive of

muscle action. Now, this could either be a case of one muscle

overpowering its antagonist by being in chronic contracture OR it

could be a case of the antagonist being weak and the other muscle is

doing its thing from just normal strength. And in addition to the

specific muscles at the ac joint, there are also several ligaments

that might be acting up.

Specifically, there are four ligaments that connect the clavicle to

the scapula: The acromioclavicular ligament joins the acromion

process and the clavicle. The coracoacromial ligament actually runs

between the acromion process and the coracoid process of the

scapula. The trapezoid and conoid ligaments run from the bottom of

the clavicle to the upper medial edge of the coracoid process. If

these ligaments become weak or stretched, the ac joint will also

become weak and unstable. If you then add some muscle imbalances to

the equation, you end up with a shoulder separation.

And since the area beneath the clavicle on the front of the shoulder

is called the brachial plexus (because of all the brachial arteries

and nerves that pass through there), it is not surprising that you

would be having arm and/or hand pain. You would be getting a nice

touch of Thoracic Outlet Syndrome.

Given all of the above, my guess is that you are having a problem

with weak ligaments, as well as either chronically contracted or

chronically weak antagonist muscles that are pulling the scapula

forward and under the clavicle. You could also be having a case of

the clavicle itself getting dislocated which then allows the scapula

to slide under.

Digest some of this and get back to me. Depending on what you think

it might be, there definitely are some energy techniques that might

help. I have put more than one clavicle back in place with nothing

but energy doing bone two-pointing.