Shoulder Pain

Usual Suspects:

  1. The muscles surrounding and overlying the shoulder blade
  2. The muscles of the front of the neck
  3. The muscles of the back of the arm

The Imbue Pain Relief Patch temporarily relieves minor aches and pains of muscles and joints. In the diagrams below, the X’s show the locations of common trigger points (localized muscle strain), and the colored shading shows the pain pattern each trigger point produces. This pain is often several inches (or more) away from the trigger point at which it originates. If application of the Imbue Patch directly to the knee does not significantly improve your pain, applying the Imbue Pain Relief Patch at the site of strain in nearby muscles sometimes yields better results.

The shoulder is a complicated joint, and treating it can sometimes be a complicated process – usually because the pain is so often coming from a place other than where it hurts the most. It’s fine to use the Imbue Patch right where it hurts, but if the results aren’t satisfactory, some exploration is in order.

Pain of the shoulder, whether it is felt in the back, in the front, at the side, or right in the joint, is usually due to muscular tension in the muscles surrounding and overlying the shoulder blade. This includes:

  • The muscles between the shoulder blade and the spine (#1 and #5 in the diagram above – levator scapula, serratus posterior superior, superficial spinal muscles, trapezius, and rhomboids)
  • The muscles right over the body of the shoulder blade (#3 – infraspinatus)
  • The muscles along the upper edge of the shoulder blade (#2 – supraspinatus)
  • The muscles along the outer edge of the shoulder blade (#4 – teres)
  • The muscles of the back of the rib cage (#6 – latissimus dorsi)

Less commonly does it actually arise from the muscle that most people think of as the “shoulder muscle” (#8) – the deltoid. Sometimes it comes from the crest of the shoulder (7 – trapezius) or is referred upward from the muscles of the back of the arm (9 – triceps).

There are also several muscles on the front of the body that can produce shoulder pain, including:

  • The muscles between the shoulder blade and the spine (#1 and #5 in the diagram above – levator scapula, serratus posterior superior, superficial spinal muscles, trapezius, and rhomboids)
  • The muscles below the collar bone near where the shoulder joins the chest (#11 – pectoralis minor and major, coracobrachialis)
  • The muscles of the upper, outer aspect of the chest (#12 – pectoralis major and minor)
  • The muscles of the arm, just above the elbow (#13 – biceps)
  • The muscles of the front of the shoulder joint (#14 – anterior deltoid)
  • The muscles of the front surface of the shoulder blade, barely accessible behind the ribcage, near the armpit (#15 – subscapularis)

There are two basic approaches to tracking down shoulder pain. The first is to study the pain patterns of trigger points in each of these muscles and try to match one of these patterns to the pain you are experiencing. The second is to just feel all of the areas covered above and treat all the points that are significantly tender. I prefer the second approach, because even if you correctly identify a muscle with trigger points that is producing your pain, there are often other muscles that are also implicated, and you won’t know this until you discover them.

Therefore, you need a friend or a tool to methodically press throughout all the shaded red areas in the two diagrams above. You may be surprised to find pain in places you weren’t expecting. A human is the best tool to employ, since they can be sure to cover every inch and they can even use a pen to mark the most tender spots they find. If you want to do the investigating yourself, though, the two best tools are a smallish ball – a lacrosse ball is best, but a tennis ball will work – or a Thera Cane.

If you’re using a ball, you can approach this process in either of two ways. 1. Lie on the floor with your knees bent and your feet flat on the floor, place the ball between your back and the floor, then roll around on it, being sure to cover all the areas shown in the diagram above. 2. Stand against a wall with the ball between your back and the wall, and search for tender spots by moving the ball with your body or a hand.

Any especially tender region is a good candidate for placement of the Imbue Patch placement, but the areas most likely to yield positive results are those that produce broad, expansive pain patterns – especially when they either alleviate or reproduce the same pain you have been experiencing. It is always worthwhile to massage these places while you’re at it.

 

Key Muscles Involved in Shoulder Pain

In each of the following diagrams, the X’s indicate common sites of trigger points in the muscle, and the red shading shows the pain pattern these trigger points are capable of causing. While the most common sites of trigger points are shown, these are not the only places they may occur. So, always be sure to feel an area several inches wider than where the X’s are shown.

Supraspinatus:

This is one of the four rotator cuff muscles. It runs from the upper surface of the shoulder blade through the shoulder joint and attaches to the top of the arm bone (humerus). It is somewhat hidden under other layers of muscle, so press deeply to feel all along the region just above a horizontal ridge of bone on the shoulder blade (the spine of the scapula). Trigger points in supraspinatus can cause aching in the shoulder, sometimes extending to the outside of the upper arm, forearm, and even wrist; raising the arm may be difficult and painful.

 

Infraspinatus:

Infraspinatus, despite being a very easy muscle to access, is often overlooked, maybe because the bulk of it is on top of the shoulder blade and people either don’t think to press on bone or believe it’s sore just because there’s bone beneath it. The X’s in this diagram show where main infraspinatus trigger points occur in this rather shallow, tight muscle. Infraspinatus is one of the most epidemically cranky muscles in the human body. The infraspinatus joins the back of the shoulder blade to the top of the arm bone (humerus) and when it’s irritated, it usually sends pain deep into the joint and into the front of the shoulder, sometimes also inhibiting shoulder movement (“frozen shoulder”). The pain can even extend down the arm and forearm, to the middle fingers and thumb. It occasionally radiates into the neck. Trigger points in infraspinatus may weaken the shoulder and make it difficult to reach behind the back.

Serratus Posterior Superior:

Serratus posterior superior connects the spine of the upper back to the ribs underneath the shoulder blade. When it is strained, it produces a dull ache under the shoulder blade, and can also refer pain to the back of the shoulder joint, the tip of the elbow, the outside of the wrist, the pinky side of the hand, the pinky, and even the chest directly in front of the muscle. The primary serratus posterior superior trigger points occur on top of the ribs, just next to or slightly underneath the shoulder blade.

 

Latissimus Dorsi:

Latissimus dorsi is a very large muscle covering much of the middle to lower back. It has many possible trigger point locations producing several different pain patterns. The one implicated in shoulder pain is located near the lower, outside edge of the shoulder blade, on top of the ribs. The X in this diagram shows the general area of this trigger point. This pain is typically felt at the lower portion of the shoulder blade and back of the shoulder, but it can also spread down the back and inside of the upper arm and forearm, and even into the ring finger and pinky.

To find this trigger point, press firmly on the area just to the outside of the lower tip of the shoulder blade (feel a few inches in all directions). You can often feel this area directly by reaching through your armpit with the opposite hand and using your fingertips to press on the back of the rib cage, although you may wish to enlist the help of a friend, a ball, or a Thera Cane.

Subscapularis:

Subscapularis is a tricky muscle to find and a painful one to work on, but it’s often the key to stubborn shoulder pain. This muscle is primarily attached to the front surface of the shoulder blade – the side that faces the back of the rib cage – and it connects to the upper arm. The red shading in the diagram shows the areas of pain this muscle is capable of producing, which includes the area over the shoulder blade, the back of the shoulder, the shoulder joint itself, the underside of the arm, and the wrist.

The black X on the left points to the edge of the shoulder blade where it’s possible with some digging to feel a bit of subscapularis. This is easiest when the shoulder blade is made to protrude beyond the side of the rib cage. This can be accomplished by bringing your arm across your chest and then using the thumb of the other hand to feel for the edge of the shoulder blade a bit below the armpit. Another way to get to it is to sit in a chair and slump over, so that your arm hangs down at your side. This also brings the shoulder blade out over the side of the rib cage. With the other hand, you can get your fingers or thumb into the tight space between the edge of your shoulder blade and the rib cage. You’ll know you’ve got it when you find some very tender spots.

Massaging these spots is usually unpleasant but if subscapularis is implicated in shoulder pain, releasing tension here can provide almost immediate relief. You can use the Imbue Patch on this area, though it is not always beneficial, since the muscle is mostly hidden. If you wish to try, another area to consider is over the back of the shoulder blade (directly behind this muscle) in the regions of the outlined X’s on the right side of this diagram.

Scalenes:

These muscles, a group of three bands on the front/side of the neck, can cause very unusual patterns of pain sensations in the arms, hands, chest, and back (see red shaded regions on diagram). People almost never suspect them because there is rarely discomfort of the muscle itself. They are fairly unpleasant to have massaged, but when the scalenes are implicated in pain, getting them to relax can yield profound results.

Start by pressing just above the middle of your collar bone on the side that you have pain on. Then gradually work your way toward the front of the neck where you will feel a superficial band of muscle (SCM), which lies on top of the scalenes. Then begin working your way up the neck, pushing the SCM aside, pressing instead on the harder deeper muscle beneath. Next work back, going as far back as the very side of the neck. Try to cover the entire area in the red triangle in the lower diagram. Pay special attention to points that produce an unpleasant painful or nervy sensation that may travel to other areas. These are key spots for self massage and placement of the Imbue Patch.

Biceps Brachii:

Strain or trigger points in the biceps muscle (shown in red in the diagram) can cause shoulder pain, primarily in the front. Pain may also refer to the crease of the elbow and sometimes to the top of the shoulder blade. Press methodically in this muscle, especially midway between the shoulder and the elbow, to locate any significantly tender spots. The X’s in the diagram show likely locations of trigger points. If you find one (or more), and especially if they produce pain that radiates upward, place the Imbue Patch here. You can also massage these points, and try pressing on each tender point while slowing flexing and extending the forearm repeatedly.

Triceps Brachii:

The triceps is a three part muscle that covers the back of the upper arm. Trigger points at the upper inside aspect of the triceps can cause pain that radiates up the back of the arm into the back of the shoulder, and also down to the outer aspect of the elbow, mimicking “tennis elbow.” The X’s in this diagram show common sites of irritability in the triceps where trigger points occur (feel the back of the arm thoroughly, as they may occur elsewhere) and the red shading shows the common pain pattern. Note that these points may be may be tucked more toward the inside of the arm than is depicted in this diagram.

 

Pectoralis Major and Minor:

These muscles, more commonly known as the “pecs,” radiate pain into the chest, shoulder, and arm. The green X’s in the diagram show common sites of trigger points in pec major (clavicular section) and the red X shows the common site of trigger points in pec minor. The green shading shows pec major’s pain pattern – primarily into the front of the shoulder and side of the chest. The red shading shows pec minor’s pain pattern – more broadly in the chest, and also the shoulder, and sometimes down the inside of the arm to the palm and fingers. Rather than hunting for trigger points of one muscle or the other, methodically feel this whole region, searching for tenderness and broad pain into the shoulder. Then put the Imbue Patch here. Always get chest pain checked out by your doctor.

Deltoid:

The deltoid is the muscle that appears to “cap” the shoulder joint. It has an upside-down teardrop shape, and it consists of three portions – the front section (anterior deltoid), the side section (lateral deltoid), and the back section (posterior deltoid). Trigger points in the deltoid are unique in that their pain is felt right at the point, and does not spread much beyond this region. Also, while many other muscles refer pain into the deltoid area, the deltoid is somewhat less likely to be the primary source of pain here. Nonetheless, it is worth feeling this area thoroughly if you experience pain in this area. The X’s in the diagram indicate common sites of trigger points, but you should methodically press on the muscle in vertical lines, starting at the front and gradually making your way to the back. If you find any spots with significant tenderness, massage them and apply the Imbue Pain Relief Patch.

 

Other Causes of Shoulder Pain

Although the muscular causes of shoulder pain listed above are most common, there are other potential sources of pain in the shoulder, which you can investigate with your healthcare practitioner if necessary.

Bursitis is a condition in which the sac that encloses the joint – called a bursa – becomes inflamed, usually following an injury. Even in the presence of bursitis, we still find that myofascial trigger points in the muscles above are often critical in perpetuating the problem.

Rotator cuff injuries beyond those described above are also a possible cause of shoulder pain. The four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) hold together and move the shoulder joint, and anything from minor pinching to a complete tear is possible.

• Also possible with a shoulder injury is a labral tear (glenoid labrum tear). The labrum is a cuff of cartilage that encircles the shoulder joint to make it a deeper “cup” for the top of the arm bone to fit into. A sudden, intense movement of the shoulder can damage this tissue.

Frozen shoulder (adhesive capsulitis) is a condition in which chronic inflammation and/or immobility of the joint gradually leads to a stiffening of the shoulder and reduced range of motion. It usually resolves within one to two years with stretching, but this process can often be greatly shortened by working with a good acupuncturist, massage therapist, or chiropractor.

• Problems with the upper spine, such as arthritis or a degenerated disc in the neck, can lead to pressure on a spinal nerve, which may send pain to the shoulder (and all the way to the fingers).

Gallbladder problems, such as gallbladder inflammation (cholecystitis) and gallstones (cholelithiasis), can refer pain to the shoulder (usually the right shoulder, typically felt more after eating, and most frequently after a greasy meal or following foods that one has a sensitivity to).

• A shoulder separation (acromio-clavicular separation), dislocation, broken collarbone, and broken scapula are a few of the more severe traumas one can experience in the shoulder region. It’s unlikely that you’d be browsing the web looking for an explanation if you have one of these problems, since they all result from some sort of traumatic event (although some very flexible people have shoulders that can be easily dislocated and reduced).

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