Patient education is one of the most crucial aspects of the physical therapy experience. Formal clinic time is limited and what the patient does over the balance of the week with respect to protecting injured structures, while at the same time progressing with their home exercise program is crucial in order to return to normative daily function. Here is a brief explanation of how the shoulder functions in the interest of patient education.
The Complexity of the Shoulder Joint
As a physical therapist, I deal predominately with shoulder care. The shoulder joint is highly complex and educating the patient in this regard as it correlates to the healing process and return to function plays a crucial role in one’s overall success.
The shoulder is like no other joint in the body. The only place that it is actually attached to the skeletal framework via normative joint structure is where the collar bone attaches to the sternum. The shoulder blade, to which the arm attaches, basically floats across the rib cage and relies on muscles to hold it in place, yet dynamically moves it as well.
Movement & Functionality
The movement of the shoulder blade ensures maximal function at the ball and socket joint via the four rotator cuff muscles and the major mover muscles such as the pectorals and deltoid. The synchronous motion between shoulder blade and upper arm ensure proper length tension relationships to maximize strength output for all muscles that cross the region.
The rotator cuff muscles actually work as a cantilever to maintain ball on socket rolling (as opposed to shearing) as the arm i.e. moves over head. In all, around 20 muscles need to work together for us to do even the simplest of activities with the shoulder/arm. Appreciate this the next time you see a gymnast do an iron cross and then rotate their body parallel to the floor.