I love the shoulder joint. When a patient comes into the office with pain and discomfort in their shoulder I enjoy the challenge this condition brings to me as a clinician. The shoulder is a very unstable joint. This instability is caused by its anatomy and function.

The shoulder is made up of three bones. The upper arm bone, called the humerus, the clavicle and the scapula.

It also has a number of muscles and tendons attaching to these bones. The muscles of the chest, upper arm, neck, shoulder pad and upper spine all converge in the area of the shoulder.

All this anatomy must be in perfect balance for the shoulder to function optimally. In the old days they used to call this anatomy the shoulder girdle. All this anatomy was needed to stabilize and support the shoulder like a girdle.

What makes the shoulder so unique is its range of motion. You can move the shoulder in so many directions. The downside to this motion and the workload demanded by athletes makes it vulnerable to injuries.

The shoulder can throw a baseball 90 mph. It is used to tackle a man running at full speed. It can also swing a tennis racket so you can hit a serve 125 mph over the course of 3 sets.

Injuries to the shoulders can be as simple as a strain of a muscle to more severe injuries such as fractures of the clavicle, subluxation or particle dislocation, dislocation or torn tendons.

I have patients come into the office and they have self diagnosed their shoulder pain. The most common self diagnosis is an injury to the rotator cuff or roto cuff attachment.

The rotator cuff is a tendon. Four muscles of the shoulder join together and anchor to the shoulder by this one tendon.

A blunt force or wear and tear from throwing or swinging a racket can injure this tendon.

One patient came in the office complaining of shoulder pain from pitching. He is in high school and was told he had a roto cuff injury.

Evaluation revealed his shoulder to have full range of motion. I performed muscle testing of the four muscles of the roto cuff. The supraspinatus was weak and tender to palpation. He had an elevated shoulder. His shoulder blade was out of alignment.

Treatment consisted of manipulation of the shoulder blade and the upper spine to relax the shoulder. He was given exercises with a tube to promote strength.

I spoke with his coach. We discussed his pitching motion. I want him throwing with his legs and not just his arm. He responded well and continued to pitch without issues.

Bench pressing heavy weights can also compromise the shoulder. If you bring the bar too low, so the elbow goes past 90 degrees, it puts a huge strain on the shoulder.

A patient was convinced he hurt his bicep tendon benching. He had pain in the front of the shoulder.

He is in great shape for his age but he had the range of motion of a fire hydrant. This is a problem for athletes that concentrate on building muscle without flexibility.

He strained his AC joint. This is the junction of the shoulder blade and collar bone. His anterior deltoid was weak. His bicep tendon was not involved.

I manipulated the AC joint and used ultrasound. We also recommend stretching exercise to improve his range of motion. Benching properly with less weight was reinforced.

If you take good care of this magnificent joint it will take good care of you.

Dr. Robert Lynch is a former president of the Maine Chiropractic Association and head of the Lynch Chiropractic Center in South Portland. “Staying in the Game” appears every other Thursday in the Press Herald. Contact him at:

drlynch@drlynch.com