Shoulder-blade position and neck, arm and upper back pain

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The resting position of the shoulder-blade is important to the health and comfort of the muscles of the neck shoulder and upper back, and also to the nerves that run from the neck into the arm.

I recently taught a shoulder course, and so neck, upper back pain and nerve pain into the arm have been on my mind a lot. These are very common problems that many people suffer from, and although they can have many different causes, improving overall posture as well as the resting position of the shoulder-blade are frequently overlooked as potential solutions.

The shoulder blade or scapula is the triangular bone that sits on the back of our upper ribcage, which houses the arm socket. But unlike the hip socket which really is a cup that the leg bone (femur) sits in, the arm socket is shaped more like a tiny plate. Furthermore, the ball that forms the top of the arm bone (humerus) is a lot larger than the plate of the socket, so it is a bit analguous to a golf ball on a tee rather than in a cereal bowl. Except of course, when we talk about the shoulder joint, the plate is sitting on its rim. It becomes immediately obvious that the joint itself is inherently unstable, and it must largely rely on the ligaments, tendons and muscles that surround it to “strap” the arm to the body.

However, the angle of the plate can make a big difference to the strain the muscles are placed under. If the plate of the socket is angled up a slight bit, the humeral head (arm ball) can rest on the rim, whereas if the plate of the socket is angled down, the humeral head is essentially falling out of the socket, and the muscles have to work much harder to hold the arm in place.

Also, if the glenohumeral joint is pointing down as can be seen in the upper left diagram, usually the shoulder-blade will not rotate far enough when the arm is moved up overhead, and the arm bone (humerus) will bang up against the bony protuberance of the shoulder-blade called the acromion, creating an impingement problem, which may in time damage the supraspinatus (rotator cuff) tendon.

Furthermore, if the glenohumeral joint (arm socket) is angled down, the nerves that leave the cervical spine to go into the arm have a very long way to go – much further than if the glenohumeral joint were angled up. Nerves don’t like being stretched, and stretched nerves tend to be painful. I find that when I see someone that has a shoulder socket pointing down with radiating arm pain or sore neck/shoulder muscles , I tell them to relax, and I pick up their armpit (actually the upper arm near the armpit) and hold it up for a few minutes. Frequently their pain goes away, and then I know that providing an exercise program that improves the position of the shoulder socket will probably work.

So, how do you tell if your arm socket is pointing up or down? Tough to do on your own, but if you have very long, sloped shoulders you can be suspicious. If the outer end of your collarbone is lower than its attachment at the sternum, your glenohumeral joint is pointing down. Most of you will need to ask a friend or partner to look at your shoulder blades from the back. If the bottom corner of the shoulder blade is closer to the spine than the top part of that inner border as shown in the left upper diagram, then your shoulder joint is pointing down.

If you are in pain and you discover that your socket is pointing down, you need to find a good physiotherapist , CHEK Practitioner or an extremely knowledgeable personal trainer that can teach you how to build muscle endurance in serratus anterior, low traps, and upper traps without overusing levator scapula, rhomboids, and lats, and even more importantly, teach you how to move your arm and shoulder-blade so that you recruit the right muscles in the right order to keep your shoulder, upper back and neck happy.

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Sahrmann, Shirley Diagnosis and Treatment of Movement Impairment Syndromes Mosby Inc., St. Louis, Missouri, 2002.

Kendall and Kendall Muscles: Testing and Function, with Posture and Pain (Kendall, Muscles) Williams and Wilkins, Baltimore Maryland, 2005.

Donatelli, Robert A. Physical Therapy of the Shoulder (Clinics in Physical Therapy) Churchill Livingstone, St. Louis, Missouri, 2004.

Porterfield, James and DeRosa, Carl Mechanical Shoulder Disorders: Perspectives in Functional Anatomy with DVD Saunders, 2003.

Cailliet, Rene Shoulder Pain (Pain Series) 1991.

Chek, Paul C.H.E.K. Practitioner Level 3 Certification Manual – The Upper Quarter The Chek Institute, 2000

Copyright 2008 Vreni Gurd

www.wellnesstips.ca

13 Comments »

  1. Rob Nielsen said,

    April 9, 2008 @ 12:53 am

    Hi Vreni

    Nice basic review of scap positioning. Only thing I would say is that most chronic patients muscles are so bound up and scarred exercises have limited effect unless they are released first ie ART
    Keep up the good work…I enjoy these!!
    Rob

  2. RADO said,

    April 11, 2008 @ 2:13 am

    I TRIPPED OVER THE IRON TEETH OF A FORK LIFT AND TOOK A VERY HARD NASTY FALL, I AM STILL IN PAIN, INITIALLY IT WAS IN BOTH SHOULDERS, BOTH UPPER ARMS, NECK AND UPPER BACK MOSTLY ON THE LEFT SIDE OF MY SPINE.
    SHARP STABBING PAINS, BURNING PAIN, TINGLING, AND NUMBNESS ON THE SIDE OF LEFT HAND INCLUDING TWO FINGERS.
    IT IS ALSO RADIATES DOWN MY SPINE CLOSE TO THE LOWER BACK.
    MY NECK IS SO PAINFUL, I HOLD A STIFF NECK.
    PLEASE TELL ME WHAT IS WRONG?
    I AM BEING TOLD THE PAIN IS ALL IN MY HEAD, AND NO ONE HAS THAT MUCH PAIN, AND I AM A PILL HEAD. FIRST OF ALL I DON’T LIKE DRUGS, HOWEVER IT HAS BECOME NECESSARY FOR ME TO SEEK MEDICAL ATTENTION WITH COMPLAINTS OF THE SEVERITY OF THE PAIN AND STIFFNESS.

  3. Mike Limbean said,

    May 15, 2008 @ 6:38 pm

    Hi my name is Mike i am 39 year old Male from RedLands,Calif. i want tell you about my Right Shoulder Blades that Really Hurt in Painfull Pinch Nerver & my Right side Hip Pain, also my Right Knee.

    here how it happen. i was a young Teenage as age of 18, my mom and my stepdad went on vacation,i was at home cause i had Bowling Leauge on monday night, so i got upset with my older evil brother & his dumb girlfriend they were begin a smart brat mouth,so i end up walking to the bowling on my own, so this 2 bowling ball weight 15 pounds each that 30 pounds together in 1 double bags,i have a Shoulder strap which it was not a good kind it was a very thin strap & it hurt when i walk,i walk from my house to the bowling alley about 1 miles and half,took me nearly an hour walk so by about a week my upper back blades starting to feel really hard pain my upper blades was in painful and my upper blade pull my right arm backward the blades was big around like a softball size i feel the pinch nervers then my ribcage go pull up to the under side of my upper blade which it hard to sit down in a chair or on a floor you are gonna feel that ribcage hurt there by sitting, my upper blades never got heal since after age 18,it still hurtting & if i workout on the weight bench press the blade will grow out again like a softball size & it hurt too what can it be done to get my upper back blade & ribcage back to normal?

    now my right hip. my hip really hurt like crazy it hard to discribie it, my hip start this pain a year ago,i can feel the pain point in my hip area to my butt area that i `m sit on,it hard to sleep,stand,walk and sit, when i stand it rough it start to pain in my hamstring all the way down pass my back knee to my foot it burn tingle and fuzz feeling,when i sit i can`t get myself to sit in a normal position,when i sleep it hard to get up and turn,now walking this hip pain really painful walk i walk too long it hurt my upper hip to my butt,then down to my lower hip buttt then it make me stop walking by it locked on it on,it take 5 min to release it. when i walk i walk as Limp. so my Dotor tell me that i am too young to get Hip Replacement is that True?..

    now my right knee..this was all started was back in my child year in 1977. after lunch we all kid were out playing on the playground,i was on a swing and my g/f was calling me so i ran to her this other kid up toward me and we both were on the same driction straight at eachother, so when we collidie he went down to the ground i flew in the air around nearly 7 feet and Smash my rightknee into the ground hard i busted my right knee,my atch guard teacher cam over to me with my g/f i got her worry my teacher ask me if walk i said i done if i could walk or not,so i try to stand up & walk i feel down 3 times,so my g/f ask me to go to the hospital i said no so i try it a 5th time and i walk,my g/f warn me about my future she said mike you will find out when you get older it will come back. well guess what She was Right i Should of Listen to her by going to the Hospital instead of letting it go now my knee is start to wear out,my doctor took some x~ray and we found out that my knne 2 chip bone together in my cartiage area just slip out about 1 inch going backward..do i need a knee surgery???
    need your advice pllease..

    thank you…

    Mike

  4. Johnny Sokko said,

    July 29, 2008 @ 2:38 am

    Mike,
    You sound like you are having a hard time. I think i have some information that could be of help to you.
    How is your shoulder and knee feeling now ?

  5. carol pinkham said,

    September 8, 2008 @ 1:46 pm

    I have got pain on right side of back and shoulder blade when i hold my hand there and less pain. i take parceatomel every days . Dr send me Bone Scan i take some tables recently seems not helpful . When i walk or stand too long it is pain and ache.

  6. Katie said,

    February 5, 2009 @ 5:59 pm

    when i woke up this morning i had a sharp knife like feeling in my left upper back were the bra line is , thinking it was just the way i slept thought nothing of itt , it went away for a while , when i slouch on the couch i feel it when i try to sit forward , a pain on my left side bra line , i sit up proper and fix my postture then pain subsides , i turn just little turns to the left i feel a sharp pain almost brath taking and then it goes away . now im laying on my stomach and no pain and i can move to the left and the right freely on my stomach no pain …
    and when i try to get up it hurts a little .
    WHAT DO YOU THINK COULD BE WRONG ?
    the way i slept ?
    please reply to me , so i can find out if i have to go to the doctors .
    thanks ; katie

  7. rustie said,

    February 7, 2009 @ 3:48 pm

    I have tried all of this, my pain in my right side just keeps getting worse. My nuerologist put me on neurton it helped for a while but he has to keep upping the dose. Can’t sleep on that side can’t lift, can’t vaccum, can’t do anything that uses that side. Even have trouble walking.

  8. Angie said,

    April 6, 2009 @ 5:13 pm

    In 2004 I had spinal fusion for scoliosis, stenosis, kyphosis. I was In a plaster body cast for 6 mos. My incision is the length of my back. From scalula area to my butt. Since then I have had intense pain in the area between shoulder blades. Most of the time the pain radiates through my body to my chest. I call it my tunnel of pain. One time it was so bad, my children took me to ER thinking I was having heart attack. I have pain on the right side starting from the base of my head, neck, shoulder to my feet. Dr. suggests some kind of neck surgery, saying it is a nerve causing all this. The fusion was a brutal surgery. I am 82 yrs. old and do not think I could stand the recovery period required with this kind of surgery. Being in a neck brace and not able to move my head. I have so many meds, looks like a “drug:” store. Nothing helps. They only make me sleep.
    I have had 2 cervical epidurals plus other injections. No help at all.

  9. Karen said,

    May 8, 2010 @ 7:54 am

    how to build muscle endurance in serratus anterior, low traps, and upper traps without overusing levator scapula, rhomboids, and lats, and even more importantly, teach you how to move your arm and shoulder-blade so that you recruit the right muscles in the right order to keep your shoulder, upper back and neck happy.

    This is exactly what i need some exercises , stretches to build up my muscles can you help me with some drawings or pics and explaination of exercises to do.
    Many Thanks Karen

  10. Vreni said,

    May 8, 2010 @ 12:15 pm

    Hi Karen,

    I suggest you see a physio who can teach you this. Descriptions and drawings are not adequate to ensure you are doing the exercises correctly, and the power of the exercises is in the details. You need someone to observe you doing them and correct you as needed until you get the feel of them. If you are in the Vancouver area, I’d be happy to help you.

  11. Marjorie Palacio said,

    August 5, 2010 @ 7:23 pm

    Hi um I hope that this is free advise im asking for cause withall that talk of about people claiming to be someone else on the web can steal an identity so sorry if im a little paranoid but anyways back in 2006 i accidentaly ramed right into a railing system while trying to catch up with a the corner of the railing systen made impact directly in my muscle and the pain was sharp unbearable and that numb tingling feeling went all the way to my hand that day and I went on with my day thinking that it was nothing so now and days it hurts and Im feeling a small gap in my shoulder and sometimes sharp pain but its not as much now since it was an old injury I asked two people i trust both told me that my shoulder is alittle bit out of its socket when i move the whole arm it hurts and I hear it popping also sometimes when I put a little bit of pressure that relieves the pain a little I want to know if its a symptom of a dislocated shoulder and if so I cant go to the doctor cause I have no Health insurance and not much money to pay, if need be i will go to the hospital but If i can get someone to pop it back in I need to know how to get that done step by step and what signs to look for that will tell me i need to go to the hospital in an emergency if something goes wrong i know someone with the same problem who can help me with this

  12. Marjorie Palacio said,

    August 5, 2010 @ 7:27 pm

    Back in 2006 i accidentaly ramed right into a railing system while trying to catch up with a the corner of the railing systen made impact directly in my muscle and the pain was sharp unbearable and that numb tingling feeling went all the way to my hand that day and I went on with my day thinking that it was nothing so now and days it hurts and Im feeling a small gap in my shoulder and sometimes sharp pain but its not as much now since it was an old injury I asked two people i trust both told me that my shoulder is alittle bit out of its socket when i move the whole arm it hurts and I hear it popping also sometimes when I put a little bit of pressure that relieves the pain a little I want to know if its a symptom of a dislocated shoulder and if so I cant go to the doctor cause I have no Health insurance and not much money to pay, if need be i will go to the hospital but If i can get someone to pop it back in I need to know how to get that done step by step and what signs to look for that will tell me i need to go to the hospital in an emergency if something goes wrong i know someone with the same problem who can help me with this

  13. Fort Lauderdale Personal Trainer said,

    October 28, 2011 @ 9:25 pm

    Great article, not many people know how shoulder and neck pain can originate from the scapula.

    Shoulder stabilization exercises like YTW’s, band shoulder tree, band pull aparats, scap ups are great ways to teach people how to position their scapula.

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