What causes pain in the shoulder, elbow or wrist? Shoulder Impingement.

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So above we have a picture of the shoulder joint, looked at from the front.  If we peer hard we can see the word acromium on the outside edge of the outermost top bone.  It is the  area beneath this that is under the spotlight today.

Why people develop carpal tunnel syndrome, golfers or tennis elbow, joint spurs1  etc is due to modern lifestyle encouraging rounded shoulders and upper back and a head poked forwards which in turn leads to tension in the muscles of the upper back as they strain to hold the weight of the head plus a good dose of stress which leads to the shoulders climbing into the ears.  I have also found that most people have poorly functioning abs which leads to the shoulders tensing in an effort to stabilise the body.  In a very real sense, the shoulders become the abs.


To the left we can see the nerves of the shoulder coloured in red and yellow.  So due to lifestyle, the shoulders are rolled forwards and lifted.  When we come to lift the arm the space below the acromium, where the nerves pass through,  gets drastically reduced, squeezing the nerves and the bones may rub on each other.  None of this is good news for the long term health of the arm or shoulder joint.  The technical term for this is impingement.

The picture below right shows the trapezius in bright red.  Again after a bit of peering you will see fibres running upwards towards the head- the upper trapezius – fibres running towards the spine – the middle trapezius – and fibres running downwards – the lower trapezius. So when the shoulder lifts the lower trapezius should fire to stop the shoulder rising unnecessarily, but again due to tight upper shoulder muscles, this muscle is unable to fire and do its job.

Things can be done to prevent pain – or reduce it if already started.  The simplest is to reach down before lifting the arm as this will help create a space below the acromium.  Stretching the pec minor helps since this will reduce the roll forwards of the shoulders.  Increasing the flexibility of the upper back will help and so will properly strengthening the abs.  An exercise worth trying is shoulder scapation shown at the bottom of the blog on the dumbbell lateral raise.  The text does give hints as to how to make this exercise work.

  1. I am absolutely certain it also leads to frozen shoulder – but since they all love to argue about what the cause is, I’d daren’t put this in the main text!  This theory of mine will only be found by the dedicated few. []

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