My shoulder clicks, snaps and grates!
Has daily movements such as reaching up towards a shelf or rotating your arm as a warm up practice before sports cause a tinge of annoyance (and probably concern) as they are accompanied by clicking or grating in the shoulder joint? Before diving into the cause of these sounds, it is important to first understand the stabilizers of the shoulder joint. This is known as the rotator cuff group.
What is the Rotator Cuff Group?
As the name suggest, the rotator cuff surrounds the entire shoulder joint which happens to be one of the most mobile joints in the body. However, with great mobility comes great instability. Fortunately, the shoulder joint which can be divided into several joint parts is held by an extensive network of ligaments and muscles to keep it stabilized. One important muscle group that holds the humerus bone in the glenoid cavity is the rotator cuff group which consists of 4 main movers: supraspinatus, infraspinatus, subscapularis and teres minor, commonly abbreviated as SITS.
What happens when injuries occur?
Injuries in this group can greatly affect the stability in the shoulder. These include tears, tendinitis, tendinopathy and impingement. Rotator cuff tears usually require surgical repair especially in a macro tear as compared to a micro tear since huge portions of tissues are severed. Rotator cuff tendinitis involves acute inflammation of the rotator cuff tissues. When acute inflammation becomes a chronic reoccurrence, this is known as tendinopathy. Degeneration occurs in the rotator cuff tissues and causes recurrent pain and movement dysfunction. In terms of impingement, the most common type is known as the subacromial impingement syndrome. The subacromial space is an area between the acromion process and humeral head. Pain is normally elicited when tendons passing below the acromion are inflamed or being compressedwhen one raises their arm above shoulder level.
Among the several pathologies mentioned above, tendinopathies and impingement issues are still the most commonly seen in clinical settings. Despite being less severe than rotator cuff tears, these chronic conditions usually take a longer time to recover completely and tend to affect activities of daily living greatly. Simple movements such as taking off one’s shirt or reaching to the top shelf to get something may be restricted due to the pain.
How does clicking/snapping/grating come about?
Post-injury
When soft tissues heal, scar tissues form. This is similar to how a wound on your skin will eventually form a thick, tough scab and tighter new skin layer below it as it recovers. When tendons repair, they tend to be thicker and tighter than before. These ‘new’ tendons that were previously fitted nicely would move out of alignment and glide over bony prominences, causing tendons to ‘click’ and ‘snap’.
Poor Posture
This may also be a result of poor postural alignment of the shoulders known as rounded shoulders. When shoulder blades glide forward, the subacromial space reduces and compresses structures in the space easily. Muscles tighten up further, causing tendons to work out of alignment. In this case, the chest muscles tighten while the upper back muscles become weaker. As a result of poor overall joint stability, joint space reduces and causes bones to friction against one another during movement, eventually leading to early arthritis with the presence of crepitus or ‘grating’ sounds.
What can be done about it?
Research has found that there is no one specific exercise for rotator cuff injuries. Rather, dynamically activating all the rotator cuff muscles is the way to go. Furthermore, since the rotator cuff group ‘cuffs’ the scapula and humerus together, training muscles that move the shoulder blades are equally important. Despite a detailed assessment needed by a professional to provide a proper diagnosis, here are some exercises that may help at home. (Check out the video attached to see the movements more clearly!)
Corner wall pec stretch
- Stretches chest muscles to correct rounded posture
Keep arms supported from the hands to the elbows at 90 degrees on the wall
Lean in and take deep breaths
Wall angel
Keep back in contact with the wall with both arms at 90 degree angles at the sides
While squeezing shoulder blades close to each other, gradually slide arms up & down the wall
*Be careful not to hyperextend the lower back! This tends to happen to those with tight shoulders.*
Push up plus
Start with a normal push up
At the top, push the hands down even more and feel shoulder blades gliding forward
External Rotator Strengthening Exercise
Putting a towel between the elbow and body helps provide a reminder to prevent the arm from abducting. Use a resistance band increases difficulty in the movement.
Turn arm to the back while squeezing shoulder blade
Internal Rotator Strengthening Exercise
Tie and anchor resistance band onto a stable surface. Start with your arm facing outward.
Pull band inwards
Supraspinatus Strengthening Exercise
Anchor resistance band with foot
Pull band sideways to approximately a 30 degree angle (front & side view)
Reference
1. Brewster, C., & Schwab, D. R. (1993). Rehabilitation of the Shoulder Following Rotator Cuff Injury or Surgery. Journal of Orthopaedic & Sports Physical Therapy, 18(2), 422-426. doi:10.2519/jospt.1993.18.2.422
2. Heron, S. R., Woby, S. R., & Thompson, D. P. (2017). Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial. Physiotherapy, 103(2), 167-173. doi:10.1016/j.physio.2016.09.001