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Anterior Lateral Shoulder
Let’s talk about the shoulder. Beginning with the lateral (outside) and anterior (front) shoulder. I make this distinction because people will point to three different areas when talking about their shoulders. We will begin with lateral and anterior shoulder, and we will begin at the beginning with the anatomy. The glenohumeral (shoulder) joint is an articulation (coming together) of the humerus, the upper arm bone, and the scapula (shoulder blade). Specifically, the head of the humerus meets with the glenoid cavity of the scapula. The glenohumeral joint is interesting because it is not directly attached to the trunk of the body. It is secured and stabilized by muscles and lots and lots of connective tissue (connective tissue = ligaments, tendons, fascia, bone, blood, etc.). This leaves the joint and the tissue around the joint vulnerable to injury.
Within the glenohumeral joint is a patch of connective tissue that builds out the glenoid cavity called the labrum. The glenoid cavity is smaller than the head of the humerus. The labrum deepens the glenoid cavity so the humeral head fits better. Surrounding the joint is the articular capsule (also called the joint capsule) of the glenohumeral joint. The articular capsule secretes synovial fluid, the fluid that bathes and nourishes the joint. The articular capsule is also the first layer of connective tissue protecting the joint. Superficial to or on top of this capsule are the tendons of the rotator cuff, providing another layer of protection and creating stability. Superficial to the rotator cuff tendons are various muscle tendons, including the bicep tendons, pectoralis major, latissimus dorsi, teres major, and the triceps tendons. Finally, superficial to these attachments is the deltoid muscle, which sits just under the skin. As you can see there is an tremendous amount of connective tissue holding this joint to the body.
Connective tissue is made of approximately 70% water. Tension, inflammation, and damage can occur at the glenohumeral joint due to simple dehydration. Many people do not drink nearly enough water. They drink, but they drink pop, juice, coffee, tea, etc. They don’t drink water. Several of the larger processes in the body require water to work. An example would be your digestion. One of the first places your body will pull fluid from if you are even mildly dehydrated is connective tissue, and specifically tendons and ligaments. The shoulder is particularly vulnerable to tightening caused by dehydration. This tightening severely increases the possibility of injury in or around this joint.
And this is the hardest joint to rehab. Shoulder surgery, more than hip or knee surgery, leaves the patient with continued range of motion problems, weakness in the tissues, and a heightened vulnerability. Shoulder surgery, whether it be for a tear or a replacement, also fails more than those for other major joints. While much of the success of shoulder surgery depends on choosing the right surgeon and not overloading the joint after surgery, massage can be an integral part of the pre- and post-surgical treatment. Working on the tissue before surgery leaves the tissue as healthy as it can be going into the surgery. This enhances the body’s healing abilities after surgery. After waiting an appropriate amount of time after surgery, and beginning very lightly, massage can prompt healing in the area, which will lessen pain, which will allow for better and more sleep, which will allow for more healing, which lessens pain, which allows for better and more sleep, etc., etc.
