Shoulder pain/injuries are some of the most common issues I see at my office. The causes vary from a sudden movement, powerful strike or repetitive movement. Many clients come in complaining of this pain and more often than not they use the terms like "Rotator Cuff" without knowing what it really is. Most of these people are right with the terminology but often wrong when it comes to the reason why they might have that pesky shoulder pain. Today I'm going to go over one cause of shoulder pain that is not very widely known about and is not part of the "rotator cuff". Before I do I have to make one thing clear. The shoulder is the very top portion of the arm that connects the arm to the body and moves in various plans of motion. It's a common mistake people make when they say they have pain in their shoulder and they point to the area that is in the upper portion of their back AKA upper traps. Now that I've pointed that out I hope the rest of this is entry will be comprehensive.
Now let me ask you an odd question...Have you ever heard of a slap tear/injury? Its possible you have if you watch a lot of sports or are a medical professional, but the vast majority of people have no idea what it is. Well, let me first describe it in the simplest of ways. It is an injury to the upper portion of the arm where it meets the shoulder. Now let me describe in a little more depth. It's an injury to the upper long head tendon of the bicep. The bicep is the prime mover in bending your elbow and it assists with raising your arm in front of you or as nerds like to say anteriorly. The bicep has two upper tendons; the long head tendon and the short head tendon. It is only the long head tendon that the "slap tear" injury is associated with. This is due to where the tendon sits on the upper portion of the arm; the bicipital groove. This groove is located at the top of the humorous or humeral head. Now by design this tendon is protected by other muscles, ligaments and tissue but it is still very vulnerable to injury. The short head of the bicep lays deeper and closer to the body near the arm pit attaching to a bone of the scapula called the coracoid process. The placement of this tendon makes it much less prone to injury. So when a slap tear injury occurs the biceps long head tendon is torn, irritated or displaced to some degree. Other common pathology to this area is a tendinosis and tendinitis which is basically mild to severe irritation of the tendon. When a slap tear injury initially occurs it is usually very painful and the degree to which the injury has occurred is best seen with the use of a MRI. If a tear is partial and does not require immediate surgery then injection based therapies should be applied to promote regeneration such as Prolo therapy and the use of Therapeutic Massage can take place.
Therapeutic massage can help with the healing process of an injured bicep long head tendon If it is not a full tear. By releasing muscles that are near the bicep long head tendon and have tendons that come close to it like the peck major, supraspinaus, anterior deltoid. Also releasing muscles that protract the scapula making the shoulders round forward like the subscapularis and upper trapezius. If the tendon has been displaced from the bicipital groove then a passive active manipulation must be applied to place it back in the groove. Once the tendon is back in the proper place and all associating muscles are brought to a proper resting place then the healing process takes much less time and pain is usually resolved. In order to bring the area back to full health it must have full range of motion and strength pain free. This can be achieved with a combination of low impact movements that stretch over active muscles with activations of weak ones and continued therapies that keep the area healthy.