Shoulder Series Part 2 - The Neck, Ribs and Scapula By Osteopath Cameron Allshorn

In my last blog I spoke about the rotator cuff and broke down the individual key components that make up shoulder function (Read part 1 here) . The shoulder is complex and there is more to it than meets the eye. A key component of the shoulder is how it functions around other regions such as the neck, ribs and scapula.  

THE SCAPULA

Physically part of the bony makeup of the shoulder joint however it also forms part of the acromioclavicular (AC) joint, the scapulothoracic articulation (ST) and provides an attachment point for fifteen muscles.

While not considered a true joint the ST articulation can been seen as a good indicator of efficient shoulder function. The AC joint is one you are likely familiar with as it a common site of injury particularly in throwing or contact sports. The AC joint is a critical joint for our overhead abilities. Some key muscles that attach to the scapula are Pectoralis Minor, Serratus anterior, Triceps (Long head), Trapezius plus the rotator cuff muscle group (Discussed here in part 1).   

THE NECK

Is the origin of all of the nerve supply to the shoulder and surrounding areas thus any restriction or injury that impacts at a nerve root level can affect the shoulder via pain, weakness, muscle spasm or loss of muscular tone. (more on this in part 3)

Additionally, the neck is closely linked with shoulder function via multiple muscular connections. Often injury to either the neck or the shoulder can impact the other. Muscular links between these areas include the upper portion of the trapezius, levator scapulae and scalenes while the platysma and sternocleidomastoid (SCM) should also be considered through their attachment to the clavicle and thus potential to impact the shoulder via the AC joint.

THE RIBS

Connected to the shoulder via the scapulothoracic articulation (ST) that functions as the relationship between the anterior face of the scapula and the posterior surface of the rib cage.

Injuries to the ribs (fractures, costovertebral joint sprains or intercostal strains) can disrupt the fluidity of the ST and thus impact the function of the shoulder. Muscular attachments to consider here are the pectorals, particular pectoralis minor that originates at the coracoid  process of the scapular and attaches to the anterior 1st-3rd ribs. Additionally the serratus anterior fans between the medial (inside) border of the scapula and the upper 8 ribs with the action of protracting and stabilising the shoulder, particularly in overhead movements. The rhomboid group while not directly linked to the ribs themselves runs between the scapula and the thoracic spine and thus could be impacted via a costovertebral (rib) dysfunction or sprain.

BREATHING

May not be something you closely relate to your shoulder or shoulder pain in general however it is something that can often be overlooked.

A lot of the musculature we have discussed previously here make up what is collectively called the accessory muscles of respiration (trapezius, pec major and levator scap plus many others), generally these muscles contribute to respiration only during periods of high exertion however the presence of injury or dysfunction through the upper body can increase accessory activity.

As Osteopaths

when dealing with a shoulder presentation, we will test and asses various regions of the body in addition to the presenting shoulder. This will include the neck, ribs and thoracic areas to provide us with as much information as possible regarding the presentation of the injury. This allows us to provide an accurate working diagnosis and the ability to give you -the client- the best possible prognosis and overall outcome from your consultation.

Thanks for reading :)

Cameron.