Physical Therapy in Congress Park, Denver Downtown, Central Park, and Highlands Area for Shoulder
Welcome to Atlas Physical Therapy's patient resource about Shoulder problems.
The shoulder is an elegant piece of machinery. It has the greatest range of motion of any joint in the body. However, this large range of motion can lead to joint problems.
Understanding how the different layers of the shoulder are built and connected can help you understand how the shoulder works, how it can be injured, and how challenging recovery can be when the shoulder is injured. The deepest layer of the shoulder includes the bones and the joints. The next layer is made up of the ligaments of the joint capsule. The tendons and the muscles come next.
This article will help you understand:
what parts make up the shoulder
how these parts work together
Hear from some of our patients who we treated for Shoulder Pain
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Alex and his staff recently helped me with a knee injury and frozen shoulder. A couple years ago they helped me after my neck surgery. I am very pleased with the results and highly recommend their... ”
“ Alex and his staff recently helped me with a knee injury and frozen shoulder. A couple years ago they helped me after my neck surgery. I am very pleased with the results and highly recommend their services. ”
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I have had a shoulder impingement type pain for years and finally decided to have it looked at. Alex was my PT and he immediately was able to diagnosis the issue. After he worked on it, I was amazed... ”
“ I have had a shoulder impingement type pain for years and finally decided to have it looked at. Alex was my PT and he immediately was able to diagnosis the issue. After he worked on it, I was amazed how much more mobility I had and reduced pain. The team gave me strengthening and mobility exercises to prevent future discomfort. Absolute pleasure working with Atlas and the team.Thank you ”
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I’ve been going to Atlas PT for a shoulder injury and to resolve some back pain. Brett and Angela are fantastic at their craft and very personable. Brett helped me understand how certain movements... ”
“ I’ve been going to Atlas PT for a shoulder injury and to resolve some back pain. Brett and Angela are fantastic at their craft and very personable. Brett helped me understand how certain movements irritated my biceps tendon causing shoulder pain and how to work around this issue. I’ve been impressed with his insight into what has caused my shoulder pain and back pain. Angela is thorough in showing me PT exercises and is really encouraging. I definitely recommend them! ”
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Alex and the staff at the Quebec location have helped me through rotator cuff surgery along with a couple more injuries. Highly recommend their services! ”
“ Alex and the staff at the Quebec location have helped me through rotator cuff surgery along with a couple more injuries. Highly recommend their services! ”
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Saw Kate for my PT and recovery after surgery to repair a torn rotator cuff. She is wonderful and caring and thorough. I highly recommend her and the entire crew at Atlas.Thank you. ”
“ Saw Kate for my PT and recovery after surgery to repair a torn rotator cuff. She is wonderful and caring and thorough. I highly recommend her and the entire crew at Atlas.Thank you. ”
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I have been going to Atlas Physical Therapy for years, alas for different body parts. Each time I have gone, for various body parts (knee, shoulder, and now hip), Atlas has been there for me. You... ”
“ I have been going to Atlas Physical Therapy for years, alas for different body parts. Each time I have gone, for various body parts (knee, shoulder, and now hip), Atlas has been there for me. You won't regret it. Hope to (not) see you there - to your health! ”
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I was suffering from a frozen shoulder which was causing me a lot of pain. My doctor suggested going to Atlas Physical Therapy-Downton. Dr. Brett Green and Will did an incredible job in getting full... ”
“ I was suffering from a frozen shoulder which was causing me a lot of pain. My doctor suggested going to Atlas Physical Therapy-Downton. Dr. Brett Green and Will did an incredible job in getting full movement back! With it, "no more pain". I highly recommend them! ”
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I’ve been coming here for almost a year after a shoulder surgery, and every single person I’ve talked to at Atlas is amazing. Gabriel(previous Lukas) and Isabel do a great job of fixing the... ”
“ I’ve been coming here for almost a year after a shoulder surgery, and every single person I’ve talked to at Atlas is amazing. Gabriel(previous Lukas) and Isabel do a great job of fixing the shoulder - I doubt there’s a better PT group in Denver and always recommend them to friends ”
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Somehow at the ripe age of 35, I’ve had a lot of issues and I’ve worked with a lot of acupuncturists and chiropractors over the years with varied results and satisfaction rates. I’ve been seeing... ”
“ Somehow at the ripe age of 35, I’ve had a lot of issues and I’ve worked with a lot of acupuncturists and chiropractors over the years with varied results and satisfaction rates. I’ve been seeing Luke off and on since 2015 and I feel safe when I’m under Luke’s care.. I know when I leave I will always be better than when I entered. I started seeing him due to chronic neck issues and continued to see Luke when I tweaked my shoulder. Both issues are on-going, but that’s because I play hard and haven’t gone to see Luke in quite some time. He was my primary choice when I eventually had hip reconstruction. He was patient with me after that surgery yet he pushed me when I didn’t want to work any more which led to a better recovery than I could have had otherwise. Luke is friendly, thoughtful, and in most importantly in this role, he is competent. Just scheduled my first appointment in a while and felt that a review was in order to help others make a decision if they were on the fence while choosing a great PT. Thanks for all you’ve done for me. See ya next week :) ”
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I've worked with Andrea and Nate after a shoulder replacement surgery. I've found them both to be knowledgeable and professional and with their support and exercise instruction my shoulder has... ”
“ I've worked with Andrea and Nate after a shoulder replacement surgery. I've found them both to be knowledgeable and professional and with their support and exercise instruction my shoulder has improved greatly, in spite of a setback due to a hairline fracture in my acromium. I highly recommend both Andrea and Nate. . ”
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Going to Atlas was one of the best decisions I made in regards to rehabilitation for my shoulder. Brett and Will were professional, easy to get along with, and incredibly knowledgeable. If anyone is... ”
“ Going to Atlas was one of the best decisions I made in regards to rehabilitation for my shoulder. Brett and Will were professional, easy to get along with, and incredibly knowledgeable. If anyone is considering PT, I would highly recommend Atlas! ”
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I had been going to a different therapist for several months with little progress. Just three visits with Alex and my neck and shoulder feel better than they have in months. Steve ”
“ I had been going to a different therapist for several months with little progress. Just three visits with Alex and my neck and shoulder feel better than they have in months. Steve ”
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I had a wonderful experience at Atlas, specifically with Nikhil and Frank. They were great to work with, their program resolved my neck and shoulder issues quickly, and they helped treat and relieve a... ”
“ I had a wonderful experience at Atlas, specifically with Nikhil and Frank. They were great to work with, their program resolved my neck and shoulder issues quickly, and they helped treat and relieve a great deal of pain. Just as important, after only a few visits, they left me with a home plan to provide aid if the problem ever presents itself again.
Can't say enough positive things about my experience, about Nikhil and Frank, and they'll be my first call should I need PT of any kind again. ”
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It’s a super friendly environment. Everyone is relaxed and caring. I worked with the PT Kate on a shoulder/arm problem over a couple of months, along with Hailey who led me through stretches and... ”
“ It’s a super friendly environment. Everyone is relaxed and caring. I worked with the PT Kate on a shoulder/arm problem over a couple of months, along with Hailey who led me through stretches and exercises. I’m happy to say I’m pain-free now and stronger! I definitely recommend this place! ”
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After experiencing shoulder and hip pain for a few months while swimming and running, I came to Atlas Congress Park looking for help. My pain was keeping me out of the pool and regularly truncating my... ”
“ After experiencing shoulder and hip pain for a few months while swimming and running, I came to Atlas Congress Park looking for help. My pain was keeping me out of the pool and regularly truncating my runs.
My experience at Atlas was excellent. The office was clean and comfortable, there was always parking in the lot, the entire team was efficient and helpful. My physical therapist, Brett, was especially great. He was evidently knowledgeable and invested in my recovery. He used several approaches and techniques to make the most of each appointment, including targeted massage, mobility training, and strength exercises. Beyond his professional aptitude and competence, Brett is also a genuinely great guy. His affable, warm nature made the recovery process enjoyable. The whole team was great, including my trainer Will.
Physically, I am noticing significant improvement in both my hip and shoulder. With the support of the team at Atlas, and the skills I've been taught, I expect this improvement to continue. I can't recommend the practice enough! ”
The important structures of the shoulder can be divided into several categories.
These include:
bones and joints
ligaments and tendons
muscles
nerves
blood vessels
bursae
Bones and Joints
The bones of the shoulder are the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone). The roof of the shoulder is formed by a part of the scapula called the acromion.
Shoulder Bones
There are actually four joints that make up the shoulder. The main shoulder joint, called the glenohumeral joint, is formed where the ball of the humerus fits into a shallow socket on the scapula. This shallow socket is called the glenoid.
The acromioclavicular (AC) joint is where the clavicle meets the acromion.
Acromioclavicular and Glenohumarel Joints
The sternoclavicular (SC) joint supports the connection of the arms and shoulders to the main skeleton on the front of the chest.
Sternoclavicular and Scapulothroacic Joints
A false joint is formed where the shoulder blade glides against the thorax (the rib cage). This joint, called the scapulothroacic joint, is important because it requires that the muscles surrounding the shoulder blade work together to keep the socket lined up during shoulder movements.
Articular cartilage is the material that covers the ends of the bones of any joint. Articular cartilage is about one-quarter of an inch thick in most large, weight-bearing joints. It is a bit thinner in joints such as the shoulder, which don't normally support weight. Articular cartilage is white and shiny and has a rubbery consistency. It is slippery, which allows the joint surfaces to slide against one another without causing any damage. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to make motion easier. We have articular cartilage essentially everywhere that two bony surfaces move against one another, or articulate. In the shoulder, articular cartilage covers the end of the humerus and socket area of the glenoid on the scapula.
Ligaments and Tendons
There are several important ligaments in the shoulder. Ligaments are soft tissue structures that connect bones to bones. A joint capsule is a watertight sac that surrounds a joint. In the shoulder, the joint capsule is formed by a group of ligaments that connect the humerus to the glenoid. These ligaments are the main source of stability for the shoulder. They help hold the shoulder in place and keep it from dislocating.
Ligaments attach the clavicle to the acromion in the AC joint. Two ligaments connect the clavicle to the scapula by attaching to the coracoid process, a bony knob that sticks out of the scapula in the front of the shoulder.
A special type of ligament forms a unique structure inside the shoulder called the labrum. The labrum is attached almost completely around the edge of the glenoid. When viewed in cross section, the labrum is wedge-shaped. The shape and the way the labrum is attached create a deeper cup for the glenoid socket. This is important because the glenoid socket is so flat and shallow that the ball of the humerus does not fit tightly. The labrum creates a deeper cup for the ball of the humerus to fit into.
The labrum is also where the biceps tendon attaches to the glenoid. Tendons are much like ligaments, except that tendons attach muscles to bones. Muscles move the bones by pulling on the tendons. The biceps tendon runs from the biceps muscle, across the front of the shoulder, to the glenoid. At the very top of the glenoid, the biceps tendon attaches to the bone and actually becomes part of the labrum. This connection can be a source of problems when the biceps tendon is damaged and pulls away from its attachment to the glenoid.
Labrum
The tendons of the rotator cuff are the next layer in the shoulder joint. Four rotator cuff tendons connect the deepest layer of muscles to the humerus.
Muscles
The rotator cuff tendons attach to the deep rotator cuff muscles. This group of muscles lies just outside the shoulder joint. These muscles help raise the arm from the side and rotate the shoulder in the many directions. They are involved in many day-to-day activities. The rotator cuff muscles and tendons also help keep the shoulder joint stable by holding the humeral head in the glenoid socket.
Rotator Cuff Tendons
The large deltoid muscle is the outer layer of shoulder muscle. The deltoid is the largest, strongest muscle of the shoulder. The deltoid muscle takes over lifting the arm once the arm is away from the side.
Deltoid Muscle
Nerves
All of the nerves that travel down the arm pass through the axilla (the armpit) just under the shoulder joint. Three main nerves begin together at the shoulder: the radial nerve, the ulnar nerve, and the median nerve. These nerves carry the signals from the brain to the muscles that move the arm. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature.
Blood Vessels
Traveling along with the nerves are the large vessels that supply the arm with blood. The large axillary artery travels through the axilla. If you place your hand in your armpit, you may be able to feel the pulsing of this large artery. The axillary artery has many smaller branches that supply blood to different parts of the shoulder. The shoulder has a very rich blood supply.
Bursae
Sandwiched between the rotator cuff muscles and the outer layer of large bulky shoulder muscles are structures known as bursae. Bursae are everywhere in the body. They are found wherever two body parts move against one another and there is no joint to reduce the friction. A single bursa is simply a sac between two moving surfaces that contains a small amount of lubricating fluid.
Think of a bursa like this: If you press your hands together and slide them against one another, you produce some friction. In fact, when your hands are cold you may rub them together briskly to create heat from the friction. Now imagine that you hold in your hands a small plastic sack that contains a few drops of salad oil. This sack would let your hands glide freely against each other without a lot of friction.
Summary
As you can see, the shoulder is extremely complex, with a design that provides maximum mobility and range of motion. Besides big lifting jobs, the shoulder joint is also responsible for getting the hand in the right position for any function. When you realize all the different ways and positions we use our hands every day, it is easy to understand how hard daily life can be when the shoulder isn't working well.
These include:
