As we age, our bodies often remind us of the years gone by through various aches and pains. For many older women, shoulder pain can become an all too familiar companion, interfering with daily activities and diminishing quality of life. However, behind this discomfort lies a hidden culprit that often goes unnoticed: the subscapularis muscle.
Hello, I’m Sue, a physical therapist assistant dedicated to helping individuals reclaim their mobility and live pain-free lives. In this blog post, we’ll delve into the world of the subscapularis muscle and its pivotal role in shoulder pain, offering insights and strategies tailored specifically for older women.
Understanding the Subscapularis Muscle
“The subscapularis muscle is the strongest and largest muscle of the rotator cuff. It plays an essential role in the stability and function of the shoulder.”
Longo UG, Berton A, Marinozzi A, Maffulli N, Denaro V. Subscapularis tears. Med Sport Sci. 2012;57:114-121. doi: 10.1159/000328886. Epub 2011 Oct 4. PMID: 21986050.
Despite its importance, the subscapularis muscle often remains overshadowed by its more well-known counterparts. The rotator cuff muscles are Supraspinatus Muscle, Infraspinatus Muscle, Teres Minor Muscle, and Subscapularis Muscle.
Origin: The subscapularis muscle originates from the subscapular fossa, a depression on the anterior surface of the scapula.
Insertion: It inserts onto the lesser tubercle of the humerus, forming part of the rotator cuff tendon.
Action: The primary action of the subscapularis muscle is to medially rotate the arm at the shoulder joint. It also assists in stabilizing the shoulder during arm movements.
Nerve Supply: The subscapularis muscle receives innervation from the subscapular nerve, which is a branch of the brachial plexus.
Blood Supply: Blood supply to the subscapularis muscle is primarily provided by branches of the subscapular artery.
Lymphatics: Lymphatic drainage of the subscapularis muscle occurs through lymph nodes in the axilla region.
Function: In addition to its role in arm rotation and stability, the subscapularis muscle contributes to overall shoulder function, allowing for a wide range of motion and coordinated movement patterns.
Cracking the Code of Shoulder Pain
When the subscapularis muscle becomes tight or weak, it can lead to a range of shoulder issues, including pain, stiffness, and reduced range of motion. Common causes of rotator cuff tears are due to repetitive actions. Everyday activities such as reaching, lifting, and even dressing can become challenging and uncomfortable.
For older patients, whose muscles and joints may already be experiencing the effects of aging, addressing subscapularis dysfunction is essential for maintaining independence and mobility.
Signs and Symptoms Subscapularis Tears
Signs and symptoms of a subscapularis tear may vary depending on the severity of the injury, but commonly include:
- Shoulder Pain:
- Severe pain localized to the front or deep within the shoulder joint, particularly during activities involving arm movement, such as reaching, lifting, or throwing.
- Weakness:
- Difficulty in lifting or rotating the arm, especially during movements that require internal rotation, such as reaching behind the back or reaching across the body.
- Decreased Range of Motion:
- Limited ability to move the arm, particularly during activities that involve rotating the shoulder inward.
- Instability:
- Feeling of shoulder instability or “slipping” sensations, especially when performing overhead movements or lifting objects.
- Popping or Clicking Sensation:
- Some individuals may experience audible or palpable clicking, popping, or grinding sensations within the shoulder joint.
- Muscle Atrophy:
- Over time, muscle wasting or atrophy may occur due to decreased use and functional impairment of the subscapularis muscle.
- Swelling and Inflammation:
- Inflammation of the shoulder joint, accompanied by swelling, tenderness, and warmth, may be present, particularly in acute cases.
It’s important to note that these signs and symptoms may overlap with other shoulder injuries or conditions. Therefore, proper diagnosis by a healthcare professional, often including imaging studies such as MRI or ultrasound, is crucial for accurate assessment and appropriate treatment planning.
Also, if it is left untreated it may lead to other shoulder complications such as adhesive capsulitis or frozen shoulder. If you experience persistent shoulder pain or functional limitations, it’s essential to seek medical attention for evaluation and management.
Most Common Cause of a Subscapularis Tear
The most common cause of a subscapularis tear is typically a combination of degenerative changes and overuse or repetitive strain on the muscle and tendon. Some of the primary factors contributing to subscapularis tears include:
- Age-related Degeneration:
- As individuals age, the tendons within the shoulder, including the subscapularis tendon, may undergo degenerative changes, such as tendon weakening, thinning, or loss of elasticity.
- These age-related changes can increase the risk of tears, particularly in older adults.
Overuse or Repetitive Strain:
- Activities that involve repetitive overhead motions, such as throwing, lifting, or reaching, can place excessive stress on the subscapularis muscle and tendon, leading to microtrauma and eventual tearing.
- This is commonly seen in athletes, manual laborers, and individuals with occupations or hobbies that require repetitive shoulder movements.
- Traumatic Injury:
- Acute trauma, such as a direct blow to the shoulder or a fall onto an outstretched arm, can cause sudden, forceful contractions of the subscapularis muscle, resulting in a tear.
- Traumatic injuries are more common in younger individuals and athletes involved in contact sports or activities with a high risk of falls or collisions.
- Chronic Overloading:
- Activities or occupations that involve heavy lifting, carrying, or pushing/pulling objects can gradually overload the subscapularis muscle and tendon, leading to chronic strain and eventual tearing.
- This is often seen in individuals with physically demanding jobs or those who engage in repetitive manual tasks.
- Poor Shoulder Mechanics:
- Improper shoulder biomechanics, such as poor posture, muscle imbalances, or faulty movement patterns, can contribute to excessive stress on the subscapularis muscle and predispose it to injury.
- Inadequate strength or stability in the surrounding shoulder muscles can also increase the risk of subscapularis tears.
Strategies for Subscapularis Tear Relief
Treatment for a subscapularis tear depends on its size and impact on daily life. For small tears with manageable symptoms, conservative measures like icing, heat therapy, and pain medication such as ibuprofen may be recommended, along with physical therapy, particularly for older individuals. A steroid Injection is also an option.
However, if the tear is full-thickness or complete tears, causing significant disability, or fails to improve with conservative treatment over three to six months, surgery is typically advised.
Arthroscopic rotator cuff surgery, performed through small incisions with the aid of a camera, is the most common approach. It allows for precise visualization and manipulation of instruments.
Here are some key approaches:
- Gentle Stretching: Incorporating gentle stretches that target the subscapularis muscle can help alleviate tightness and improve flexibility. Simple movements like arm crosses and a doorway stretch can be beneficial.
- Strengthening Exercises: Strengthening the muscles surrounding the shoulder, including the subscapularis, is crucial for stability and support. Exercises such as external rotations and resisted shoulder internal rotations can help build strength in this area.
- Posture Correction: Maintaining proper posture is essential for reducing strain on the shoulders and promoting optimal alignment. Encouraging older women to be mindful of their posture throughout the day can make a significant difference in managing shoulder pain.
- Modalities: Modalities such as heat therapy, ice packs, and therapeutic massage can provide temporary relief from shoulder discomfort and promote relaxation of the subscapularis muscle.
Tests For Subscapularis
The lift-off test assesses the strength and function of the subscapularis muscle by having the patient lift their hand off their lower back while resisting pressure applied by the examiner.
The bear hug test evaluates the integrity of the subscapularis tendon by assessing the patient’s ability to resist inward pressure applied to their arms as they attempt to hug themselves.
The belly press test is another method for testing subscapularis strength and function. It involves pressing the hand against the abdomen while the elbow is extended and the arm is internally rotated.
The Takeaway
In conclusion, shoulder pain doesn’t have to be an inevitable part of aging. By understanding the role of the subscapularis muscle and implementing targeted interventions, it’s possible to crack the code of shoulder pain and reclaim freedom of movement. If you or a loved one are struggling with shoulder discomfort, don’t hesitate to reach out to a qualified physical therapist for support and guidance on your journey to better health.
Remember, you’re never too old to prioritize your well-being and live life to the fullest. Here’s to a future filled with strength, mobility, and vitality!
Leave a Comment