NOT the Shoulder

A New Perspective

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Seth et al. PLoS ONE 2016

My initial aim in writing this series of blogs was to shed light on the issues persisting in the current shoulder classification system. The historical and current data presented in my previous blog posts serve to validate the existence of this persistent challenge.

However, identifying a problem is not solving it, and because I have more to share I have decided to complete this series of blogs with the hope that others may pick up some ideas for future research. We need to move in this direction, and based on my studies so far, new ideas are in short supply.

My new ideas came from the most powerful place - A personal injury.

Having to abandon a career of over 30 years due to long thoracic nerve palsy led me to ponder numerous questions. Delving into the recognition and comprehension of this condition became my primary focus. The insights I gained revealed a stark contrast to my previous understanding of the ailment.

Dealing with this condition firsthand compelled me to adopt a new perspective.

To share this perspctive, I wrote and published two books. Since writing the books, I have been exploring beyond the arm attachments and into a region that is NOT the shoulder.

Why?

My previous understanding was primarily focused on the shoulders. I used to think of the 'shoulder girdle' as the main source of power for the arm. I had not fully accepted the idea that the shoulder girdle, or the arm attachment mechanism, is simply a connector. The real power and mobility come from beyond the connector, with the arm primarily attaching to the THORAX.

What do we know about this region?

It is time we started to learn because without expanding the scope of routine clinical assessment to encompass a broader, more inclusive shoulder region, there will be no substantial advancements in the comprehension and treatment of numerous chronic and undiagnosed 'shoulder' conditions.

NOT the Shoulder

The true cause of many longstanding problems within this ‘shoulder’ region lies within the thorax. The symptoms are variable and diverse. Fatigue, shortness of breath, neck pain, chest pain, shoulder, arm or head pain and weakness...Sure, not the glenohumeral joint, but not the 'shoulder' either.

The spine plays a contributing role to the stability and movement within the thorax, but…when considering the biomechanics of this region, it is evident that the ribs do almost all the heavy lifting when we consider the power, stability and movement that needs to be transferred to and from the upper limb for normal and extraordinary tasks. How does this system work? How do we observe, measure or recognize normal vs. abnormal function in this region?

... If a painful or dysfunctional condition exists within the thorax...how is it recognized clinically?

Unless an obvious deformity presents itself, the musculoskeletal properites of this region are generally not evaluated.

There are no standardized tests. WHY?

Conceptually, we already understand that the thorax provides much of the power, stability and movement currently attributed to the 'shoulder.' What we haven't fully explored is how this happens, and until we start to investigate contributions from the thorax, we will never learn how to recognize or quantify them.

We know that the glenohumeral joint, its attachments and muscular support provide the most critical and easily observable elements to 'arm' function, but we also know that FULL strength and ROM of the arm cannot happen without contributions from the thorax.

Similarly, we know that the thorax serves as a fundamental structure for the internal organs and facilitates normal resting respiration. What is usually never considered is that a stable and flexible thorax is the keystone for a normal, active lifestyle.

Like a See-Saw, The power that drives the upper extremity is enhanced by the strength, stability and movement provided by the thorax/axial skeleton.

Reciprocally, strength, stability and movement generated within the thorax or axial skeleton is enhanced by the contributions provided by the upper limb.

To maintain this symbiotic relationship, there needs to be an equilibrium in the contribution and support provided. The thorax, serving as a significant mixing pool for the body, continuously adapts and modifies movement patterns through compensatory mechanisms to enhance human performance. Consequently, understanding the mechanics of the thorax proves to be the most intricate aspect of the body. While some argue that the 'shoulder' is the most intricate area, numerous 'shoulder' functions are covertly carried out by the thorax.

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The thorax…its size, shape, mobility and supporting contractile and non-contractile elements, provides a missing piece to this poorly understood ‘shoulder’ puzzle.

Get ready for new blogs on topics such as: The upper extremity human kinetic chain and the latest research on sexual dimorphism of the human thorax.

Next Blog will start us off with some necessary terminology clarification.

Here is a prevue:

Medical Terminology: Do we understand what we are saying?

Before moving toward a better understanding of the thorax, we should clarify and define some familiar terms.

Frequent or overuse of these familiar terms will sometimes result in multiple interpretations of the same word.  

While examples of non-specific or poorly defined medical terms are too numerous to list, my study regarding the thorax has led me to take a closer look at these:

Abduction/adduction

Protraction

Core

Kinetic chain

Stay Tuned...