Peter Attia· MD
yes this person has a labral instability versus they don't this may actually just be bicep tendon injury versus not what else is on your differential diagnosis in the exam you don't have the MRI yet the guys just says he's got shoulder pain it's great I'm gonna draw another picture okay so I've drawn the shoulder again I've added on I've added on a couple of things I've added on the clavicle the collarbone and I've and and I've added on this other structure up here which is the Bony structure if you tap on the top of your shoulder that's the Bony roof of the shoulder that's the acromion and yet another part of that super weird scapula okay so the The Joint that when you hear about someone separating their shoulder it's this joint right here which is the acromioclavicular joint and that is just a it it only rotates about 20 degrees it's just a the way I liken this especially being in Texas you can talk about it because there's a lot of car lovers and you know about it as a major car lover driver is it effectively is a McPherson strut on uh on a car so it's a stabilizer bar if you don't have those and there are people that are born without um without that collarbones or without collarbones they can bring their shoulders completely together right here in the center just like this it's kind of super cool but it holds those out so that's why you know it's the one most commonly injured in cyclists who who wipe out because they fracture here because they land on the outside of their shoulder but the AC joint the acromioclavicular joint is what happens when people separate their shoulders which is awesome from a dislocation different from dislocation that's usually from a force coming down from the top so we're pitched forward we land on the point of our shoulder and it jams it down and we can talk about that later it's super interesting but this acromion again is the Bony roof and under that roof is where the rotator cuff Glides and let me draw this foreign arrows back and forth the arrows here so as the head rotates back and forth around the rotator cuff is attached here and it goes back and forth here so it's rubbing or moving underneath this any place in our body that there's two structures and a uh anatomically in the limbs that move differentially like with one another there's usually a bursa that forms in between and so that Bursa is here I'll draw it in green that Bursa lives right in there and so it's just the thin filmy structure that can thicken up and become very inflamed and become bursitis and that's very painful so that's a common cause otherwise the