한국 사람들이 어깨가 아프다고 하면 크게 두 가지 상황이다. 하나는 어깨 관절의 통증, 즉 위팔뼈(humerus)와 어깨뼈(scapula)가 만나는 부위의 관절 통증을 이야기한다. 두번째, 더 흔히 이야기하는 어깨 통증이 바로 한강의 시에서 표현된 "목덜미와 어깨 사이가 쪼개질 듯 저려올 때면"의 통증이다. 기술적으로 이야기하자면 이 부위는 어깨라기보다는 목, 혹은 위쪽 등(upper back) 통증이라고 해야 옳다. 일본인 학생이 전하는 바로는 일본 사람들 역시 이 부위 통증을 가타 코리(Kata kori/肩こり)한다., 카타가 어깨이니 우리나라 사람들과 똑같은 표현을 하는 셈이다. 그래서, 영어로 shoulder pain이라고 하면 미국인들이 잘 못알아들었다는 이야기를 해주었다. 아마도 한국과 일본에서 모두, 등 뒤의 날개뼈(scapula)를 어깨뼈라고 흔히 부르니, 그냥 날개뼈 부위 주위의 모든 통증을 어깨 통증이라고 하는 듯하다.
좀 진지하게 과학적으로 이야기하면, 어깨 관절 통증과 목과 위쪽 등의 근육 통증으로 구분해서 부르면 좋을 듯하다. 흔히 말하는 어깨 근육이 뭉치고 아픈 것은 목과 어깨 사이의 승모근(trapezius muscle), 견갑거근(levator scapulae muscle), 그리고 견갑골(날개뼈) 근육인 극상근(supraspinatus muscle)과 극하근(infraspinatus muscle), 그리고 날개뼈 사이의 근육인 능형근(rhomboid muscle)의 통증을 의미한다. 어깨 관절 통증의 큰 이유 중 하나가 극상근의 건염이니, 극상근은 관절통과 근육통에 모두 해당하는 근육이다.
미국에서 진료하면서 간혹 헷갈렸던 것 또한 어깨라는 표현이었다. 미국 환자들이 목과 등 부위 통증을 호소할 때, "어깨가 자주 아프세요?"라고 내가 묻곤 한다. 그럼, "아니요, 등근육(upper back)이요", 혹은 "목(neck)이요"라고 답이 돌아오고는 했다. 그런데, 또 진료를 하다 보면 미국인들도 그 부위를 어깨 통증이라고 간혹 이야기하기도 하니, 딱히 정해진 것은 아닌 듯하다. 아래는 미국인들이 바로 그 어깨와 목뒷덜미쪽 통증을 표현하는 예시들이다. 목과 등이이 stiff하다던가, tendor, tight, 혹은 knot이 있다던가 하는 표현을 많이 사용한다.
"I have a stiff neck and shoulders."
"My upper back is really tight today."
"I've got a knot right between my neck and shoulder."
"My trapezius muscles are killing me."
"I have so much tension in my upper back and neck."
"There's this tender spot where my neck meets my shoulder."
"My shoulders and neck feel really tense."
"I think I'm carrying all my stress in my upper back."
"I have this constant tightness between my shoulder blades."
"My neck and shoulders are so sore from sitting at the computer."
"I need to get these knots worked out of my upper back."
"The muscles in my neck and shoulders are rock-hard."
"My neck feels really stiff and tight. It’s hard to tilt my head without pain shooting down into my shoulder."
"There’s this constant burning sensation running from the side of my neck to my shoulder blade."
Among Korean female writer Han Kang's poems, who recently won the Nobel Prize in Literature, there is one titled "Shoulder Bone." The poem includes these verses:
Someone once asked me
Which part of the human body
Is the most spiritual
Then I answered
It is the shoulder
...
When my nape and shoulder
Would ache as if splitting apart
While pressing and kneading
That spot with my hands
I would often think
If only these hands
Could be sunlight
Could be the gentle sound
Of May winds rustling
When Koreans complain of shoulder pain, there are typically two distinct situations. One refers to shoulder joint pain, specifically the pain at the junction where the humerus meets the scapula. Secondly, the more commonly described shoulder pain is the kind expressed in Han Kang's poem as "when my nape and shoulder would ache as if splitting apart." Technically speaking, this area should be more accurately described as neck or upper back pain rather than shoulder pain. According to a Japanese student, Japanese people also refer to this type of pain as "Kata kori/肩こり," where "kata" means shoulder, using the same expression as Koreans. I wonder if this Kata kori in Japanese culture is also associated with psychological issues. It seems that in both Korea and Japan, since the scapula in the back is commonly called the shoulder blade, people tend to refer to any pain around the scapular region as shoulder pain.
Speaking more scientifically, it would be better to distinguish between shoulder joint pain and muscle pain in the neck and upper back region. What people commonly describe as tight and painful shoulder muscles actually refers to pain in the trapezius muscle between the neck and shoulder, the levator scapulae muscle, the scapular muscles including the supraspinatus and infraspinatus muscles, and the rhomboid muscle between the shoulder blades. Since supraspinatus tendinitis is one of the major causes of shoulder joint pain, the supraspinatus muscle is involved in both joint and muscle pain.
When Koreans complain of shoulder pain, there are typically two distinct situations. One refers to shoulder joint pain, specifically the pain at the junction where the humerus meets the scapula. Secondly, the more commonly described shoulder pain is the kind expressed in Han Kang's poem as "when my nape and shoulder would ache as if splitting apart." Technically speaking, this area should be more accurately described as neck or upper back pain rather than shoulder pain. Japanese people also refer to this type of pain as "Kata kori/肩こり," where "kata" means shoulder, using the same expression as Koreans. Also, Kata kori (肩こり) is often linked to mental health issues, including stress and depression. It seems that in both Korea and Japan, since the scapula in the back is commonly called the shoulder blade, people tend to refer to any pain around the scapular region as shoulder pain.
To be more scientifically precise (though I might as well wish for the moon), I wish my patients would be more specific in differentiating between shoulder joint pain and muscle pain in the neck and upper back region. When patients actually point to their shoulder joint pain accurately, it's typically caused by rotator cuff tear, frozen shoulder, calcific tendonitis, or impingement syndrome. What people commonly describe as tight and painful shoulder muscles actually refers to pain in the trapezius muscle between the neck and shoulder, the levator scapulae muscle, the scapular muscles including the supraspinatus and infraspinatus muscles, and the rhomboid muscle between the shoulder blades. Since supraspinatus tendinitis is one of the major causes of shoulder joint pain, the supraspinatus muscle is involved in both joint and muscle pain.
During my practice in the United States, I often encountered confusion regarding the term 'shoulder.' When American patients complained of neck and upper back pain, I would ask, 'Do you have shoulder pain?' They would frequently respond, 'No, it's my upper back' or 'It's my neck.' However, I've observed that some Americans do describe this same area as shoulder pain, leaving me uncertain about the precise terminology they prefer.
In my experience, Americans typically describe discomfort in the shoulder-neck region using terms like 'stiff neck and shoulders,' 'tender muscles,' 'tightness,' or mention having 'knots' in these areas."
"I have a stiff neck and shoulders."
"My upper back is really tight today."
"I've got a knot right between my neck and shoulder."
"My trapezius muscles are killing me."
"I have so much tension in my upper back and neck."
"There's this tender spot where my neck meets my shoulder."
"My shoulders and neck feel really tense."
"I think I'm carrying all my stress in my upper back."
"I have this constant tightness between my shoulder blades."
"My neck and shoulders are so sore from sitting at the computer."
"I need to get these knots worked out of my upper back."
"The muscles in my neck and shoulders are rock-hard."
"My neck feels really stiff and tight. It’s hard to tilt my head without pain shooting down into my shoulder."
"There’s this constant burning sensation running from the side of my neck to my shoulder blade."
