Shoulder Pain and You

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The Sports Injury Clinic

Lachlan Heron

August 9, 2012

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The shoulder has the greatest range of motion of any joint in the body. It is our shoulders that allow us to put our hands where they need to be for work, play, and all of our daily activities. To manage this, the shoulder has to have the right balance of strength, flexibility, and stability. Loss of this balance effects shoulder posture and can lead to pain and injury. Maintaining this balance through exercises aimed at stretching and strengthening can help avoid shoulder problems.

Rotator Cuff Injuries

The shoulder joint is surrounded by four rotator cuff muscles and their tendons. A bursa sits adjacent to the rotator cuff which helps the tendons slide, protecting it from the above bone, the acromion. The rotator cuff is susceptible to many problems which can cause weakness, tenderness and pain. These problems include tendon pain and tendinopathy, which can be caused by certain activities that involve shoulder elevation and rotation- causing a potential reduction in the space for the rotator cuff to move, with the potential to lead to tears.

Overhead sports such as throwing, swimming, or tennis can lead to tendinopathy. If the space between the rotator cuff and the bone above it is narrowed, the rotator cuff tendons and the overlying bursa can be compromised. This will lead to bursitis and tendon damage. This can also lead to impingement of the tissue in the subacromial space.

Occasionally a calcium deposit may form in the rotator cuff. We call this calcific tendinopathy. The rotator cuff tendons are also susceptible to the process of aging. As we get older, the rotator cuff tendons degenerate and weaken. A rotator cuff tear can occur due to this degeneration alone, or when the weakened tendons are stressed during activities or accidents. Most rotator cuff problems can be treated with rest, medication and gentle exercises, but pain which persists more than two weeks should be evaluated by a physiotherapist.

Common Shoulder Injuries Among Active People

The shoulder is at risk for injury in many activities. The rotator cuff can be injured through overuse or through trauma. Rotator cuff tendinopathy is common in overhead sports as well as any repeated manual tasks of reaching or lifting. Rotator cuff tears can occur if the tendons are overloaded with both repetitive or one off strenuous activities.

The shoulder has ligaments which hold the joint stable. The shoulder has a very large range of motion which is due to its shape and surrounding tissue flexibility-but also requires stability for strength.. If the ligaments become stretched or torn, this can lead to instability. Instability will allow the shoulder to either move or translate within the socket, or slip part way out of socket, called a subluxation. When the shoulder comes completely out of its socket this is called a dislocation. Subluxation or dislocation can occur with nearly all sporting activities. The ligaments of the shoulder are attached to the socket at the labrum. Tearing of the labrum sometimes occurs with instability. Another part of the shoulder commonly injured is the acromioclavicular or AC joint. The clavicle or collarbone meets the shoulder at the acromion where a small joint is found. This joint can be injured to varying degrees in a fall onto the outside part of the shoulder. AC injuries are graded depending on the degree or position of separation. They frequently occur in contact sports and are frequently seen in skiing and cycling falls.

MANAGEMENT OPTIONS

  • An ultrasound and X-ray may be performed to determine the presence of any bony or soft tissue injury. A surgeon my also request an MRI if needed.
  • You may commence physiotherapy to address any muscle weakness or instability issues around your shoulder and this is best to commence early .
  • You may require a course of soft tissue work around the shoulder to address any contributing soft tissue tightness especially your postural muscles. This can also help reduce pain.
  • Injection therapy can be an option and your Doctor or Physiotherapist may suggest this.
  • Awareness of modifying your activities to avoid aggravating your shoulder. You will be instructed which activities to avoid.
  • Care to ensure that your shoulder does not progressively stiffen up. This can lead to a troublesome shoulder called adhesive capsulitis-commonly called a frozen shoulder.
  • Often a surgical opinion will be considered depending on the longevity of your symptoms. Surgical approaches will be assessed if conservative measures are not adequate. Surgery if considered, will involve further exercise and rehabilitation.

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