COMMON SHOULDER INJURIES
by Ala Shuman
The shoulder joint is made up of multiple bones, held together by various muscles and tendons. It is the most mobile joint in the body. We use it for throwing, lifting, pushing, pulling, eating, driving, and a myriad of other activities. Because of its increased mobility and variety of functions, it is also very easily injured. Some common injuries to the shoulder include: instability, rotator cuff tears, impingement, and frozen shoulder.
Shoulder instability happens most often in younger people and athletes. When the muscles and ligaments that hold the shoulder joint together are stretched beyond their normal limits, the shoulder becomes unstable. This can be caused by a dislocation of the shoulder joint, when the top of the upper arm bone is forced out of the socket. Dislocations can be complete-the ball comes all the way out of the socket, or partial-with the ball of the upper arm coming just partially out of the socket. A partial dislocation is also known as a subluxation.
If the joint becomes too loose, it can lead to recurrent dislocations, which causes pain and unsteadiness when you raise your arm overhead or move it away from your body. Repeated dislocations can lead to a tear in a cartilage structure called the labrum. The labrum acts as a “rim” around the socket to keep the shoulder from slipping out of joint, much like the rounded lip of a golf tee keeps the golf ball from falling off the tee.
Symptoms of labral tears and shoulder instability include:
- Pain in the shoulder joint
- An unstable feeling during movement
- Locking or catching sensations within the joint
- Limited overhead activities
- Loss of range of motion or strength
Instability is diagnosed by an Orthopedic Physician through a clinical exam, as well as further diagnostic testing including X-rays +/or an MRI. Treatment can include Physical Therapy, cortisone injections, anti-inflammatory medications, or possible surgical intervention.
Rotator Cuff Tears
The rotator cuff is a group of four muscles in the upper arm. These muscles are attached to the bones by tendons. The tendons allow the muscles of the rotator cuff to raise and rotate the arm. A tear occurs when any of these four tendons rips, either partially or completely. Tears are common with people who repeatedly perform overhead motions, but can also occur as people age and become less active. Aging causes tendons to start to degenerate and lose strength, leading to a tear. The shoulder has a poor blood supply, which means tears to the rotator cuff do not heal easily on their own.
Symptoms of rotator cuff tears include:
- Pain that radiates from the upper shoulder down to the elbow
- Difficulty moving the affected shoulder
- Pain that is worse with lying on the affected shoulder
- A dull, achy sensation in the shoulder and upper arm
- Pain or weakness with moving arm overhead
Treatment options can involve nonsurgical interventions such as Physical Therapy, improvement of posture and shoulder mechanics, cortisone injections, or surgical interventions which could involve a reattachment of the torn tendon or a clean up of the frayed tissue.
Shoulder impingement occurs when one or more of the tendons of the rotator cuff gets trapped and pinched between the top of the shoulder blade (acromion) and the upper arm bone. This happens when the arm is lifted overhead or away from the body. As the arm is lifted, the acromion rubs or “impinges” on the tendons of the rotator cuff, causing pain, inflammation, and limited mobility.
Shoulder impingement is common in people who perform repetitive overhead motions, especially swimmers, tennis players, and throwing athletes. Impingement is so common in swimmers that it has the nickname, “swimmer’s shoulder.” Impingement is also seen in people with poor postural positioning, including a forward head and rounded shoulders. Unfortunately, in this day and age, the excessive use of computers, tables, and cell phones all reinforce this poor posture and contribute heavily to occurrences of shoulder impingement. Prolonged shoulder impingement can eventually lead to a rotator cuff tear.
Symptoms of Shoulder Impingement include:
- Difficulty raising arm above shoulder height or behind back
- Pinching feeling when moving the shoulder
- Shoulder or upper arm pain that is worse with overhead motions or sleeping on involved arm
Treatment for shoulder impingement will focus on postural retraining, shoulder blade and rotator cuff strengthening, activity modification, and anti-inflammatory measures including ice, injection, or medications.
Frozen shoulder, also known as adhesive capsulitis, is the result of scarring, thickening, and adhering of the joint capsule that surrounds the shoulder that can lead to severe limitations in range of motion as well as significant pain. Frozen shoulder can develop as a result of any other injury to the shoulder (tendonitis, bursitis, rotator cuff injury), but more frequently it can develop without any prior injury. These insidious cases tend to occur in women aged 40-60, or with individuals who have diabetes, hypo- or hyperthyroidism, cardiovascular disease, or Parkinson’s disease.
Symptoms of Frozen Shoulder include:
- A slow and gradual loss of shoulder mobility occurring over the course of several months, known as the “freezing” stage
- A “frozen” period when range of motion is severely limited and daily activities are difficulty
- A “thawing” period when strength and range of motion gradually return to normal
- Severe pain can occur during the freezing and frozen stages due to overall inflammation of the shoulder
Treatment can consist of aggressive physical therapy, corticosteroid injection, or a manipulation under anesthesia, in which the scar tissue and adhesions are forcefully broken apart by a physician.
If you are experiencing any of the above symptoms, the physicians and staff at OrthoNeuro can get you back to throwing, swimming, lifting, and pain-free living! Call 614-890-6555 to schedule an appointment today.