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Shoulder Injuries
By Shihan Don Corrigal
Shoulder Injuries
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 can lead to pain and injury. Maintaining this balance through exercises aimed at stretching and strengthening can help avoid shoulder problems.
Rotator Cuff Injuries
Four muscles and their tendons surround the shoulder joint. These are collectively referred to as the rotator cuff. The rotator cuff is surrounded by an empty sac, or bursa, which helps the tendons slide. The rotator cuff is susceptible to many problems, which can cause weakness, tenderness, and pain. These problems include overuse tendonitis, which can be caused by certain activities.
If the space between the rotator cuff and the bone above it is narrowed, the rotator cuff tendons and the overlying bursa can be squeezed. This will lead to bursitis and tendonitis. This is called impingement. Occasionally a calcium deposit may form in the rotator cuff and cause acute inflammation of the tendon and bursa. We call this calcific tendonitis. 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 a physician should evaluate pain, which persists more than two weeks.
Common Shoulder Injuries Among Athletes
The shoulder is at risk for injury in many sports. The rotator cuff (see above) can be injured through overuse or through trauma. Rotator cuff tendonitis is common in overhead sports such as baseball, tennis, volleyball, and swimming. Rotator cuff tears can occur if the tendons are overloaded in weight lifting or football. There are ligaments, which hold the shoulder bone in its socket. The shoulder has a very large range of motion, and needs some flexibility of the ligaments to allow for that range. But if the ligaments become stretched or torn, this can lead to instability. A mild amount of instability will allow the shoulder to 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 sport 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. Injury to the AC joint is called an AC separation. AC separations occur in contact sports and are frequently seen in skiing and biking falls. Clavicle fractures are common injuries seen frequently in sports where speed or contact are involved.
Dealing with Shoulder Injuries
Injuries occur and when they do, they can interfere with training as well as competing.
Probably all athletes have had some shoulder pain at one time or another, which has kept them out of training. What causes shoulder pain, what can be done to prevent it, and how should it be treated?
Shoulder pain probably occurs because of the repetitive arm movements. Any attempt to treat or correct shoulder pain must also focus on proper posture and proper development of the back shoulder muscles.
Shoulder pain is almost always associated with some sort of training error. "Too much, too fast" is usually the cause.
Before discussing the treatment of shoulder pain, we have to know exactly what the cause is in each case. Certain diagnoses tend to be related to age. For example, in an athlete older than 40, pain that radiates up into the neck or down the arm may be related to the cervical spine. If pain is down the left arm, radiates up into the jaw, and occurs with exercise, then it could be related to the heart. Pain on the top of the shoulder is more likely related to the acromio-clavicular joint and pain along the side of the shoulder may be related to the rotator cuff.
The first response to shoulder pain is to rest until the pain goes away. This may not mean stopping training but rather altering it to the point where pain does not occur. The most important thing is that the pain goes away and the shoulder remains flexible.
People ask whether nonsteroidial anti-inflammatory agents are beneficial. This is a controversial question. There is some indication that nonsteroidial anti-inflammatory agents actually interfere with tendon healing. Proper nutrition — a good, balanced diet — is one of the best ways to repair injury.
Once pain is gone, the second phase rehabilitation process begins, which involves not only the shoulder muscles but also the shoulder blade stabilizers. These muscles are rehabilitated also.
All exercises should be done below the level of the shoulder with very lightweights and high repetitions. Strengthening of the deltoid muscles as well as the supra and infrasinatus muscles is very important to rehabilitating the shoulder.
The third phase is to return to training quickly, but within the limits of the pain. The warm-up and cool-down portions of any workout are essential. It has been said that 10 percent of a workout should be spent either warming up or cooling sown. Some trainers recommend that athletes more like 20 percent of their workout warming up and 20 percent cooling down.
If shoulder pain persists beyond two weeks despite a period of rest, if the pain is waking you at night, if you have noticed significant weakness in your arm, if you have any numbness or tingling in your fingers, if you have felt your shoulder come out of its socket, or the pain cannot be relieved by the judicious application of ice, it is time to see your sports medicine physician.
