The shoulder is a complex joint built to allow movement in many directions: forward, backward, around in a circle, and away from the body. Muscles and ligaments help keep the shoulder stable and secure in your shoulder socket. However we depend on our shoulders to support many of our most basic motions, including pushing, pulling, lifting, and throwing. Because the shoulder is a very flexible joint, it is highly vulnerable to injury, whether you are a competitive athlete or an active elder suffering from years of repetitive motion. The human shoulder is the most mobile joint in the body, the shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle).
CONDITIONS OF THE SHOULDER
Arthritis, which is loss of the normal cartilage, or smooth surfaces that line your shoulder joint, makes moving your shoulder and arm painful. In addition to pain, arthritis inflammation can cause swelling and joint damage. Types of shoulder arthritis include:
- Osteoarthritis: The natural aging process can wear away at the cartilage between the bones at your shoulder joints, causing inflammation and pain.
- Rheumatoid arthritis: This immune system dysfunction attacks and wears away the cartilage lining between the bones in your shoulder joint. The disease often affects multiple joints in your body.
- Post-traumatic arthritis: This form of arthritis results from an injury or fracture to the shoulder.
Shoulder arthritis symptoms generally include:
- Pain in the shoulder
- Redness or heat in the area
- Trouble raising your arm
- Clicking sound when you raise your arm
2. Frozen Shoulder
Frozen shoulder occurs when the capsule of connective tissue that surrounds the shoulder thickens and contracts, leading to stiffness and pain from restricted movement. The condition generally affects adults ages 40 to 60 and can be caused by diseases such as diabetes, hypothyroidism (less), hyperthyroidism(excess) and cardiac disease. It can also result from immobilizing the shoulder too long after an injury, which is why a vital part of any shoulder recovery is physical therapy.
3. Rotator Cuff Conditions
Three bones form the shoulder joint: the collarbone, the upper arm bone, and the shoulder blade. Together, these bones give the shoulder its wide range of motion. Attached to the shoulder is a group of muscles known collectively as the rotator cuff. These keep your arm in place while allowing it to move up and around. Rotator cuff disorders include:
- Tendonitis and bursitis
Tendonitis and bursitis, both inflammatory conditions, are the most common causes of shoulder pain and stiffness. They can result from repetitive motion, such as in sports, or from a serious, sudden injury. The conditions are most common in adults older than 40, as the tendons have aged and are more susceptible to injury.
- Tendonitis occurs when tendons in the rotator cuff become inflamed or irritated.
- Bursitis occurs when the fluid-filled sac that protects the space between tendons and bones becomes inflamed or irritated.
Treatment goals include reducing pain and inflammation. Rest, hot/cold compression and splinting are also recommended. If those treatments are not successful, a physician may provide corticosteroid injections, recommend physical therapy, and in the most severe cases, perform surgery.
Rotator Cuff Tear
Rotator cuff tears are a common cause of shoulder pain and disability in adults and can seriously inhibit many daily activities, like combing your hair or getting dressed. This type of injury typically results from a wearing down of the tendon, which occurs slowly over time, but it can also be caused by a sudden trauma. Some common symptoms of rotator cuff tears include:
- Pain in the shoulder and arm
- Weakness and tenderness in the shoulder
- Limited range of motion and pain, especially when raising and lowering your arm
- Snapping or cracking sensation when moving the shoulder
- Inability to rest or sleep on the affected shoulder due to pain
Because the shoulder joint is so mobile, it can be very easy to dislocate the bone from the socket. The top of the upper arm bone (humerus) can partially or completely come out of the socket (glenoid).
- Partial: The bone moved partially out of the shoulder joint socket and returned on its own.
- Total: The bone moved completely out of the shoulder joint socket and had to be returned to its proper position by external force.
Causes and Symptoms
Shoulder dislocations can occur from falls, car accidents, or strong contact during sports. Those with a dislocated shoulder can experience swelling, numbness, weakness, bruising, pain, instability, and even muscle spasms.
Fractures are broken bones and those that affect the shoulder typically involve the
- Clavicle (collar bone)
- Humerus (upper arm bone)
- Fractures of the collarbone and humerus often result from the force of a hard fall, collision, or motor vehicle accident.
- Scapula (shoulder blade)
- The shoulder blade is not as easily fractured because of the protection afforded by the chest and surrounding muscles. Therefore, shoulder blade fractures are commonly the result of more severe traumas and are associated with injuries to the chest.
Shoulder fractures may affect anyone but can be common in older adults when linked to osteoporosis (brittle bones). Children are more likely to fracture the collarbone, while adults fracture the upper part, humerus more frequently.
- Shoulder pain
- Swelling and bruising of the shoulder area
- Inability to move the shoulder without pain
- A bump or disfigurement at the site of the fracture
- Snapping or cracking sensation when moving the shoulder
Shoulder instability develops when your muscles and ligaments are not strong enough to hold the shoulder bones securely in the socket. This can lead to multiple painful shoulder dislocations or prevent you from using the shoulder or lifting your arm. Shoulder instability can develop as a result of:
- Previous shoulder dislocations: The more often you experience shoulder dislocations, the less stable your shoulder becomes.
- Loose ligaments: Ligaments are the tissues that bind bones together. Shoulder ligaments can either be naturally loose or become loose over time, especially if you repeatedly bring your arm up over your head, as in swimming or tennis.
It is often is confused with shoulder dislocation, but the two are very different injuries. Shoulder separation occurs when the connection between the shoulder blade and collarbone is disrupted. Typically, this injury occurs after a fall onto the shoulder (common in sports).
Symptoms depend on the severity of the separation, but always include severe pain, swelling, bruising and sometimes deformity
If the shoulder pain does not improve with simple home treatments, there are other alternatives
Most shoulder problems will benefit from physiotherapy.
Physiotherapists are specialists who can help reduce your shoulder pain and show you how to improve the way your shoulder works by using a variety of strengthening and stretching exercise, massage and other therapeutic techniques.
They will work to improve your symptoms and help get your shoulder moving properly again. What they suggest will depend on whether the problem is short-term or a long-standing condition. Almost everyone will benefit from physiotherapy, using methods such as:
- Exercises to strengthen weakened muscles, change their co-ordination and improve function
- Advice on improving shoulder, neck and spine posture
- Exercises to ease or prevent stiffness
- Exercise to increase the range of joint movement
- Applying adhesive tape to the skin to reduce the strain on the tissues, and to help increase your awareness of the position of the shoulder and shoulder blade
- Manual therapy to the soft tissues and joints – such as massage and manipulation.
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The 3 Rules of Shoulder Injury Prevention:
1. Proper posture
2. Good body mechanics
3. Well rounded exercise program
We are a product of our environment. A normal day for someone consists of the following: Wake up and head down to the breakfast table. We may sit for 20 minutes eating breakfast. Shower, get in the car, train or matatu and sit for a daily commute to work. Many people are sitting at a desk working on a computer for at least 5 hours daily. Then we get back in the car for the commute home. Dinner time arrives and again we sit down at the table for an hour. Following dinner maybe we sit and watch television or sit reading a book. Do you see a common theme here?
Most of us are sitting all day long. When positioned in a seated position, gravity works against us to pull our head and shoulders forward. This posture leads to a decrease in front muscles of the shoulder space and places us at risk for shoulder impingement. How can this be avoided?
Having a good ergonomic chair that places the hips slightly above the knees will orient the back in a good position. Arm rests are important for taking pressure of the shoulder girdle. The neck should be positioned in neutral by tucking the chin back in an attempt to lengthen the neck. The shoulders should be positioned down and back. Try to imagine bringing the shoulder bladestoward the opposite back pocket. A stretch should be felt across the chest and shoulders.
Lifting, throwing and exercising using proper positioning can make a big difference in preventing injury. When lifting something overhead, the shoulders must stay down. If the shoulder moves upward towards the ears, you are increasing risk for impingement by closing down the sub-acromial space. Repetitive movements using improper body mechanics leads to shoulder injury. If movements such as the golf swing or tennis serve leads to pain in the shoulder do not try to work through the pain avoid a serious injury by inquiring when the discomfort first begins. Waiting until you cannot bear the pain usually means the injury is serious and may require surgery.
Exercising the shoulder to prevent injury should be conducted atleast three times per week. There are many variations of exercises that can be used to strengthen the rotator cuff muscles and back musculature. Seated rows and lateral pull-downs are great ways to strengthen the muscles around the shoulder blades. Keeping the shoulders down and pinching the blades together is the proper mechanics during this movement with this exercise.
Finally, proper stretching to keep the shoulders and pectoral muscles (chest muscles) loose is vital to healthy shoulders. A door or corner stretch is great to open up the thoracic spine (mid-back). This is accomplished by placing both forearms along the frame of the door with the elbows at shoulder height and keeping the abdominals tight. Gently bring the chest forward into the door until a comfortable stretch is felt across the chest and shoulders. Do not bounce or arch low back. This stretch should be held for a minimum of 30 seconds.
In summary, proper posture and body mechanics is vital for preventing shoulder injuries.
A well balanced exercise program that promotes flexibility, back strengthening and precise body mechanics during exercise will allow persons to excel in their respective activities minimizing the risk for shoulder injury.
Biomechanics Mark Frankle, Scottmarkle
Chiropractic & Physiotherapy Health Centre