Shoulder Injuries & Treatment

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Shoulder Injuries & Treatment
(American Academy of Orthopaedic Surgeons)

The shoulder is one of the most highly used muscle groups and joints in the body. It is used for lifting, pushing and even employed while doing housework or mowing the lawn. Consequently, the shoulder is often prone to injuries, including strains, tendinitis and rotator cuff tears. Athletes and weightlifters are particularly vulnerable to shoulder injuries. Fortunately, most shoulder injuries can be treated without surgery.

The Anatomy of the Shoulder

The shoulder is a ball-and-socket joint where the humerus connects to the scapula. The clavicle rests atop the scapula or shoulder blade. A convolution of muscles cover the joint, including the three heads of the deltoid. And the uppermost parts of the bicep and tricep muscles lie underneath this mass. All of these muscles are conjoined to the head of the humerus bone by ligaments. This group of muscles and tendons is also known as the rotator cuff. The shoulder joint is cushioned by the articular cartilage, which covers the top of the humerus bone. The scapula extends up and around the shoulder joint in back and forms a roof called the acromium. It also has a front end that is known as coracoid process. The far end of the scapula is called the glenoid. And it is this edge of the bone that connects to the humerus to form what is known as the glenohumeral cavity. The fusion of these two bones gives the shoulder its ball-and-socket formation. All of these muscles and the joint provide the necessary stability for the shoulder to handle its demanding workload.

Shoulder Injuries & Treatment
Elaine Eatkins Physioltherapy

Types of Shoulder Injuries and Symptoms

Shoulder injuries can vary from strains or tendinitis to tears and dislocations. They can also be due to the ageing process. Basically, like other joints, shoulder injuries can occur in the muscle, ligament or joint area. They can stem from falls, overuse and stress from athletics as well as from traumatic incidences like car accidents. Whatever the case, any shoulder pain that persists for more than a couple of days probably needs treatment. Bruises and strains are the most common shoulder injuries. Contusions are not that serious. A strain usually occurs in the deltoid or bicep area. It can be a result of overuse or even lifting a heavy object. Strains typically heal themselves and only last a few days. More severe strains may take longer to heal. Shoulder tendinitis or bursitis occurs when there is an inflammation of the tendons and the bursa that surround the tendons. The clinical term is "impingement syndrome." This is usually a result of friction between the top of the humerus and the acromium. Between these tendons lies the rotator cuff tendons and bursa, which protects the tendons. People who suffer from tendinitis can have pain while sleeping at night or when they lift their arm overhead. Though tendinitis and bursitis are different ailments, most flare-ups are caused by a combination of both. Tendinitis is more common with people over 40 and caused by wear and tear over time as well as overuse. Weightlifters and professional athletes often development tendinitis after years of activity. Tendinitis and bursitis can last for weeks without treatment, but neither requires surgery. Shoulder joint injuries are more serious than muscular ones. They may require surgery. One such injury is a torn labrum. The labrum is a cuff of cartilage that provides support for the humerus bone to move around. Symptoms of a labral tear can include aching or pain with certain activities, or the shoulder can feel as if it is catching with movement. There are several types of labral tears. SLAP tears are common with baseball players and occur at the top of the shoulder where the bicep tendon is attached. Bankart lesions occur when the shoulder is dislocated or comes out of the joint. Posterior labral tears are when the rotator cuff and labrum are pinched together at the rear of the shoulder. Most labral tears can heal on their own as the cartilage regenerates itself.
Rotator cuff tears are another type of shoulder injury. Most people who sustain this injury complain of pain at the top of the shoulder or along the outside of the arm down to the elbow. These tears can often make it difficult for a person to lift their arm over their head or reach for things. Shoulders can also be separated or dislocated. A shoulder separation occurs where the scapula and clavicle are joined together. It is known as the acromioclavicular joint, which is at the top of the shoulder. A shoulder dislocation is an injury that occurs at the joint between the scapula and humerus. The humerus can either be pushed forward (anterior dislocation) or backwards (posterior dislocation). Only about 5 per cent of dislocations are of the latter variety. Shoulder dislocations are most always caused by falls or by extreme impact. Shoulder separations can cause extreme pain because it is often accompanied with nerve and muscle damage. Sometimes fractures occur in the surrounding bones as well. X-rays can detect both injuries.

Treatment for Shoulder Injuries

Shoulder strains usually heal on their own as does rotator cuff tendinitis and bursitis. But pain can persist for days and even weeks. Strains are a sign that muscles in the shoulder have been overworked or stretched. Tendinitis occurs closer to the bone. Both injuries require rest. The best treatment for tendinitis is rest and ice. Depending on the severity of the inflammation, ice can be applied every two hours for 20 minutes, especially the first couple days. There are a number of good ice packs available on the market. Doctors typically recommend that the shoulder be elevated during ice treatment.
Drugs such as ibuprofen can help reduce the inflammation caused by tendinitis. Corticosteroids can also be prescribed for those under the care of a physician. Most labral tears do not require surgery if pain or symptoms eventually subside. Ice and anti-inflammatory medications can help with assuaging the pain. The severity of the injury can be detected through CAT scans or an MRI. If surgery is required it can be performed arthroscopically. Using small incisions, the labrum can be reattached to the socket. It normally takes about four to six weeks for the labrum to be fully reconnected.
Rotator cuff tears usually do not require surgery. Anti-inflammatory medicines and steroid injections are often used to alleviate pain. A physical therapist can help patients with exercises that can strengthen the area. Depending on the severity of the tear, either arthroscopic surgery can be recommended or open incisions. Open incisions allow for a more secure repair. However, damaged tissues and bone spurs can be cleaned out with arthroscopic surgery. A shoulder separation often requires a sling. The AC joint needs time to heal. Advil or ibuprofen can mitigate the pain. There are several types of shoulder separations (Types I, II and II). Type III shoulder separations are the ones that can require surgery. In most of these cases, the ligament simply needs to be reconstructed. Screws can be used to hold the bones in place while the injury heals. If muscles such as the deltoid or trapezius need to be reattached, surgery is definitely needed. These types of shoulder separations will take longer to heal and physiotherapy may be prescribed. Shoulder dislocations often involve both bone displacement and ligament tears. The bone needs to be manipulated back in place. Slings are used for shoulder dislocations to keep pressure off the joint. An orthopaedic doctor can determine whether surgery is required. Some dislocations like Bankart lesions can heal on their own but perhaps not in the proper position. This can leave the affected area prone to future dislocations.

Rehabilitation of the Shoulder

As the shoulder injury heals and the inflammation subsides, stretching and some light resistance training can help increase the shoulder's range of motion. Rehabilitation will vary depending on the severity of the injury. Any motion or exercise that causes pain should be avoided. Exercises and stretching are more focused on the muscles that support the shoulder joint. Either can help increase blood flow to the injured area, which expedites healing. Massage is often recommended for rotator cuff injuries in addition to stretching and light weightlifting.
Rehabilitation of the shoulder can vary among athletes as well. Baseball players are often instructed to lightly throw a tennis ball against a wall to help regain mobility. Weightlifters can start with stretching and some light weightlifting. The goal for athletes and bodybuilders is to gradually build strength and flexibility back into the shoulder. They will soon work their way back to full motion and activity.

How to Prevent Shoulder Injuries

Although a should injury can occur despite taking preventive measures, there are ways to lessen the chance of sustaining a shoulder injury. The most important thing is to warm up properly before engaging in any physical activity. Also, the stronger and more flexible the shoulder joint, the more likely it can withstand impact, falls or heavy lifting. Hence, stretching should always be part of your warm-up routine.
Stretching can vary from raising elbows straight up to pulling elbows toward the chest with the opposite hand. Poles can often be used in stretching as can large rubber bands and towels. Either way, stretching can increase flexibility of the shoulder, reduce incidences of injury and better prepare the shoulder for rigorous activity.
Weightlifting is one of the best ways to help prevent shoulder injuries, provided it is done correctly. Shoulders can be strengthened through exercise that directly or indirectly works the deltoid area. Exercises like shoulder presses, lateral raises and the bench press work the deltoids more directly. Motions should be done slowly and smoothly and not jerkily. By strengthening the shoulder area, it will have a greater capacity to handle more lifting and activities and simultaneously be less prone to sudden injury. Technique is another consideration. Baseball players should throw or swing a bat in a motion that is comfortable to them. Weightlifters need to learn proper form for each exercise to help avoid injury. Anyone involved in bodybuilding should also strive for a balanced physique. For example, always work the front, side and rear deltoids equally so that one area does not strengthen at the expense of the other. The shoulder is a complex group of joints and muscles. They are used in practically every physical endeavour. Proper stretching and exercise can help prevent shoulder injuries. If an injury does occur, it needs to be properly diagnosed and treated accordingly. If in doubt, call your doctor and set up an examination to determine what type of shoulder injury you have. Then get your treatment going right away.

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