SPORTS MEDICINE
Dr. Anthony Allotta
To Beat Shoulder Pain, Prevention is Key
THE SHOULDER is one the most amazing joints in the human body. Unlike other joints, the shoulder has a seemingly limitless range of motion. Because of this amazing range of motion, the shoulder is also very susceptible to injury.
Types of Injuries
Acute injuries have a definite cause, and it is usually evident exactly when they occur. Because the shoulder moves almost without restriction, it has a greater propensity to dislocate, and makes up half of all joint dislocations. AC separation, which is known commonly as simply “shoulder separation,” is also due to acute traumatic shoulder injury. These two injuries are commonly confused, but they are very different conditions.
The shoulder joint is located at the junction of three different bones: the clavicle, the scapula, and the humerus. In a shoulder separation, the junction of the clavicle and scapula is disrupted. In a shoulder dislocation, the humerus (arm bone) is displaced from the socket. Not only are the injuries different in anatomic terms, but the implications for treatment, recovery, and complications are also different.
Fractures of this area may involve the clavicle, scapula, or humerus. Because of the complex anatomy and functional mobility of the shoulder it is difficult to mobilize the shoulder in a cast, and fractures sometimes require surgical intervention.
Soft tissue injuries
Traumatic soft tissue injuries of the shoulder include cartilage and tendon injury. A labral tear involves a cuff of cartilage called the labrum, which circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for its very wide range of movements.
Fortunately, Most labral tears do not require surgery; however, in patients who have persistent symptoms despite more conservative treatments, surgery may be necessary.
Tears or rupture of tendons associated with the muscles of the rotator cuff or bicep are common findings in traumatic shoulder injuries, and are treated based on the severity of disruption and the functional goals of he patient.
SHOULDER PROBLEMS, including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body, but it’s an unstable joint because of the range of motion allowed. It’s easily subject to injury because the ball of the upper arm is larger than the shoulder socket that holds it.
Chronic injuries
No matter what your activity of choice, with proper training, you do not need to suffer through most overuse injuries.
Arthritis of the glenohumeral joint generally causes pain with activity, loss of passive motion and stiffness. Some patients may complain of nighttime pain. Multiple joint involvement is suggestive of rheumatoid arthritis.
Rotator cuff tendonitis is commonly seen when there is a muscular imbalance in the shoulder and one of the four rotator cuff muscles is unevenly stressed, subsequently leading to inflammation.
Of the injuries in this class, impingement syndrome is the most common. This occurs when the uppermost muscle of the rotator cuff is impinged on the bone that sits above it, the acromion. Pain results when the arm is lifted away from the body. If these problems persist, it can lead to a condition in which the capsule that sits around the shoulder joint becomes inflamed and freezes up. This condition is commonly known as frozen shoulder or adhesive capsulitis.
Prevention
To prevent overuse injuries there are two main factors to consider: Flexibility and core stability.
- Flexibility allows freedom of movement. This needs to be present in all parts of the body. In the shoulder, balance of the forces of the rotator cuff is essential. It is more critical that these muscles are equally flexible than how flexible they are. Too much flexibility can be dangerous and lead to injury. Stretching before physical activity is important to ensure increased blood flow, temperature, and elasticity of the soft tissues. Stretching should be done in short durations. Stretching for 20 seconds or more per muscle group is done to increase flexibility only and should not be done immediately prior to vigorous exercise.
- Core stability is also very important. To avoid injury one must focus on postural skeletal structure and musculature including the lumbar spine (low back), the cervical spine (neck), the scapulothoracic joint (upper back), trapezius and serratus anterior muscles.
These skeletal structures and muscles hold the scapula in neutral position. If these areas are unstable the excess strain and workload get passed on to the shoulder. Deficiencies in muscle strength and core postural stability are frequently found in conjunction with chronic shoulder pain and injuries. To beat shoulder pain, prevention is the key.
Dr. Allotta is board certified in Family Medicine and fellowship trained in Sports Medicine. He is a graduate of Touro University College of Osteopathic Medicine in Vallejo, California. He practices in Port St. John, Florida as a member of Premier Orthopedics and can be reached at 321-433-1439.
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