Your Shoulders Work Hard for You Ruthan Brodsky
It’s no surprise that I’m writing about shoulder injuries since my husband, Bernie, had rotator cuff surgery earlier this summer. What did surprise me was the number of people I’ve talked to who also have shoulder issues.
Bernie has been an outstanding patient. It started with his surgery; he took no general anesthesia and watched the entire procedure on a monitor. He also had long conversations with the surgeon as the doc cut and sewed. (Wouldn’t you know it; the surgeon was an instrument rated pilot also so they talked a lot about flying during the surgery.) The good news was Bernie didn’t need a day or two (or more) to get over the anesthesia. He did have a pain block that last about 18 hours and I know he wished that could have lasted a lot longer.
These past few months, Bernie’s been in physical therapy, now has complete range of motion, and should be taking a full swing with a golf club (albeit not at warped speed) in the next month.
Whether it’s golf, tennis, taking a shower or cooking a dinner, I had no idea how much we rely on our shoulders in whatever we do. The shoulder is our most mobile joint. It’s a complex arrangement of bones and a network of ligaments, tendons and muscles working together to produce shoulder movement. They all interact to keep the joint in place even while it moves through its extreme ranges of motion. This mobility, however, is often at the expense of stability. As a result, the shoulder is the site of many common problems: sprains, strains, dislocations, separations, tendonitis, bursitis, torn rotator cuffs, frozen shoulder, fractures, and arthritis. And it doesn’t get better as you get older.
The shoulder joint is composed of three bones : the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). The end of the humerus is round and it fits into a socket in the scapula. The scapula extends around the shoulder joint to form the roof of the shoulder, and this joins with the clavicle. Surrounding the shoulder is a bag of muscles and ligaments. Ligaments connect the bones of the shoulders, and tendons connect the bones to surrounding muscle. Four muscles begin at the scapula and go around the shoulder, where their tendons fuse to form the rotator cuff.
Normally, the shoulder has a wide range of motion. When the shoulder moves, the end of the humerus moves in the socket. Very little of the surface of the bones touch each other. Ligaments and muscles keep the humerus from slipping out of the socket and keep the clavicle attached to the scapula.
Some kinds of work and sports activities put great demands upon the shoulder and injury can occur when movement limits are exceeded or the individual structures are overloaded.
Instability
Shoulder instability occurs when the shoulder feels like it may slip out of place. This occurs most with young people and athletes. The shoulder becomes unstable when muscles and ligaments that hold it together are stretched beyond their normal limits. At the other end of the spectrum, shoulders generally stiffen or tighten with age particularly when less movement characterizes the lifestyle.
A shoulder separation, a sprain, occurs when the ligaments that hold the clavicle to the roof of the shoulder start tearing. If this happens, the clavicle is pushed out of place and forms a bump at the top of the shoulder. Sprains are common in falls when the hand or arm is outstretched to stop the fall or when the fall is on a hard surface. Treatment varies depending on how bad the sprain, but it usually includes ice, wearing an arm sling and limiting movement to allow the ligaments to heal all of which is followed by physical therapy exercise.
If the ligaments tear that hold the shoulder muscles to bones and can’t hold the joint together, the shoulder is dislocated. Treatment calls for ice and traction to pull the shoulder back in place .
“Injuries to shoulders are common in sports which involve the use of shoulders such as repetitive throwing and overhead movements in tennis and the crawl stroke in swimming,” explains Tam member Mark Rottenberg, MD, Medical Director of the Pain Management & Rehab Associates in Farmington Hills
Rotator cuff tear
The rotator cuff refers to a group of 4 muscles of the upper arm that raise and rotate the arm. The muscles are attached to the bones by tendons and the tendons allow the muscles to move the arm. As teenagers, the rotator cuff complex is extremely strong and can be envisioned as a thick leather strap. As we age, the cuff becomes much thinner and it’s difficult for the tendons to repair themselves and easier for them to tear because the blood supply to the area is reduce.
Shoulder problems are common among sports professionals. For example, shoulder pain is less common in golf than in overhead sports, but overuse injuries – no matter what the activity - frequently take place. What’s more better players are less likely to have trouble with the shoulders because they use their bodies more correctly. Even so, more pros on the Champions Tour, the Tour for guys 50 and over, have shoulder injuries than on the regular PGA tour.
Tennis-related injuries, on the other hand, are common at all levels of the game – junior, recreational or pro tour. The shoulders are used in just about every shot but what’s common is an overuse injury by repeated overheads and serves. These could be associated with poor technique, relying too much on arm power rather than body rotation. Also, tennis players need to stretch after they play and that doesn’t always take place.”
Treatment depends on the severity of the injury and not all rotator cuff tears require surgery. If the tear isn’t complete, often times the recommendation may be RICE: rest, ice, compression, and elevation.
Frozen Shoulder
Extreme stiffness often occurs when a minor shoulder injury heals with scar tissue and affects how the joint moves. The scar tissue reduces flexibility in the shoulder and makes it more prone to injury. The major symptom is the inability to mover the shoulder in any direction without pain.
“Most frozen shoulder treatment involves controlling shoulder pain and preserving as much range of motion in the shoulder as possible, “says Mark. “Your doctor may recommend you see a physical therapist and work on motion exercises at home. Other recommendations may include taking NSAIDs (non-steroidal anti-inflammatory medications), applying ice to reduce swelling, having cortisone injections, physical therapy and in some cases, surgery. Doing stretching exercises before and after activities helps to reduce further injury and stiffness.”
Overuse and Strains
Sudden increases in activity can place extensive stress on the shoulders and lead to reduced flexibility. This is a common problem for week-end warriors who play 4 hours of tennis or 36 holes of golf and haven’t exercised all year. It’s also a common problem in middle age. Although painful, these overuse problems can usually be treated with rest, NSAIDs and stretching exercises.
Arthritis
Beginning as early as age 50, the smooth surfaces of the cartilage that line the bones of the shoulder joint start wearing away and the joint begins to wear out and become larger. This degeneration leads to osteoarthritis and movement becomes painful. The most common cause of osteoarthritis is overuse. Again, treatment for shoulder arthritis depends on the severity of pain. The usual treatments are rest, NSAIDs and cortisone injections. In some instances , a replacement of the shoulder joint is necessary.
Preventing Injuries
While many of us lift weights to strengthen the pectoral, deltoid and bicep muscles, few recreational athletes strengthen the rotator cuff and a weak rotator cuff is asking for problems. I for one am going to include strengthening the shoulder muscles in my workout and stretching before and after golf or tennis.”
Mark also recommends that when you’re working out with weights and strength training that you give your body time to recover. He extends this advice to consecutive days of playing golf or tennis.
“Most importantly, when something you do in your exercise program causes you pain, STOP what you’re doing,” warns Mark. “Your body is telling you something isn’t right. Listen!”
The information on this site should not be used as a substitute for the care and advice of your physician or other health care provider.
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