The shoulder is the most mobile joint in the body, allowing us to have a very wide range of motion. However, this means it is not very stable and can be easily injured. We rely on our shoulder to do a number of activities, whether it be reaching for an object, lifting boxes, gardening, or throwing a ball.
Who is most susceptible to shoulder injuries?
- Young sportspeople, especially those involved in throwing sports such as softball, baseball or cricket
- Those who have had an accident such as a fall or skiing injury
- Older age groups due to age-related degenerative changes. It takes less to injure the structures in our shoulder as they become weaker and stiffer as we age.
Common ways to injure the shoulder
- Lifting something too heavy or at an awkward angle
- Lifting a heavy object away from the body or above shoulder height
- Repetitive motions that place great stress on the shoulder
- Reaching behind the backseat of your car to lift or place heavy items
Common signs of a shoulder injury
- Pain at night and difficulty sleeping on the affected side
- Feelings of stiffness in the shoulder
- Discomfort with overhead activities, or reaching behind your back
- Feeling as if the shoulder could pop out of its socket
- Problems with everyday activities due to lack of shoulder strength or flexibility
Some of the most common shoulder injuries are explained below.
Shoulder instability is common in young people and athletes. The shoulder becomes unstable when the muscles and ligaments that hold it together are stretched beyond their normal limits.
Certain motions used in tackling, throwing, pitching or bowling can put great force on the shoulder, which can stretch the ligaments. Pain can arise quickly or over time, and people often describe feeling that the shoulder is loose, or feels weak.
If the ligaments are too loose or completely tear, a shoulder subluxation or dislocation can occur. This is often caused by falling onto an outstretched hand, a violent twisting motion, or a contact with arms overhead.
Rotator Cuff Tear
The rotator cuff is a group of muscles surrounding the shoulder that act to support and stabilise the joint. An injury to the rotator cuff often occurs from repetitive overhead work (e.g. painters, carpenters), sport (e.g. tennis, baseball), or general wear and tear as we get older. It can also happen when trying to lift a heavy object with an extended arm, trying to catch a falling object, or it can occur after a fall.
As people age and are less active, tendons start to degenerate and lose strength, and hence can be torn more easily. Tendons have a poor blood supply which also makes it harder for them to fix and maintain themselves.
Rotator cuff tears can result in a dull, deep ache in the shoulder and painful reduced range of motion, making day to day tasks difficult such as combing your hair or putting your hand behind your back.
Frozen shoulder is a painful condition characterised by stiffness and limited range of motion. It may be triggered by trauma, postoperatively, or a previous shoulder injury, but can also arise without warning. The joint capsule tightens and becomes inflamed. Scar tissue then forms, causing adhesions which result in a stiff and painful shoulder. This condition can take up to 2-3 years to completely resolve. Physiotherapy treatment aims to speed up the recovery by massaging to loosen up the muscles around the shoulder, gentle mobilisation of the shoulder joint, range of motion stretches, and strength work once the pain subsides.
Imaging for shoulders
Generally scans of the shoulder are only helpful if you have had a history of trauma (eg falling directly onto the shoulder), a history of dislocation or cancer, or if symptoms are worsening despite treatment.
Abnormalities found on scans are found just as commonly on people with no shoulder pain. There is no correlation between the size of a tendon tear shown on MRI or ultrasound, and the duration or amount of pain. Most changes seen on scans are normal age-related changes.
- Anti-inflammatory medication to help reduce pain and swelling
- Apply a hot pack for 20minutes before bed to help relax the muscles
- Activity modification: avoid repetitive overhead activities, rest from sport etc
- Physiotherapy involves massage to alleviate the muscle tightness and joint mobilisations to restore the pain
- Ultrasound, heat and TENS for pain relief
- Comprehensive exercise program to address the underlying muscle tightness and weakness to help prevent recurrence
- Important advice on posture, desk setup, and sleeping positions
Examples of exercises
Lean forward with your uninjured arm supported. Relax the injured arm and allow it to hang. Slowly begin to swing your arm in circles by moving your body. Repeat, this time moving your body to allow your arm to swing in a line forwards and backwards. Complete 30 repetitions
Hook the resistance band around a door handle. Begin standing with arms outstretched holding each end of the band. Squeeze shoulder blades together and pull back until your elbows are inline with your trunk. Complete 3 sets of 10 repetitions
Begin standing with your elbows bent to 90 degrees by your side, holding a 1-2kg weight in each hand. Rotate your forearms away from the body, keeping your elbows by your side. Complete 3 sets of 10 repetitions
If you are suffering from shoulder pain and would like more information or help please call us on 9875 3760 or email us on firstname.lastname@example.org. We would be more than happy to assist you in your recovery.