You were playing catch with your golden retriever at the park on a warm spring day. In one hand you were holding a tennis ball. As she watched you excitedly, you bent your arm to throw it and—pop! There was an audible noise, and you felt your shoulder being jolted out of place.
You ignored it and went about your day job. But over time you noticed your arm was getting worse. What at first was just a mild feeling of discomfort is now making it difficult to sit at your desk, to put groceries away, to reach for your wallet.
If you’ve experienced this or something like it, you may have a shoulder injury. The shoulder’s mobility makes it highly susceptible to injuries, both among athletes and in the general population, with over 14 million people visiting a doctor every year because of shoulder pain. If not taken care of, the symptoms are likely to worsen rather than getting better. It’s for this reason that immediate and thorough shoulder pain treatment is essential to a healthy recovery.
A clear understanding of shoulder injuries requires a basic grasp of shoulder anatomy and the mechanics of movement. The shoulder joint is a ball-and-socket joint in which the rounded end of the humerus(a long bone in the arm) fits snugly into the socket of the glenoid fossa, a shallow, articular cavity. The shoulder is held in place by a series of ligaments, which attach bones to each other, and tendons, which attach bones to joints.
In addition to the humerus, there are three primary bones in the shoulder girdle. The clavicle, or collar bone, runs between the lower throat and the top of the sternum. The scapula, shaped like a pair of wings resting on either end of the body, is the bone that we normally associate with the shoulder blade. (The acromion is the pointed tip of the scapula that forms a bony protuberance).
Of the joints formed by the union of these bones, there are four major ones. The acromioclavicular joint is formed by the union of the clavicle and acromion. Theglenohumeral joint is formed by the union of the upper arm bone and the scapula, and provides the shoulder with most of its movement. The sternoclavicular joint is formed by the joining of the sternum and clavicle, and helps to stabilize the shoulder. Lastly, the scapulothoracic joint is a pseudo-joint, or a “false joint,” to which muscles are attached. Each of these four joints is surrounded by ligaments and tendons.
Shoulder conditions can result from external blows, misuse, overuse, or the degeneration that often accompanies aging. The soft tissues surrounding the shoulder can deteriorate with age, leading to the weakening of ligament and tendon structures. This is why, with the exception of arthritis and direct injury, shoulder problems are most common for those between the ages of 50 and 60.
Shoulder impingement is a relatively common condition in which the bones of the shoulder impinge on neighboring tendons or bursa. This can result from repetitive overhead activity, such as reaching upward, painting, lifting, and playing tennis. Patients with bone abnormalities may also be at risk. Symptoms include a peculiar, sharp pinching sensation when lifting the arm, pain when putting on a coat or shirt, and pain when lying on one’s side. If not treated, in time it can lead to inflammation of the tendon or inflammation of the bursa—tendinitis and bursitis, respectively.
Shoulder subluxation, or dislocation, affects the glenohumeral joint responsible for most of the shoulder’s motion. The shoulder joint is among the most commonly dislocated joints. This injury can occur when the shoulder is pulled out of joint by an external force or an extreme rotation. When this happens, the patient may experience an audible snapping or popping sound, along with a feeling that the shoulder has slipped from its socket. Partial dislocations are much less debilitating than total dislocations.
Osteoarthritis is a common condition in the cartilage of a joint begins deteriorating. When this happens, the bones can rub against each other painfully. Typically shoulder osteoarthritis occurs first in the acromioclavicular joint, though it may eventually spread into the glenohumeral joint. Osteoarthritis can result from muscle imbalance, repetitive, improper body mechanics, or the natural degeneration of aging. Symptoms include pain in the shoulder and limited mobility.
|In addition to X-rays or MRIs, a physician may assess whether or not a patient is suffering from shoulder impingement through a simple range-of-motion test.
He or she may also assess muscle imbalances by comparing the strength of one side of the patient’s body relative to the other side.Shoulder dislocation diagnosis is comparatively straightforward. The physician will examine the joint to see if any displacement has occurred. He or she may also perform tests to determine mobility. Assessment for osteoarthritis is similar, though the physician will additionally perform a comprehensive physical evaluation and examine the patient’s health history.
Following diagnosis a therapist will assist you in developing a treatment plan for the next four to six weeks of recovery. The steps involved and the patient’s level of participation in them will largely depend on his or her pain threshold and range of motion.
During the initial (acute) stage of recovery the patient’s goal is to prevent additional injuries and relieve immediate symptoms. In cases of shoulder impingement and frozen shoulder, it’s important not to keep the shoulder overly protected, because total immobilization can actually exacerbate pain and immobility. It’s estimated that muscle strength can decline by up to 17 percent within the first three days of injury, and the longer the shoulder remains immobilized, the greater the patient’s chances of long-term tissue dysfunction and atrophy.
During the second stage of recovery, the “recovery” phase, a patient seeks to avoid further injury while performing exercises that can restore bodily strength and muscle balance. Ideally, soft tissues should begin healing, and range of motion return, by the end of this stage.
During the third stage, a patient seeks to transition back into normal living by continuing training exercises, and making the proper postural and motion adjustments that may be needed to prevent future recurrence of injury. Following the completion of physiotherapy, the therapist may evaluate the patient to determine whether he or she is ready to resume daily activities.
Patients suffering from shoulder injury and shoulder arm pain will find the resources they need to experience healing at New York Dynamic Rehabilitation Clinic (NYDNRehab). Our clinic on midtown Manhattan combines manual techniques with some of the most advanced technologies currently available. One example of the latter is extracorporeal shockwave therapy (ESWT), which may be employed when treating damage to the rotator cuff, chronic tendinitis, or a related injury. Recent medical studies have revealed that this emerging technology, which has seen growing acceptance in the last 10 to 15 years, may provide a safe and effective alternative to surgery. During ESWT, a physician will sound low-intensity sound waves directly through the skin at the site of injury to facilitate regeneration of tissue and accelerate healing. This method has proven able to advance the healing of musculoskeletal tissue. Best of all, it’s quick, gentle, and virtually painless. And it’s one of several rehabilitative treatments available for hurting shoulders at NYDNRehab.