Common Injuries of the Shoulder

Common Injuries of the Shoulder

Whether throwing a ball, paddling a canoe, lifting boxes, or pushing a lawn mower, we rely heavily on our shoulders to do a number of activities.

Normally, the shoulder has a wide range of motion, making it the most mobile joint in the body. But because of this flexibility, it’s not very stable and is easily injured.

The shoulder is made up of 2 main bones: the end of upper arm bone (humerus) and the shoulder blade (scapula). The end of the humerus is round and fits into a socket in the scapula. Surrounding the shoulder is a group of muscles and ligaments. Ligaments connect the bones of the shoulders. Tendons connect the bones to surrounding muscle.

To keep shoulders healthy and pain-free, it’s important to know how to spot and avoid common injuries.

Shoulder instability

Shoulder instability happens most often in young people and athletes. When muscles and ligaments that hold it together are stretched beyond their normal limits, the shoulder becomes unstable. For younger people, this health problem may be a normal part of growth and development. Shoulders often stiffen or tighten with age.

In athletes, shoulder instability is caused by certain motions used in tackling or pitching, for example. These motions put great force on the shoulder, stretching the shoulder ligaments over time. It can cause pain that comes on either quickly or gradually, a feeling that the shoulder is loose, or a weakness in the arm. Treatment includes rest, physical therapy, or surgery.

A shoulder separation, or sprain, happens when the ligaments that hold the clavicle to the acromion tear. If this happens, the clavicle is pushed out of place and may form a bump at the top of the shoulder. Sprains often happen during a fall, when your hand or arm is outstretched to stop the fall, or when you fall on a hard surface. When the sprain happens, it causes severe pain, a misshapen shoulder, and decreased shoulder movement. Treatment depends on the severity of the sprain. To help ease pain and swelling, apply ice right after the injury. Keeping the arm in a sling to limit the movement of the shoulder lets ligaments heal. This is often followed by physical therapy exercises. Sometimes, surgery is needed.

If the ligaments holding the shoulder bones tear and can’t hold the joint together, the shoulder is dislocated. Falling onto an outstretched hand, arm or the shoulder itself, or a violent twisting, can cause a shoulder dislocation. The main symptom is pain in the shoulder that becomes worse with movement. To treat a dislocation, apply ice right after the injury to ease pain, swelling, and bleeding around the joint. Within 15 to 30 minutes of the injury, the joint will be painful and swollen. A dislocated shoulder needs urgent care. Healthcare providers treat dislocations by using gentle traction to pull the shoulder back into place. When the shoulder pops out of the socket repeatedly, it’s called recurrent instability. Recurrent instability can be treated with surgery to fix the torn ligaments.

Rotator cuff tear

The rotator cuff is a group of 4 muscles of the upper arm. They allow you to raise and rotate the arm. The muscles are attached to the bones by tendons. The tendons of the rotator cuff allow the muscles to move the arm. If the tendons tear, the humerus can’t move as easily in the socket. This makes it hard to move the arm up or away from the body.

As people age and are less active, tendons start to degenerate and lose strength. This weakening can lead to a rotator cuff tear. Most rotator cuff injuries happen to middle-aged or older adults who already have shoulder problems. They can happen in younger people, too. The shoulder has a poor blood supply. This makes it harder for the tendons to fix and maintain themselves. Using your arm overhead puts pressure on the rotator cuff tendons. Repetitive movement or stress to these tendons can lead to impingement. This is when the tissue or bone in that area becomes misaligned and rubs or chafes.

The rotator cuff tendons can be injured or torn by trying to lift a very heavy object with an extended arm. It can also happen from falling, or by trying to catch a heavy falling object.

Symptoms of a torn rotator cuff include tenderness and soreness in the shoulder when using the shoulder. If the tendon has ruptured, you may not be able to raise the arm at all. It may be hard to sleep lying on that side. You may feel pain when pressure is put on the shoulder.

Treatment depends on the severity of the injury. If the tear is not complete, your healthcare provider may suggest RICE (rest, ice, compression, and elevation). Resting the shoulder is probably the most important part of treatment. But after the pain has eased, you will need to start physical therapy to regain shoulder movement. Your healthcare provider may prescribe a non-steroidal anti-inflammatory drug (NSAID). These help ease pain and swelling. NSAIDs are the most common medicines used. Medicines may be prescribed or bought over the counter. They may be given as pills. Or they may be put on the skin as a gel, cream, or patch.

Frozen shoulder

This extreme stiffness in the shoulder can happen at any age. It affects about 1 in 50 Americans, most often between ages 40 and 60. The causes are not fully understood. Frozen shoulder can affect people with diabetes, thyroid disease, heart disease, or Parkinson disease. It can also happen if the shoulder has been immobile for a period of time. It can happen when a minor shoulder injury heals with scar tissue that affects how the joint moves. This scar tissue reduces flexibility in the shoulder and makes it more prone to injury. The main symptom is not being able to move the shoulder in any direction without pain. Treatment can be NSAIDs, cortisone shots, or physical therapy. You can reduce further injury and stiffness by stretching before starting activities.

Overuse/strains

A sudden increase in activity can place great stress on the shoulders and lead to a loss of flexibility. This is a common problem in middle age, especially among people who don’t exercise regularly, but go out every now and then for an intense sport.

Although painful and inconvenient, overuse problems can often be treated with rest, NSAIDs, and stretching exercises.

Arthritis

Starting as early as age 50, some people get osteoarthritis, which causes painful movement. This happens as the smooth surfaces of the cartilage that line the bones of the shoulder joint are worn away, and joints start to wear out. The most common cause of osteoarthritis is overuse. Treatments for arthritis in the shoulder depend on the severity of pain. The usual treatments are rest, NSAIDs, and cortisone shots. In some cases, a replacement of the shoulder joint is needed.

Online Medical Reviewer: L Renee Watson MSN RN
Online Medical Reviewer: Raymond Turley Jr PA-C
Online Medical Reviewer: Thomas N Joseph MD

Date Last Reviewed: 2/1/2021
© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.
Stretches to Strengthen Your Core

Stretches to Strengthen Your Core

THURSDAY, March 21, 2019 (HealthDay News) — Ever had a bad spasm from bending down to pick up your child or tie your shoes?

Keeping your core muscles — the workhorses that stabilize your spine — flexible with a stretching routine can help prevent this common occurrence and protect your back in general.

The Pelvic Tilt targets your lower back and your abdominals. Lie on your back with knees bent and feet about hip-width apart. Flatten and then press your lower back into the floor. You’ll feel your hips tilt forward. Hold for 10 to 20 seconds and repeat five times.

The Side Stretch helps your back and sides become more limber. In a standing position, extend your right arm above your head. Put your left hand on your hip. Slowly bend to the left without twisting or jerking. Hold for 10 to 20 seconds and repeat five times. Then repeat the sequence on the other side.

The Back Arch stretches hips and shoulders as well as your back. Stand up straight, legs shoulder width apart. Support your lower back with both hands and bend backwards. Hold for 10 to 20 seconds and repeat five times.

As a reminder, never bounce when stretching. This can cause muscles to tighten and lead to injury. Ease into every stretch with a slow, steady movement. Stop if any stretch feels uncomfortable. You should feel slight tension, but not pain. And do stretches that you hold only when your body is warm — after a workout is perfect.

More information

Love yoga? The American Council on Exercise details how you can use yoga to work core muscles.

Copyright ©2017 HealthDay. All rights reserved.
Physical Therapy for Shoulder Pain

Physical Therapy for Shoulder Pain

Shoulder pain is a common symptom for athletes and office workers alike. These simple exercises can improve flexibility and prevent future injury.

The shoulder’s complex structure makes it susceptible to injury, especially from one-too-many many weightlifting exercises. Whatever the cause of your pain or discomfort, the healing process often involves physical therapy to stretch and strengthen the surrounding muscles.

Be sure to consult a doctor before beginning a physical therapy regimen, as shoulder pain can be a symptom of a variety of conditions, like impingement or a rotator cuff tear. The following exercises offer gentle stretching and light conditioning to get you on the road to recovery.

1. PENDULUM EXERCISE
The pendulum exercise can help you recover from a shoulder injury, as it encourages blood flow and develops your range of motion. To get started, stand near a table with your feet slightly more than shoulder width apart. Place the hand of your uninjured arm on the table, then bend over and let your injured arm dangle toward the floor. Shift your body weight in order to create movement in the arm: forward and back, side to side, or in a small circle. Do not engage your shoulder muscles, but let the arm swing freely.

Start with 30 seconds of motion, a few times per day. Over the next few weeks you can gradually increase to several minutes of movement. You can also do a variation of this exercise on a bed if leaning over is hard on your back or neck, though you may need someone else to set your arm in motion. As your recovery progresses, you may be able to use light dumbbells to further stretch the shoulder — but be careful not to engage the muscles and risk re-injury.

2. SCAPTIONS
This exercise targets the rotator cuff, building strength in the scapula and rhomboids to prevent and relieve pain. It can also help strengthen your back and improve your posture.

Stand with your feet below your shoulders, core engaged and knees at a slight angle. With a light dumbbell in each hand, palms inward, raise your arms out in front of you in a broad V shape. Then slowly draw your shoulder blades together. Be careful not to raise your arms above your shoulders. Hold this position momentarily, then lower. Repeat about ten times, for three sets.

3. EXTERNAL AND INTERNAL SHOULDER ROTATION
The rotator cuff muscles that allow for internal rotation are the supraspinatus and subscapularis. These let you draw your arm forward, with your palm facing in, and are commonly used in gym exercises and everyday life. Overuse causes these muscles to tighten, often leading to pain.

To begin strengthening the rotator cuff, you can practice a simple towel stretch. Grasp a towel or strap with your right hand and drape it over your right shoulder so it hangs down your back. Your right hand should be level with the back of your head, or lower toward the back of your neck if it’s comfortable. Turn your left arm behind your lower back with your palm facing behind you as you raise your left hand to meet and grasp the bottom end of the towel. Don’t force the stretch, but spend 15 to 30 seconds just at your point of flexibility. Try three repetitions on each side, and over time you will be able to bring your hands closer together at your back.

The external rotator muscles in the rotator cuff are the infraspinatus and teres minor. These typically get less training, which can create an imbalance and eventually lead to pain. To strengthen these muscles, use only one- or two-pound weights until you are able to easily add more, one pound at a time. Lie on your side, with your upper arm at a 90-degree angle, elbow against your side. Slowly rotate your forearm out and up, to your side, drawing your shoulder blades together until your palm faces forward. Hold for two seconds, then lower down. Repeat 10 times on each side.

4. SHOULDER RETRACTIONS
There are a number of exercises that involve shoulder retraction, and they all aim to correct a slumped posture. If your shoulder blades, or scapulae, are constantly hunched forward, it can affect how you use your shoulder joint, lift your arms, and stand. Poor posture can even affect the blood flow and nerves in your arms and hands, and make it harder to breathe by collapsing your chest. You should perform shoulder retraction stretches as much as possible to counteract these effects, and build up the muscles to help prevent shoulder pain.

To begin this exercise, stand straight, arms at your sides, with your shoulders relaxed. Pull your shoulder blades down and back, without arching your back. Hold this for 5-10 breaths, and repeat 3-5 times.

For a more targeted exercise, lie facedown on a mat, resting your forehead on a towel. Hold your arms straight out at your sides, palms down. Use your shoulder blades to lift your arms off the floor, holding this position for a few breaths.

EXERCISES TO AVOID
As you perform these exercises, keep in mind that shoulder pain can have many underlying causes, and without a doctor’s diagnosis you risk exacerbating the issue. Take your time when introducing new exercises into your routine to give your body time to adjust. To avoid further damage, be sure to start with no weight or very light weights for any strengthening activities.

You should also avoid exercises that are counterproductive to the healing process. Stay away from common gym exercises like dips, upright rows, overhead presses, and lat pull downs done behind the neck, which can put stress on the neck and shoulders.

If you’re suffering from shoulder pain, you may want to schedule an appointment with an orthopedic specialist. At CompOrtho, specialists will help identify any underlying conditions that may be causing you discomfort.

How to Fix Shoulder Pain from Weightlifting

How to Fix Shoulder Pain from Weightlifting

If you’re a weightlifter, don’t ignore an aching shoulder. Follow our tips to prevent and treat these three common conditions.

Experiencing shoulder pain while weightlifting? This might be a sign you need to take a step back and re-examine your form. Here are some ways to prevent your slight twinge from turning into a serious injury.

WEIGHTLIFTER’S SHOULDER


Weightlifter’s shoulder, or distal clavicular osteolysis, affects the collarbone where it meets the shoulder blade at a point known as the acromion. This joint is very flexible, and therefore one of the least stable in the body. Stress over time can lead to micro fractures on the end of the collarbone.

If you have weightlifter’s shoulder, you may experience:

  • Dull aching
  • Tenderness or sharp pain when you press on the area
  • Swelling
  • Weakness or stiffness
  • Pain after exercising
  • Pain when you extend the arm across to the opposite side

Weightlifter’s shoulder can be avoided with good training practices. It is usually caused by overdoing shoulder extension exercises like bench presses, dips, or push-ups. When you work out, be sure not to use too much weight and give your muscles time to recover in between training sessions. Have a trainer check your form, and be careful not to push through when you’re experiencing pain. To build up your shoulder strength, try out the “Blackburn” exercise.

If you are suffering from weightlifter’s shoulder, the condition may respond to conservative treatment. Take a hiatus from lifting weights, ice the area, and take anti-inflammatory medications. Your doctor may suggest corticosteroid injections along with physical therapy. If surgery is needed, your doctor can perform a minimally invasive procedure using small incisions to remove about a centimeter of your collarbone, which will help eliminate pain and restore your range of motion.

SHOULDER IMPINGEMENT

Shoulder impingement affects the rotator cuff in the upper arm. Each time you raise your arm, you create less space between the tendons and the shoulder blade. Over time, the shoulder blade’s acromion may begin to irritate the rotator cuff or its bursa sac.

Motions that use the rotator cuff tendons increase the likelihood of impingement. This includes any sport with overhand motions or exercises that include lifting weights above the head. Many people don’t realize that the mild pain is a sign of impingement, and unfortunately don’t seek treatment until the pain has worsened.

You may have a shoulder impingement if you experience:

  • Swelling or tenderness
  • Pain whether you’re resting or exercising
  • Sharper pain when lifting or reaching
  • Weakness and loss of motion
  • Difficulty reaching behind your back

There are several ways that you can prevent this condition. If you’re just starting a training plan, add reps slowly and trade off between push and pull exercises to build both front and back muscles (i.e., for every pushup, do a row). Avoid overdoing exercises where the elbow is above the shoulder, like upright rows and shoulder presses, along with lateral raises and behind-the-neck pulldowns. For more stability, activate your lower trapezius muscles before pulldowns by bringing your shoulders down and together.

If you do experience shoulder impingement, we recommend temporarily replacing your weightlifting regimen with physical therapy. Your doctor may suggest cortisone injections as well. These conservative treatments are often sufficient, but if needed a doctor can perform surgery to remove or repair the damaged areas. This can prevent future injury to the tendons, especially if you have bone spurs.

ROTATOR CUFF TEAR


A rotator cuff tear affects the muscles and tendons that cover your upper arm bone, keep it in the ball-and-socket shoulder joint, and help you lift and rotate your arm. The stress of weightlifting can cause a tear as the tendon degenerates over time. Direct impact can cause damage as well — if you try to lift heavy weights with a jerking motion, you could tear the tendons.

You may have a torn rotator cuff if:

  • Your pain is worse when you raise your arm overhead
  • Pain makes it hard to sleep at night
  • You experience weakness and limited motion in your shoulder
  • You are unable to hold your arm at shoulder level without dropping it to your side

To prevent this injury, use lower resistance exercises with more repetitions to gradually strengthen the rotator cuff muscles. Balance these exercises with arm raises and external rotations to build up your deltoids — try the side-lying external rotation before your next workout. End your training session with cold compresses to reduce inflammation, and be sure to rest between gym days. Avoid sleeping on your sore side to help healing. The condition won’t go away on its own, but our expert orthopedists at Comprehensive Orthopaedics can diagnose your condition and get you started on the path to healing. Schedule an appointment with one of our orthopedic specialists today.  

An Orthopedic Specialists’ Guide to Frozen Shoulder

An Orthopedic Specialists’ Guide to Frozen Shoulder

Here’s what you need to know about the painful but treatable condition called adhesive capsulitis, or frozen shoulder.

Frozen shoulder, or adhesive capsulitis, is an inflammation of the shoulder capsule. This band of connective tissue encases the shoulder joint, so as inflammation progresses, patients experience a restricted range of motion along with extreme stiffness.

While the medical community has not yet been able to pinpoint the exact cause of frozen shoulder, there are a number of conditions that can contribute to its development. These include diabetes, thyroid disorders, and past surgeries on the shoulder or chest.

SIGNS AND SYMPTOMS OF FROZEN SHOULDER

Patients suffering from frozen shoulder generally experience moderate to severe pain, inflammation, stiffness, and a limited range of motion in the shoulder.

This condition normally cycles through three progressive stages. These are:

  • The “freezing” phase, where the patient experiences increasingly severe shoulder pain lasting from several weeks to nine months.
  • The “frozen” phase, where pain in the shoulder decreases but stiffness lingers, lasting from four to nine months.
  • The “thawing” phase, where pain continues to lessen and the range of motion in the shoulder slowly improves, lasting from five months to two years.
HOW TO PREVENT FROZEN SHOULDER

Frozen shoulder predominantly affects people in middle age, and it is possible to preemptively avoid this condition — especially if you’ve been diagnosed with any of the risk factors commonly associated with it, like diabetes or a thyroid disorder. The best possible prevention method is to steadily increase shoulder flexibility through stretching, including external rotation, forward flexion, and crossover arm motions.

HOW TO TREAT FROZEN SHOULDER

In many cases, conservative treatments can effectively ease shoulder pain and stiffness. These methods generally include a physical therapy regimen designed to restore shoulder motion and strengthen the surrounding muscles. Most patients will need to undergo a rehabilitation plan for approximately four to five months to ensure a complete recovery.

Sometimes, anti-inflammatories and corticosteroid injections are used to supplement physical therapy. If mobility issues continue, minimally invasive arthroscopic surgery can be utilized to break up and remove scar tissue that has built up in the shoulder, with full recovery occurring in as little as six weeks.

If you think you may be suffering from frozen shoulder, set up an appointment with an orthopedic specialist today. Backed by decades of experience in treating shoulder injuries, CompOrtho Specialists can work with you to develop a personalized recovery plan.  Dr. Main and Dr. Gershtenson are top-rated orthopedic surgeons in Southeastern Wisconsin who specializes in the shoulder.  Our team of specialists can help you through every step of your treatment, ensuring a quick and complete recovery.

Tips for preventing ski injuries

Tips for preventing ski injuries

Ski season is in full swing — but an injury can put you out of commission until next year’s first snowfall. Here’s how to stay safe on the slopes all winter long.

While many people huddle inside during the winter months, away from “bomb cyclones” and blizzards, a select few know that the best way to beat wintry weather is to embrace it — on the ski slopes, that is!

As any seasoned skier will tell you, however, their beloved sport does come with the risk of injury. Fortunately, taking some simple precautions before you hit the slopes can help you stay in peak condition regardless of how many tumbles you take.

We’ve outlined some of the most common injuries that afflict skiers, and what you can do to prevent them.

MCL Injuries

A number of injuries can affect the medial collateral ligament (MCL), but the most common by far is an MCL tears. In skiing, MCL tears most often occur when the skier falls while attempting to slow or stop in a snowplow position, in which the tips of the skis are pointed toward each other. To avoid injury in this position, make sure to always keep your weight balanced. In addition, sticking to runs with which you’re comfortable can reduce the need to enter the snowplow position at all.

ACL Injuries

A variety of falls on the slopes can result in a tear of the anterior cruciante ligament (ACL). It most commonly happens after a forward fall, during which the inner edge of the front of the ski becomes embedded in the snow, trapping the leg in the process. It can also occur when the top of the back of the boot pushes the tibia (the weight-bearing bone in the leg) forward, away from the femur. On other occasions, it arises when the skier leans back on the skis, loses balance, and falls backward. Strengthening the hamstrings, wearing proper bindings, and using shorter skis can all reduce the risk of sustaining an ACL tear.

Fractures

Like torn ligaments, fractures are most commonly caused by falls while skiing. The wrist and ankles are particularly susceptible to breaks. To help avoid broken bones, always wear adequate protective gear and practice proper techniques for falling. Increasing cardiovascular endurance and developing the surrounding muscles can also be beneficial.

Shoulder Dislocations

Most shoulder dislocations happen when skiers fall, either directly onto the shoulder or onto an outstretched hand or arm. This injury results in heavy, immediate pain, significantly restricts the shoulder’s range of motion, and can leave it misshapen. Since dislocations are caused by sudden trauma, they can be difficult to anticipate, but strengthening the rotator cuff muscles, especially if you have previously dislocated your shoulder, can lower the risk of a dislocation. As with other common skiing injuries, employing proper form will also minimize the possibility of a dislocation.

Spinal Injuries

Aside from protecting the spinal cord, the spine ensures the strength and stability of the back. It is made up of various bony segments called vertebrae separated by pieces of fibrocartilaginous tissue called intervertebral discs, any of which can be injured while skiing. Some ways to avoid spinal injuries include using spine protectors, sticking to trails on which you are comfortable, using proper equipment, and learning the technique for “safe” falls.

While some ski injuries are immediately apparent, others can be more subtle, slowly progressing with time. Fortunately, the talented team of specialists at New York Bone and Joint has extensive experience working in sports medicine and can quickly diagnose and treat any of these common problems. If you think you may have suffered an injury during your latest trip to the mountain, call us today to schedule a consultation, or if the injury has been recent, stop in to our Orthopedic Urgent Care!

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