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| Sports can Spur Shoulder Pain by Michael Adesso |
| It's that time of year when softballs and baseballs are starting to fly through the air, which makes for an opportune time to talk about shoulder injuries. |
| Overhead sports place high demand on the shoulder joint, which may lead to injury. We will do a quick overview of shoulder anatomy, and then try to sort out some of the common injuries that may occur. |
| Though the shoulder is made up of four different joints, we will focus on the ball and socket joint, or what is known as the glenohumeral joint. This is made up of the upper bone of the arm (the humerus) and the glenoid (the socket). |
| The structure of where these bones meet can be thought of as a golf ball sitting on a tee. This bony arrangement allows for a great amount of range of motion, which is needed to throw a baseball or to swim. The price we pay for this is a joint that relies mostly on ligaments and muscles to stabilize it. |
| Ideally, we want the ball to stay centered in the socket, no matter what position our arm is in. The muscles that are mainly responsible for this are the rotator cuff. This is a group of four muscles that attach to the humerus and act as a steering mechanism to keep the ball aligned with the socket, better known as dynamic stabilization. |
| The other stabilizers of the shoulder are the labrum (a ring of cartilage that deepens the socket), the capsule (a thin layer of tissue that connects the ball to the socket), and ligaments. These are called static stabilizers. |
| Though the name “static” seems to imply that theses structures do not move, they all have the capability to stretch out or tear under stress. This may happen as the rotator becomes fatigued, or if it is weak, placing more stress on the static stabilizers. That is why we have spoken in past articles of having a strong rotator cuff prior to beginning a sport or lifting weights. |
| Injuries to the rotator cuff can range from simple inflammation to different degrees of muscle tearing. Most commonly, we see what is referred to as “Impingement Syndrome” of the shoulder. This occurs when the cuff is not properly steering the ball in the center of the socket, and it is allowed to migrate too far upward, causing impingement (pinching) of the rotator cuff or bursa. This can happen if the rotator cuff or other associated muscles are too weak for the level of force being placed on them. It can also happen if the rotator cuff is too tight, or the static structures have stretched out. |
| As with many of our past topics, it is such muscle imbalances that are often the cause of injury. The treatment is to identify any joint looseness, and to strengthen the rotator cuff to meet the higher demand placed on it. If structures are found to be tight, they must be returned to a functional level of flexibility. |
| Remember, the inflammation at the shoulder is only a symptom. Using ice, resting and taking anti-inflammatories will make you feel better, but may not ultimately solve the problem. You must remedy any muscle imbalances before returning to action. |
| Nonsurgical treatment is successful in many shoulder injuries. If you have a tear in your rotator cuff or one of your static stabilizers, surgery may be your ultimate solution. This would require an evaluation by an orthopaedic surgeon, which would probably include an x-ray and MRI. The type of surgery you may need and how long your recovery will take depends on what structures are damaged. You may need immobilization from three to six weeks, and full recovery may take months. |
| The good news is that many people return to a high level of activity. To prevent possible shoulder injury, take steps to balance the strength and flexibility of your shoulder stabilizers before starting an overhead sport. Because the rotator cuff muscles are small, strengthening can be achieved by using rubber tubing or light dumbbells. The exercises or stretches needed will be specific to your problem. It is best to follow up with a health care professional before embarking on a program that you may find on the internet or that a friend has told you about. That could lead to further injury. |
| Michael Adesso, PT, ATC Director of Physical Therapy University Sports Medicine Amherst Location |