Visit the Buxton Osteopathy Clinic at 7 Bridge St, Buxton SK17 6BS

2 – Shoulder Injuries

One of the top ten sporting injuries!

Return to the Top Ten Sporting Injuries

Introduction

About 20% of sports injuries involve the shoulder. Shoulder injuries are most common in tennis, swimming, weightlifting, baseball, and volleyball — basically, any sport that involves a lot of overhead movement. Most common are

  • ROTATOR CUFF TEARS
  • IMPINGEMENT SYNDROME
  • UNSTABLE SHOULDER

Rotator cuffs in the shoulder

Typical symptoms; General shoulder pain that increases with lifting your arm (to serve in racket sports) or even sleeping on affected shoulder or carrying items such a suitcase.

Rotator cuff tears in the shoulder are a common issue in any sports that involve throwing, pushing, pulling or lifting. The humerus (upper arm bone) has a rounded head that forms a ball and socket joint with the scapula (or shoulder blade). An analogy would be like a golf ball sitting on a shallow tee, this allows great natural movement with the trade-off being stability. The rotator cuff solves this dilemma as it makes a network of four muscles whose tendons coalesce to cover the head of the humerus therefore serving to ‘strap the golf ball on the tee’. The rotator cuff muscles consist of the supraspinatous (runs across the top of the head of the humerus) and the subscapularis (runs across the front) and the infrapsinatous and teres minor muscles (run across the back). These muscles are also very important in rotating or lifting your arm.

Problems start when one or more of these tendons (most often the supraspinatous) are damaged or torn completely (full thickness tear) and no longer attach to the head of the humerus. Most often this is seen in the dominant shoulder and can be the result of repetitive stress motions seen in sports such as tennis, rowing or cricket or falling on an outstretched arm. Blood supply to the rotator cuff tendons does also diminish with age and this can impair healing. With age we can also develop bony spurs in the shoulder that rub on the rotator cuff tendons and the tendons themselves can also become calcified due to long standing inflammation.

Typical symptoms start with an acute onset of pain particularly on any movement of the shoulder (especially overhead movements). Treatment involves analgesia and ant-inflammatory medications (under advise from your GP), physical therapy and rehabilitation in order to maintain strength and flexibility. Cortisone injections can help reduce pain and inflammation although repeated injections may serve to further weaken the tendon. If the shoulder does not improve and there is a larger or complete tear surgery may be the best option to reattach or repair the tendon

 

Impingement syndrome

Typical symptoms; General shoulder pain more commonly as we age. Gradual onset, increased pain when active or at rest and sleeping on affected shoulder.

Impingement syndrome occurs in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height are also at risk.

This condition occurs because there is not enough room to let parts of the shoulder move easily in a space at the top of the shoulder called subacromial space. This is the space between the top of upper arm bone (humerus) and the tip of the outside of the collarbone (acromium). This is generally associated with inflammation. Subsequently the swollen inflamed structures cannot move and glide as easily through the space as they would normally especially when you lift your arm. This may develop unnoticed for some time until you finally become aware of it.

Generally this condition causes the rotator cuff tendons to be intermittently trapped and compressed during shoulder movements. This causes injury to the  tendons and bursa (another structure in this area) resulting in painful shoulder movements. Bursae are structures that occur throughout the body and they are basically little sacks of fluid that typically occur between bony surfaces and overlying soft tissue (such as a tendon) and there are roughly 160 in the body in total. They essentially act as little cushions that help to prevent the affect of friction.

Impingement should not occur during normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen and the condition is termed rotator cuff tendinopathy. Likewise if the bursa becomes inflamed, bursitis will develop. Both these conditions can co-exist or be present independently.

The end of collarbone can also develop tiny bony hooks as we age thus making this space even smaller. If left untreated this can develop to cause more serious issues such the rupture of a rotator cuff tendon

Commonly rotator cuff impingement has the following symptoms:

  • An arc of shoulder pain when your arm is at shoulder height and/or  overhead.
  • Shoulder pain that can extend from the top of the shoulder down to the elbow.
  • Pain when lying on the affected shoulder.
  • Shoulder pain at rest as your condition worsens.
  • Muscle weakness or pain when attempting to reach or lift.
  • Pain when putting your hand behind your back or head.

We can offer advice and recommend an appropriate course of action

Unstable shoulder

Typical symptoms; Pain with overhead activities, weakness, stiffness, there could be a catching popping or locking

Causes of unstable shoulder

Labrum tear

The humerus (upper arm bone) has a rounded head that forms a ball and socket joint with the scapula (or shoulder blade). An analogy would be like a golf ball sitting on a tee with a shallow cup, this allows great natural movement with the trade-off being stability. In order to make the shoulder socket a deeper cup, the outer rim of the cup is ringed by a tough flexible tissue called a labrum and this makes the shoulder much more congruous (joins together better). If this is torn it can cause looseness and instability. This may require ensuing surgery but we can do gentle treatment to reduce symptoms. We can help give you exercises to help strengthen the shoulder and reduce pain and swelling.

We can offer advice and recommend an appropriate course of action

Weak shoulder capsule

The shoulder is enclosed by what is essentially a sheet of ligaments (or capsule) that wrap around and encapsulate the head of the upper arm bone (the humerus). The capsule will essentially help to stop the head of the humerus pop out. If the capsule is stretched in a trauma or by repetitive movements the shoulder can become unstable. We can help give you exercises to help strengthen the shoulder and reduce pain and swelling.

We can offer advice and recommend an appropriate course of action

Rotator cuff

The rotator cuff muscles consist of the supraspinatous (runs across the top of the head of the humerus) and the subscapularis (runs across the front) and the infraspinatous and teres minor muscles (run across the back). These muscles are also very important in rotating or lifting your arm and stabilising the shoulder. These tissues form a cuff around the head of the humerus and help keep it in place. If this structure is damaged instability can result. We can help give you exercises to help strengthen the shoulder and reduce pain and swelling.

We can offer advice and recommend an appropriate course of action

Want to learn more? Get in touch

Please note: Under current legislation issued by the Advertising Standards Agency we cannot state that we treat a condition unless there is robust scientific evidence to support any given claim.

Return to the Top Ten Sporting Injuries