Whether an injury occurs from paddling a canoe, throwing a ball, or lifting boxes, it does occur. We rely on our shoulders to do a number of activities, and with use of a shoulder, injury can occur. Normally, the shoulder has a wide range of motion, more than any other joint of the body. However, because it is this flexible, it is also not very stable and prone to injury.
The shoulder is made of two main bones: the shoulder blade (scapula) and the ball of the upper arm bone (humerus/humeral head). The humeral head is round, and it fits into the scapular socket. There are several muscles and ligaments that surround the shoulder, and they are called the rotator cuff. Tendons also connect the bones to the shoulder’s surrounding muscles. Injury to any or several of these shoulder structures can produce pain and disability.
Shoulder Instability and Separation
Shoulder instability affects mostly athletes and young people, but it can occur at any age. When ligaments and muscles are stretched beyond normal limits, the shoulder becomes unstable. This condition is often part of growth and development, and shoulders can stiffen and tighten with age. For athletes, shoulder instability is caused by repetitive motions, such as pitching or throwing. These motions put tremendous force on the shoulder, and the ligaments stretch out over time.
After years of having instability, or with persistent use, shoulder separation can occur. When the ligaments that hold the clavicle to the acromion bone of the scapula tear, it is considered separately. Sprains can also occur during a fall onto an outstretched hand/arm. A sprain causes severe pain and a misshapen shoulder, which also contributes to disability and decreased shoulder mobility.
Treatment for shoulder instability and sprain can involve medications, rest, and physical therapy. A sling is often used to limit movement while the shoulder heals. With severe instability and shoulder separation, surgery is often required to remedy the problem. Your treatment plan will be determined by the orthopedic specialist, who will collaborate with other professionals to develop the best course of therapy for you.
When the ligaments that hold shoulder bones together tear, and they can no longer support the joint, the shoulder is dislocated. A shoulder dislocation can occur due to a fall onto the shoulder, a fall onto an outstretched hand, or from violent twisting. The main symptom of shoulder dislocation is a pain, and the discomfort becomes worse with movement.
To treat a shoulder dislocation, you should apply ice immediately and go see a doctor. Within 15 minutes of the injury, the joint becomes sore and painful. A dislocated shoulder often can be re-set using gentle traction, where the bones are put back in place. When the shoulder moves out of socket repeatedly, it is called recurrent instability, which requires surgery for correction.
Rotator Cuff Tear
A rotator cuff is a group of four muscles that support the shoulder. They allow a person to raise and rotate the arm. These muscles are attached to bones by tendons, which allow the muscle to strategically move the arm. When the tendons tear, the upper arm bone cannot move easily in the socket, which means you cannot move it away from the body in an upward motion. As people age, and they become less active, tendons start to lose strength and degenerate. Most rotator cuff injuries occur in older adults or middle-aged individuals.
The shoulder has a poor blood supply, which makes it harder for the tendons to repair and maintain themselves. Using the arms overhead puts pressure on the rotator cuff tendons, and repetitive movement and stress can lead to shoulder impingement. When the tissue or bone in the shoulder area becomes misaligned and rubs/chafes. The rotator cuff tendons are often injured or torn when someone lifts a heavy object with an extended arm.
Treatment of a rotator cuff tear depends on the severity of the injury. The doctor may recommend resting the extremity, using a sling to support the arm and medications. After the initial injury, swelling and inflammation are controlled with a nonsteroidal anti-inflammatory drug.