Sports Injuries : Shoulder Pain
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What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion to the arm, from scratching your back to throwing the perfect pitch. Mobility has its price, however. It may lead to increasing problems with instability or impingement of soft tissue resulting in pain. You may feel pain only when the shoulder is moved, or all of the time. The pain may be temporary and disappear in a short time, or it may continue and require medical diagnosis and treatment.
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What causes shoulder pain?
Most shoulder problems involve the soft tissues, muscles, ligaments and tendons, rather than bones. And most of these problems fall into three major categories:
- tendinitis/bursitis
- injury/instability
- arthritis
Other much more rare causes of shoulder pain are tumors, infection and nerve-related problems.
Tendinitis - A tendon is a cord which connects muscle to bone or other tissue. Most tendinitis is a result of the wearing process that takes place over a period of years, much like the wearing process on the sole of a shoe which eventually splits from overuse. Generally, tendinitis is one of several types:
- acute tendinitis following some overuse problem such as excessive ball throwing and other sports- or work-related activities.
- chronic tendinitis resulting from degenerative disease or repetitive wear and tear due to age.
- the splitting and tearing of tendons which may result from acute injury or degenerative changes in the tendons due to advancing age. Rotator cuff injuries are among the most common of these disorders. The rotator cuff is the arrangement of muscles and their tendons which provides shoulder motion and stability.
Sometimes, excessive use of the shoulder leads to inflammation and swelling of a bursa, a condition known as bursitis. Bursas are fluid-filled sacs located around the joints which lessen the friction caused by movement of the shoulder. Bursitis often occurs in association with rotator cuff tendinitis. Sometimes the many tissues in the shoulder become inflamed and painful, limiting the use of the shoulder. The joint may stiffen as a result, a condition called a "frozen shoulder." Fortunately, with appropriate care, this condition will resolve itself.
Injury/Instability - Sometimes the bones in one of the shoulder joints move (or, in an injury, are forced) out of their normal position. This condition, instability, can result in dislocation of one of the joints in the shoulder. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body. When you lift your arm over your head, the shoulder may feel as if it is slipping out of place or an uncomfortable, unusual feeling that some people refer to as having a "dead" arm.
Arthritis - Shoulder pain can also result from arthritis. There are many types of arthritis, but generally it involves wear and tear changes with inflammation of the joint, causing swelling, pain and stiffness. Arthritis may be related to sports or work injuries.
Often people will avoid shoulder movements in an attempt to lessen the pain arising from these conditions. This sometimes leads to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.
Rotator Cuff Sprain/tear/strain- Rotator Cuff Tears
Description
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Rotator cuff tear is a common cause of pain and disability in the adult population. The rotator cuff is made up of four muscles and their tendons. These combine to form a "cuff" over the upper end of the arm (head of the humerus). The four muscles - supraspinatus, infraspinatus, subscapularis, and teres minor - originate from the "wing bone"(scapula), and together form a single tendon unit. This inserts on the greater tuberosity of the humerus. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.
Most tears occur in the supraspinatus but other parts of the tendon may be involved. |
Risk Factors/Prevention
Rotator cuff tear is most common in people who are over the age of 40. It may occur in younger patients following acute trauma or repetitive overhead work or sports activity. Common examples are:
Workers who do overhead activities such as painting, stocking shelves or construction,
Athletes such as swimmers, pitchers and tennis players
A cuff tear may also happen with another injury to the shoulder, such as a fracture or dislocation.
Symptoms
Symptoms of a rotator cuff tear may develop acutely or have a more gradual onset. Acute pain usually follows trauma such as a lifting injury or a fall on the affected arm. More commonly, the onset is gradual and may be caused by repetitive overhead activity or by wear and degeneration of the tendon. You may feel pain in the front of your shoulder that radiates down the side of your arm. At first the pain may be mild and only present with overhead activities such as reaching or lifting. It may be relieved by over-the-counter medication such as aspirin or ibuprofen. Over time the pain may become noticeable at rest or with no activity at all. There may be pain when you lie on the affected side and at night. Other symptoms may include stiffness and loss of motion. You may have difficulty using your arm to reach overhead to comb your hair or difficulty placing your arm behind your back to fasten a button.
When the tear occurs with an injury, there may be sudden acute pain, a snapping sensation and an immediate weakness of the arm.
Dislocation of shoulder
Def-A shoulder dislocation is when the top part of the arm bone (humeral head) slips out of its socket (glenoid).
Forward (anterior) dislocations are most common. When this occurs the anterior inferior labrum (a piece of cartilage that stabilizes the shoulder) frequently is torn. This is known as a Bankart lesion. A dent in the humerus bone known as a Hill-Sachs lesion may accompany the Bankart lesion in severe dislocations.
Shoulder dislocations can also occur backward (posterior) and downward (inferior). Repeated dislocations and multidirectional shoulder instability are also possible.
Causes-Falling is the most common cause of a new shoulder dislocation. A dislocation can also occur when the arm is forcibly moved into an awkward position during a violent action such as tackling in football. If a dislocation or partial dislocation (medically known as a subluxation) occurs with only minor force, recurrent or multidirectional instability must be considered
