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Shoulder injuries can occur in athletes and non athletes alike. Sometimes, all it takes is reaching the wrong way to get something out of the back seat of your car or doing one too many arm balances or laps in the pool. Other times, it can be more traumatic, like slipping on the ice and catching yourself with your arm or, even worse, crashing your bike.
The shoulder is a complicated joint, and its movement is a fine-tuned dance. In order for a shoulder to work well, we need to have appropriate motion in the cervical spine, the thoracic spine, the glenohumeral joint, the scapulothoracic joint, the AC joint, the SC joint and the rib cage. The muscles of all of these joints also need to be firing with the correct timing and performing at the right length. Did you know there are over 20+ muscles that attach on the scapula (wing bone)! As if that is not enough, to make matters more complicated, posture and breathing come into play....
Here are three common shoulder injuries and how they present. Physical therapists can be a great resource to help you get over the injury when you have any of these conditions or symptoms.
1. Shoulder impingement:This is a catch all phrase/diagnosis to describe compression or soft tissue damage in the shoulder.
Shoulder impingement often presents with pain in the anterior or lateral (front or side) aspect of the arm. It is noticeable when you lift the arm between 90-110 degrees of flexion or abduction (in front or to the side). Limited range of motionoccurs and varies depending on where in the shoulder joint the impingement is occurring. There may be weakness in the rotator cuff or scapular muscles.
Sometimes, you will get sharp pain that radiates down the arm or a pinching feeling. Other symptoms might be aching in the morning, disturbed sleep or pain with use. Shoulder impingement can occur because of weakness in the shoulder stabilizing muscles (scapular muscles, rotator cuff muscles, etc), poor thoracic spine and rib cage mobility, poor postural control (shoulders rounding forward), arthritis in one of the joints, tightness in the anterior muscles or even thickening of the subacromial bursa.
2. Rotator cuff tendinopathy:Shoulder impingement left untreated can result in rotator cuff tendinopathy.
Before we go any further, let's define a few words that are commonly thrown around so that there is no confusion.
Tendonitis: acute inflammation of a tendon can be a precursor to tendinosis
Tendinosis:degenerative changes in the tendon at the cellular level secondary to overuse. This could be microtears, adhesions or even fibrosis. There is no inflammation.
Tendinopathy:Chronic tendon injury
Tendinopathy will often present with pain on the lateral (outside) aspect of the arm and aching/diffuse pain in the upper trapezius (top of the shoulder), around the shoulder blade and in the mid-thoracic (mid-back) area. There may also be point tenderness in the shoulder muscles. When the shoulder gets worse, it will often have numbness or tingling into the arm and hand.
People will often have a difficult time reaching/lifting the arm, reaching behind their back, picking objects up, working on their computers or at their desks and difficulty sleeping. The more active they are the worse the symptoms will get. This is an injury that will have been ongoing over the years, and each time it happens it gets worse and takes longer to heal.
3. Shoulder Subluxations/Dislocations (instability): Shoulders are inherently unstable. The gleaned fossa is shallow, and the humeral head is large. If a shoulder is unstable, it may eventually become a subluxation or dislocation.
A subluxation is when the humeral head (top of the arm bone) partially comes out of the socket but quickly goes back in. A dislocation is when the humeral head come out of the socket completely and has to be put back into place.
This type of injury is typically traumatic - a bike crash, falling with your arm when it is stretched out or increased traction on the arm. However, not every case is because of a traumatic event. In fact, when my shoulder dislocates (unfortunately, it happens a fair bit) it happens while I am sleeping on my stomach or reaching behind me. I have even done it while putting my shirt or backpack on or when grabbing a glass from the sink.
If you have had a subluxation of the shoulder, you will often have generalized aching and pain in the anterior (front) of the shoulder and/or into the arm. Frequently, nerve damage or injury will occur concurrently. If the shoulder is dislocated, you will not be able to move it and will likely have to go to the ER. With a subluxation, you will have difficulty reaching behind you, lifting and reaching above you.
Shoulder subluxations are much more common than dislocations.
These are a small handful of injuries that can occur at the shoulder. There are many other things that can happen, such as a shoulder labral tear, rotator cuff muscle tear, AC joint separation or degeneration, biceps tendinopathy, osteoarthritis, adhesive capsulitis and more.
A physical therapist will be able to test your shoulder to determine what is going on with it and to determine how to address it so that you can get back to living your life! Many shoulder injuries can be rehabilitated without medication, surgery or even imaging. Remember, in Georgia, anyone can see a physical therapist for eight visits without having to see a medical doctor first. Your physical therapist will know if physical therapy will help you or if you need to see a medical doctor for further testing.
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1. Sueki D., Brechter J. Orthopedic Rehabilitation Clinical Advisor. Maryland Heights, MI. Mosby INC; 2010
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