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  • Ashleigh Clinic

Shouldering the burden

Shoulder injuries are common, as the joint is very mobile and shallow which means it relies on the muscles to provide the power as well as the complex finer movements. The ligaments and fascia, which is a cling-film type of material made up of many layers, envelope all the tissues from individual  muscle fibres to whole muscle groups. Pulling them together controls and concentrates mechanical forces to enhance movement. This refines position, force and control, so the arm is allowed to move through its intended movement such as throwing a ball or lifting, while remaining stable.

 

The tasks we ask of the shoulder joint are many and, as with all joints, there are enormous compression and distraction forces going on. The network of nerves and receptors that send messages to the brain give us a continuous feedback, helping us to move more efficiently.

 

So how can our shoulder joints get injured, and what can you do to recover?




Common shoulder injury terms


There are several shoulder joint injuries. Some of the most commonly heard of are:

 

  • Dislocation The bones making up the joint slip out of place completely.

  • Subluxation The bones making up the joint partially slip out of place and may either spontaneously move back into place or need to be pushed back by a doctor or physiotherapist.

  • Rotator cuff lesion The muscles, ligaments and capsule of the joint are damaged without dislocation or subluxation.

  • Supraspinatus tenopathy/impingement This is a tendon at the top of your shoulder that helps initiate side movement

  • Acromioclavicular (AC) joint problems This is a small but very important joint that sticks out on top of the shoulder and helps control the movement of the arm during activity.

  • Frozen shoulder Generally this term relates to contractures of the muscles and ligaments that surround the joint, limiting function and making activities, particularly above shoulder height, very difficult.


Common causes


Shoulder movements rely on the joints surrounding it to allow efficient movement and the shoulder blade (scapular) is an important controller.

 

For example, when reaching out or throwing a ball, negative pressures are created, pulling the two joint surfaces together so the arm can pivot around its attachment. Any disruption to this mechanism causes a momentary loss of control and thus injury occurs. Common causes include throwing, lifting, reaching, repetitive movements, or a fall.


What are the symptoms?


  • Pain This can be immediate during activity or gradual over a period of time when it is caused by more of a repetitive activity.

  • Loss of movement, function and power The pain limits this due to the inflammatory response.

  • Stiffness and inability to move the shoulder Due to the inflammatory response, the damaged tissues contract to protect themselves. This can be why you feel stiff in the morning with most injuries.

 

ln some cases you may feel numbness, pain and loss of power in the arm or hand. This can be caused by localised impingement of the nerve and may also suggest problems with your neck more centrally and a thorough examination of both areas would be advisable.

 

lf you have dislocated or subluxed your shoulder, there will be obvious pain and lack of mobility. You may notice the shoulder contours have changed. Sometimes you may experience a dead arm feeling and be very apprehensive if anyone tries to hold your arm. This may need putting back into place and usually you are placed in a sling for anything up to four to six weeks.



Tips to help recovery


Remember to very slightly elevate your shoulder as this sometimes helps by taking some of the weight off the tissues surrounding the shoulder as they have been damaged. While you may not want this, I have personally found the immobility allows acute tissue to settle and stabilise the shoulder.

 

Further dislocations can mean surgical intervention may be required to help tighten the affected tissues, then treatment and rehab can begin. Normal soft tissue protocol is very beneficial with the less traumatic injuries, so the use of cold packs to settle the inflammatory effects is always a good idea and seek physiotherapy at your earliest opportunity to speed up recovery.

 

For general soft tissue problems, I am a firm believer of local treatment of the tissues, combined with an exercise protocol that will relate to the activities that the particular patient wants to do after recovery.

 

For example a bowler in cricket will be given a basic shoulder program similar to other sportspeople, but will in the later stages require more sports specific guidance to help fully rehabilitate function and conditioning, as well as reduce the risk of further injury. This guidance will be very different from a rugby player or swimmer for example.

 

As with all injuries, my belief is 'movement is everything' and, while you may have good strength, I believe this should be with a good, functional and as full a range of movement that is possible to regain.

 

For more guidance and advice on recovering from a shoulder issue, contact us.

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