The shoulder is the most dynamic joint of the body with unparalleled range of motion and functional ability. However, because of this great range of motion it is susceptible to instability and injury. During the summer months in particular we often see a rise in shoulder injuries. Activities such as water sports, tennis, softball and volleyball can cause acute injuries while the avid gardener or do-it- yourselfer may suffer from overuse or chronic injuries.
From an anatomic standpoint, shoulder injuries can be divided into joint problems or soft tissue problems. Osteoarthritis tends to develop slowly and is related to degeneration and use. Acute injuries to the shoulder joints include a separated shoulder and a dislocated shoulder, both usually occurring with a fall. A dislocated shoulder involves the glenohumeral joint while a separated shoulder occurs at the acromioclavicular joint.
The soft tissue structures of the shoulder include the muscles, tendons, ligaments, and the labrum. Although there are many muscles in and around the shoulder, four muscles makeup the rotator cuff that act as stabilizers and tend to be the most injured. The most common rotator cuff injuries are partial tears, complete ruptures, and chronic degeneration. Rotator cuff injuries can be acute, typically occurring in patients under 45 after a traumatic injury, but more commonly occur in patients over 45 without any recent trauma. These non-traumatic rotator cuff injuries are related to age, degeneration, overuse, bone structure, and posture. Injuries to the biceps tendon on the front of the shoulder are most commonly chronic and associated with overuse. In some cases people can also rupture the biceps tendon. The labrum, which is a cartilaginous ring that provides support and stability around the glenohumeral joint, can also degenerate and tear. Much like the rotator cuff, acute injuries to the labrum are more common in younger patients while older patients are more susceptible to chronic wear and tear.
At Spine West we are fortunate to have x-ray and musculoskeletal ultrasound on site. In addition to the history and physical exam, these modalities are an efficient way of quickly diagnosing a shoulder injury. However, in some cases an MRI is needed to be certain of the diagnosis. We can help carefully assess anatomy, structural issues, and imbalances to keep your shoulders moving and functional.
Treatment for most shoulder injuries is usually conservative. This can include medications such as anti-inflammatories, and physical therapy for range of motion, strengthening, and stability. Activity modifications, both short and long term, are sometimes necessary. In recalcitrant or more severe cases, injections can be helpful for both osteoarthritis of the joints and injuries to the soft tissue injuries of the rotator cuff, biceps tendon or labrum. In some cases surgery may be indicated, such as with large rotator cuff or labral tears, especially in a younger patient
Written by: Vaheed Sevvom, PA-C