What Can Go Wrong With The Shoulder
Shoulder instability occurs when the shoulder feels like it might slip out of place.
The shoulder joint is too loose and is able to slide around too much in the socket and in some cases the head of the upper arm bone slips out of the socket dislocating the shoulder.
Shoulder instability most commonly occurs following a traumatic incident that partially or completely dislocates the shoulder.
People, especially athletes, who do repeated shoulder motions may gradually stretch out the joint capsule, which will lead to shoulder instability.
A genetic predisposition can lead to ligaments being stretched too easily and not be able to hold the joints in place. All the joints of the body may be too loose and easily dislocated. People with this condition are sometimes referred to as double-jointed.
Symptoms of shoulder instability include pain, arm numbness, soreness and arm weakness.
If not treated, instability can lead to arthritis of the shoulder joint.
The shoulder joint is particularly prone to dislocations due to its high mobility, which sacrifices stability.
A fall onto an outstretched hand, arm or the shoulder itself, or a violent twisting, can cause a shoulder dislocation.
- sudden, severe pain, and often a feeling of the shoulder 'popping out'.
- pain is worse with movement
If there is any nerve or blood vessel damage there may also be pins and needles, numbness or discoloration through the arm to the hand.
Once a shoulder has dislocated, it is vulnerable to repeat episodes.
Treatment for a dislocation is ice applied immediately after the injury to decrease pain, swelling and bleeding around the joint.
Follow R.I.C.E. regime for the first 72 hours after injury.
A dislocated shoulder needs immediate medical care. Doctors treat dislocations by using gentle traction to pull the shoulder back into place.
Following relocation of the shoulder, most patients heal well with appropriate physiotherapy treatment.
Treatment for a dislocated shoulder usually entails an initial period of approximately 3 weeks immobilization in a sling (less time for older patients) to allow the damaged connective tissue to heal.
Supplementation with high dose magnesium will help to reduce the stiffness of the muscle around the shoulder, back and neck and will reduce pain, speeding up the healing process.
The focus is on restoreing shoulder stability by strengthening the Rotator Cuff muscles, before increasing shoulder range of movement.
Avoid the combined movements of abduction (taking the arm out to the side) and external rotation (turning the shoulder outwards) for at least 6 weeks, as this is often the position the injury occurred.
Isometric Shoulder Extension:
Stand with your back against the wall and your arms straight at your sides. Keeping your elbows straight, push your arms back into the wall. Hold for 5 seconds, then relax. Repeat 10 times.
Isometric Shoulder External Rotation:
Stand with the injured side of your body against a wall. Bend your elbow 90 degrees. Push your arm into the wall. Hold for 5 seconds, then relax. Repeat 10 times.
Isometric Shoulder Internal Rotation:
Stand in a corner or in a door frame. Place the injured arm against the wall around the corner, bending your elbow 90 degrees. Push your arm into the wall. Hold for 5 seconds, then relax. Repeat 10 times.
After six weeks progress strengthening to resisted exercises if pain free.
Continue with mobility exercises to maintain full range of motion.
Biceps Tendon Tear
The upper end of the biceps muscle has two tendons that attach it to bones in the shoulder.
The long head attaches to the top of the shoulder socket (glenoid).
The short head attaches to a bump on the shoulder blade called the coracoid process.
Many tears do not completely sever the tendon and are called partial tears.
A complete tear will split the tendon into two pieces.
Many tears are the result of a wearing down and fraying of the tendon that occurs slowly over time due to ageing or repetitive shoulder motion (swimming, tennis, weightlifting) or an injury, such as falling down with your arm outstretched.
Using corticosteroids has been linked to increased muscle and tendon weakness.
The long head of the biceps tendon is more likely to be injured.
Fortunately, the short head of the biceps rarely tears and because of this second attachment, many people can still use their biceps even after a complete tear of the long head.
- Sudden, sharp pain in the upper arm
- Sometimes an audible pop or snap
- Cramping of the biceps muscle with strenuous use of the arm
- Bruise of the upper arm
- Pain or tenderness at the shoulder and the elbow
- Weakness in the shoulder or the elbow
- Difficulty turning the arm palm up or palm down
- Bulge in the upper arm above the elbow (“Popeye Muscle”) may appear, with a dent closer to the shoulder.
One of the key components of treatment is that the patient rests from any activity that increases their pain until they are symptom free.
R.I.C.E regime is beneficial in the first 72 hours following injury or when inflammatory signs are present.
Gradual flexibility and strengthening program is recommended for patients with a biceps rupture.
Bursitis is inflammation of the bursa, the small sack of fluid that helps to lubricate the supraspinatus tendon.
A bursa can become inflamed from injury, infection (rare in the shoulder), or due to an underlying rheumatic condition.
- pain, worse with movement and usually increasing at night
- warmth, redness and swelling, if infection is present
As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.
Apply ice for 20 minutes every 2 hours during the first 2-3 days.
Avoid any movements that will provoke pain. Wear a sling or have your shoulder taped to provide pain relief.
Massage, acupuncture and Arnica cream can help reduce the pain and swelling and encourage healing during this stage.
It is important to avoid activities that irritate the rotator cuff tendons, such as overhead weight lifting (such as military press, etc), throwing activities, sleeping with the arm over or behind your head.
Symptoms related to shoulder bursitis may take several weeks to improve.
Once the shoulder pain and inflammation have resolved, focus on exercises to restore shoulder range of movement, muscle strength and stability.