June 5, 2018
The anatomical structures of the shoulder are all highly interconnected. So much, in fact, that shoulder injuries rarely affect just one area of the joint. A single shoulder injury can affect multiple muscles, ligaments, cartilage areas, tendons, and bones.
Unfortunately, injuries are most likely to occur in those who rely on their shoulder the most—over-head athletes. Shoulder injuries are exceedingly common among athletes, especially those who compete in baseball, swimming, tennis, and football. This is often due to the repetitive workouts and intense competition that high-performance athletes endure.
Shoulder injuries, of course, are not limited to athletes. Professionals who frequently use their shoulder—such as those involved in painting, yard care, or construction—experience a higher risk of injury as well.
No matter how a shoulder injury occurs, everyone wants the same result: a fast recovery.
Dr. Robert Rolf is a leading, board-certified shoulder specialist at Beacon Orthopaedics & Sports Medicine. He has helped hundreds of patients in the Greater Cincinnati region achieve lasting improvements following their injuries.
The following information provides information from Dr. Rolf about the most common shoulder injuries and how they’re treated.
The shoulder is the most mobile joint in the body. It consists of three bones: the humerus, scapula, and clavicle. It also consists of many muscles and tendons that hold the shoulder bones in place and stabilize the arm through its full range of motion. The four major muscles and tendons of the shoulder come together to form the rotator cuff.
Here is an image to better illustrate the anatomical structure of the shoulder:
Rotator Cuff Tears
A rotator cuff tear occurs when any tendon of the rotator cuff rips, either partially or completely. Rotator cuff tears are among the most common types of shoulder injuries.
Rotator cuff tears are most common in people who repeatedly perform overhead motions. These tend to be people with active jobs—such as construction workers—or athletes, though anybody can end up with a rotator cuff tear whether they’re active or not.
Rotator cuff tears vary in severity from partial- to full-thickness tears, with partial tears being far more common. It’s possible for a patient to have a partial-thickness rotator cuff tear without even realizing it.
Symptoms of Rotator Cuff Tears
- Pain that radiates from the upper shoulder down the elbow
- Difficulty moving the afflicted shoulder
- Pain that becomes worse after laying on the afflicted shoulder
- A dully, achy sensation in the shoulder and upper arm
- Weakness when moving the shoulder
- Pain when raising arm overhead
Common Causes of Rotator Cuff Tears
- Acute trauma (such as a fall)
- Repeated stress
- Normal wear and tear (as the rotator cuff naturally becomes more brittle with age)
- Exercise and rehabilitation overseen by a physical therapist
- Improving posture and shoulder biomechanics
- Corticosteroid injections
- Platelet injections
There are two main surgical options for rotator cuff tear repair: tendon reattachment or partial-tear trimming (also called “debridement”). If the tear is full, the surgeon will reattach the torn ligament back onto the bone detached from. If the tear is partial, the surgeon will shave away the torn/frayed part of the rotator cuff, as that portion often causes the patient’s pain. Debridement only removes the damaged tissue and does not affect the stability of the rotator cuff.
In either case, the procedures are performed by shoulder arthroscopy. This is a minimally invasive surgical procedure that uses a small camera (called an arthroscope) to aid in examining and repairing the torn tendons without having to make a large incision or open the shoulder.
Shoulder impingement occurs when one or more rotator cuff tendons get trapped and pinched between shoulder bones during arm movement, causing extreme pain and swelling/inflammation of the rotator cuff.
Shoulder impingement is most common in people who participate in physical activities requiring repeated overhead movements—again, mostly athletes. Swimmers, softball players, basketball players, tennis players, and golfers are all high risk for impingement. In fact, shoulder impingement is so common in swimmers that it has the nickname “swimmer’s shoulder.”
Symptoms of Shoulder Impingement:
- Weakness of the shoulders
- Difficulty raising arms or reaching up behind back
- Shoulder joint pain that gets worse after overhead movement or sleep
- Pinching feeling when moving the shoulder
Causes of Shoulder Impingement:
- Any injury (such as a sudden fall) that causes the shoulder to swell
- Bone growth/abnormalities in the shoulder
- Shoulder osteoarthritis
- Overuse of the shoulder muscles
- Improper form when swimming
- Steroid injections
- Daily stretching
- Cortisone injections
- Therapy and activity modifications
Note: Surgery is typically only considered when several months of sport-appropriate nonsurgical rehabilitation efforts have failed.
Most shoulder impingement surgeries involve either shaving down part of the acromion in order to relieve pressure from the pinched tendons, or shaving off any bone spurs to achieve the same effect.
Dr. Rolf is able to perform the procedure using an arthroscopic technique, which means that there will only be two small incisions made into the shoulder; this will lead to less scarring and quicker healing.
Other Common Shoulder Conditions
What Does Physical Therapy for Shoulder Injuries Entail?
In the majority of instances, an orthopaedist will recommend physical therapy as part of the patient’s treatment plan.
First, the therapist will educate the patient on how the shoulder functions. The goal of this step is to help the patient understand how their posture and biomechanics may have contributed to their injury, and also to teach them how to avoid those issues in the future.
Evaluating and Retraining Movements
For athletes, it’s likely that some sort of improper form contributed to their injury. So, in physical therapy, the therapist and doctor will identify the improper form (if there is any) and train the patient on how to adjust their body mechanics.
Manual therapy is when a therapist or doctor will move and massage the recovering body part, as opposed to the patient moving it themselves. This gets the shoulder moving, which increases blood flow to the area, helps reduce inflammation, facilitates healing, and helps to improve range of motion after surgery.
Strength exercises are performed in order to restore strength to the shoulder. The type of strength exercises depends on the specific injury. Some injuries are exacerbated by weak muscles that cause other muscles to compensate. The physician will identify any weak shoulder muscles and recommend exercises to strengthen those muscles. Some of these exercises will be performed in the presence of the physician while others can be performed at home.
When the shoulder is painful, many patients naturally avoid using their arm. While this can help reduce the frequency of pain, it can also cause the shoulder to become stiff. Range-of-motion exercises are performed in order to restore flexibility in the shoulder.
The therapist will also teach the patient how to adjust their functional activities in order to accommodate their repaired shoulder. This may include how to swim, how to throw a ball, or how to place items on a shelf. These adjustments allow the patient to maintain their active lifestyle while lowering their risk of further injury.
Receive Personalized Advice from Dr. Rolf
While rotator cuff tears and impingement are among the most common shoulder injuries, shoulder pain can be caused by a number of conditions. Only a certified orthopedic specialist can accurately diagnose your condition and prescribe treatment that is appropriate for your specific injury.
Dr. Robert Rolf is a board certified orthopedic surgeon at Beacon Orthopaedics and Sports Medicine who provides extensive expertise in rotator cuff tears as well as other conditions related to the shoulder.
For your convenience, Dr. Rolf meets with patients at Beacon’s Batesville, Lawrenceburg, or Northern Kentucky locations as well as Beacon West in Harrison, Ohio. Schedule an appointment online to meet with Dr. Rolf to start your journey toward shoulder relief.