Been experiencing shoulder pain for a while. Right shoulder. From the point of the shoulder down my huge bicep (hah) to my elbow. It's not intense, just nagging. I can move it. I can reach over my head. I can lift things. I can throw things. Just feels uncomfortable, especially sleeping on it, reaching up and back, or holding my arm laterally. I remember a guy at work complaining about something similar. He ended up having surgery. So I did a little research and I learned a lot. Now I might turn out to be a self-diagnosing hypochondriac, but I think I have a torn rotator cuff. Hmm. Maybe it's just bursitis or tendinitis.
Here's what I dug up. Four articles I found on the web describing how the shoulder works and related problems and treatments. - CJK
1. Common Injuries of the Shoulder
Whether throwing a ball, paddling a canoe, lifting boxes, or
pushing a lawn mower, we rely heavily on our shoulders to perform a number of
activities. Normally, the shoulder has a wide range of motion, making it
the most mobile joint in the body. Because of this flexibility, however, it is
not very stable and is easily injured.
The shoulder is made up of 2 main bones: the end of upper arm
bone (humerus) and the shoulder blade (scapula). The end of the humerus is
round, and it fits into a socket in the scapula. The scapula extends around the
shoulder joint to form the roof of the shoulder, and this joins with the collar
bone (clavicle). Surrounding the shoulder is a bag of muscles and
ligaments. Ligaments connect the bones of the shoulders, and tendons connect the
bones to surrounding muscle. Four muscles begin at the scapula and go around the
shoulder and attach to the humerus, these are the rotator cuff.
When the shoulder moves, the end of the humerus moves in the
socket. Very little of the surface of the bones touch each other. Ligaments and
muscles keep the humerus from slipping out of the socket and keep the clavicle
attached to the scapula.
Rotator cuff tear
The rotator cuff is a group of 4 muscles of the upper arm that
raise and rotate the arm. The muscles are attached to the bones by tendons. The
job of muscles is to move bones. The tendons of the rotator cuff allow the
muscles to move the arm. If the tendons tear, the humerus can't move as easily
in the socket, making it difficult to move the arm up or away from the body.
As people age and their physical activity decreases, tendons
begin to lose strength. This weakening can lead to a rotator cuff tear. Rotator
cuff injuries occasionally occur in younger people, but most of them happen to
middle-aged or older adults who already have shoulder problems. This area of the
body has a poor supply of blood, making it more difficult for the tendons to
repair and maintain themselves. As a person ages, these tendons degenerate.
Using your arm overhead puts pressure on the rotator cuff tendons. Repetitive
movement or stress to these tendons can lead to impingement, in which the tissue
or bone in that area becomes misaligned and rubs or chafes.
The rotator cuff tendons can be injured or torn by trying to
lift a very heavy object while the arm is extended, by falling, or by trying to
catch a heavy falling object.
Symptoms of a torn rotator cuff include tenderness and
soreness in the shoulder during an activity that uses the shoulder. A tendon
that has ruptured may make it impossible to raise the arm. It may be difficult
to sleep lying on that side, and you may feel pain when pressure is put on the
shoulder.
Treatment depends on the severity of the injury. If the tear
is not complete, your health care provider may recommend RICE, for rest, ice,
compression and elevation. Resting the shoulder is probably the most important
part of treatment, although after the pain has eased, you should begin physical
therapy to regain shoulder movement. Your doctor may prescribe a nonsteroidal
anti-inflammatory drug (NSAID) for pain.
2. Common Culprits of Shoulder Pain
http://community.mainlinehealth.org/Blogs/Well-Ahead/March-2012/Common-Causes-and-Treatments-of-Shoulder-Pain.aspx?feed=blogs
Years of reaching for the can on the top grocery shelf, shampooing your hair and even reaching for the car radio have begun to take their toll. Many Americans are now affected by shoulder pain, especially middle-aged men and women in their forties, fifties and sixties. Unfortunately, alleviating this pain isn’t as easy as taking a pill every four hours. Instead, depending on the cause, shoulder pain often requires a surgical solution.
Below,
Dr. Kevin Mansmann, orthopedic surgeon at
Paoli Hospital, explores the causes and treatment options for three common culprits of shoulder pain.
Rotator Cuff Tears
One of the most common shoulder injuries is a rotator cuff tear, which is the result of the rubbing and fraying of the cuff tendon after a long period of time. While a traumatic injury can result in a rotator cuff tear, they typically occur as a result years of wear and tear from everyday activities.
“Rotator cuff tears are most commonly associated with active patients, often males, affecting the dominant arm,” says
Dr. Mansmann. “The majority of tears come from years of overuse or moving your arm in a repetitive motion.” Athletic weekend warriors are at a high risk for rotator cuff tears.
Treatment: Partial rotator cuff tears can heal with physical therapy, and often don’t require a surgical solution. However, partial tears with continued pain and full thickness tears often require surgery.
Bursitis and Tendonitis
Bursitis and tendonitis are common conditions that cause swelling around muscles and bones, including the shoulder. Like a rotator cuff tear, they are caused by repetitive arm motions, but are less severe.
Bursitis occurs when a bursa, the fluid-filled sac that acts as a lubricant between a bone and muscle, skin or tendon, becomes inflamed.
Tendonitis is an inflammation of a tendon. Both problems are caused by excessive use, exceeding conditioning, with repeated, minor injury of the affected area, and can lead to a rotator cuff tear if left untreated.
Treatment: Both bursitis and tendonitis are typically easily treatable issues. Resting, stretching before and after an activity, and applying ice to the affected area can often help to alleviate pain. Injections are very helpful if activity modification is unsuccessful.
Conditions like these can happen to anyone, so
Dr. Mansmann offers some advice for those looking to avoid shoulder problems in the future.
“Stay reasonably fit,” he says. “The best prevention of shoulder pain is to participate in an exercise program and avoid weekend warrior activities that exceed your level of conditioning.
"Don’t push through the pain either, says
Dr. Mansmann. Exercising through shoulder pain can make injuries worse, so don’t push through activities, that you may have been able to do easily before, like shoveling snow. Pace yourself.
If you find yourself experiencing shoulder pain regularly, make an appointment with your physician to determine the cause.
3. Rotator Cuff Tears
http://orthoinfo.aaos.org/topic.cfm?topic=a00064
A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem.
A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.
Normal anatomy of the shoulder.
Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a network of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
This illustration more clearly shows the four muscles and their tendons that form the rotator cuff and stabilize the shoulder joint.
Reproduced with permission from The Body Almanac. (c) American Academy of Orthopaedic Surgeons, 2003.
When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved.
In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
There are different types of tears.
- Partial Tear. This type of tear damages the soft tissue, but does not completely sever it.
- Full-Thickness Tear. This type of tear is also called a complete tear. It splits the soft tissue into two pieces. In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon.
A rotator cuff tear most often occurs within the tendon.
Cause
There are two main causes of rotator cuff tears: injury and degeneration.
Acute Tear
If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.
Degenerative Tear
Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder -- even if you have no pain in that shoulder.
Several factors contribute to degenerative, or chronic, rotator cuff tears.
- Repetitive stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well.
- Lack of blood supply. As we get older, the blood supply in our rotator cuff tendons lessens. Without a good blood supply, the body's natural ability to repair tendon damage is impaired. This can ultimately lead to a tendon tear.
- Bone spurs. As we age, bone spurs (bone overgrowth) often develop on the underside of the acromion bone. When we lift our arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement, and over time will weaken the tendon and make it more likely to tear.
Risk Factors
Because most rotator cuff tears are largely caused by the normal wear and tear that goes along with aging, people over 40 are at greater risk.
People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes are especially vulnerable to overuse tears, particularly tennis players and baseball pitchers. Painters, carpenters, and others who do overhead work also have a greater chance for tears.
Although overuse tears caused by sports activity or overhead work also occur in younger people, most tears in young adults are caused by a traumatic injury, like a fall.
The most common symptoms of a rotator cuff tear include:
- Pain at rest and at night, particularly if lying on the affected shoulder
- Pain when lifting and lowering your arm or with specific movements
- Weakness when lifting or rotating your arm
- Crepitus or crackling sensation when moving your shoulder in certain positions
Tears that happen suddenly, such as from a fall, usually cause intense pain. There may be a snapping sensation and immediate weakness in your upper arm.
A rotator cuff injury can make it painful to lift your arm out to the side.
Tears that develop slowly due to overuse also cause pain and arm weakness. You may have pain in the shoulder when you lift your arm to the side, or pain that moves down your arm. At first, the pain may be mild and only present when lifting your arm over your head, such as reaching into a cupboard. Over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain at first.
Over time, the pain may become more noticeable at rest, and no longer goes away with medications. You may have pain when you lie on the painful side at night. The pain and weakness in the shoulder may make routine activities such as combing your hair or reaching behind your back more difficult.
Doctor Examination
Medical History and Physical Examination
Your doctor will test your range of motion by having you move your arm in different directions.
Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.
After discussing your symptoms and medical history, your doctor will examine your shoulder. He or she will check to see whether it is tender in any area or whether there is a deformity. To measure the range of motion of your shoulder, your doctor will have you move your arm in several different directions. He or she will also test your arm strength.
Your doctor will check for other problems with your shoulder joint. He or she may also examine your neck to make sure that the pain is not coming from a "pinched nerve," and to rule out other conditions, such as arthritis.
Imaging Tests
Other tests which may help your doctor confirm your diagnosis include:
- X-rays. The first imaging tests performed are usually x-rays. Because x-rays do not show the soft tissues of your shoulder like the rotator cuff, plain x-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur.
- Magnetic resonance imaging (MRI) or ultrasound. These studies can better show soft tissues like the rotator cuff tendons. They can show the rotator cuff tear, as well as where the tear is located within the tendon and the size of the tear. An MRI can also give your doctor a better idea of how "old" or "new" a tear is because it can show the quality of the rotator cuff muscles.
If you have a rotator cuff tear and you keep using it despite increasing pain, you may cause further damage. A rotator cuff tear can get larger over time.
Chronic shoulder and arm pain are good reasons to see your doctor. Early treatment can prevent your symptoms from getting worse. It will also get you back to your normal routine that much quicker.
The goal of any treatment is to reduce pain and restore function. There are several treatment options for a rotator cuff tear, and the best option is different for every person. In planning your treatment, your doctor will consider your age, activity level, general health, and the type of tear you have.
There is no evidence of better results from surgery performed near the time of injury versus later on. For this reason, many doctors first recommend nonsurgical management of rotator cuff tears.
Nonsurgical Treatment
In about 50% of patients, nonsurgical treatment relieves pain and improves function in the shoulder. Shoulder strength, however, does not usually improve without surgery.
Nonsurgical treatment options may include:
- Rest. Your doctor may suggest rest and and limiting overhead activities. He or she may also prescribe a sling to help protect your shoulder and keep it still.
- Activity modification. Avoid activities that cause shoulder pain.
- Non-steroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
- Strengthening exercises and physical therapy. Specific exercises will restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.
- Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine.
A cortisone injection may relieve painful symptoms.
Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.
The chief advantage of nonsurgical treatment is that it avoids the major risks of surgery, such as:
- Infection
- Permanent stiffness
- Anesthesia complications
- Sometimes lengthy recovery time
The disadvantages of nonsurgical treatment are:
- No improvements in strength
- Size of tear may increase over time
- Activities may need to be limited
Surgical Treatment
Your doctor may recommend surgery if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery. If you are very active and use your arms for overhead work or sports, your doctor may also suggest surgery.
Other signs that surgery may be a good option for you include:
- Your symptoms have lasted 6 to 12 months
- You have a large tear (more than 3 cm)
- You have significant weakness and loss of function in your shoulder
- Your tear was caused by a recent, acute injury
Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). There are a few options for repairing rotator cuff tears. Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.
4. How to Avoid Injuries to Your Rotator Cuff: Impingement Syndrome
http://www.hss.edu/conditions_rotator-cuff-injuries-impingement-syndrome.asp
Introduction
Shoulder pain is common in men and women who remain physically active in
their thirties and forties. There are many potential causes, but one of the more
common is something called impingement syndrome.
Impingement syndrome is
a condition that causes pain in the front of the shoulder, particularly with
overhead activities, resulting from
bursitis and tendinitis in
the rotator cuff tendon. Middle-aged men and women who lift weights regularly
are particularly prone to this condition because of muscle imbalances that can
develop around the shoulder with improper training. This can result in anterior
shoulder pain when lifting the arm above the shoulder or across the chest, often
with aching at night that makes it difficult to sleep.
The good news is
that this syndrome can largely be avoided by understanding the anatomy and
biomechanics of the shoulder, and following proper training techniques.
Using Proper Training Techniques
“Most people find it hard to find the time to fit a weight training program
into their already busy schedules,” explained
Lawrence Gulotta, M.D., a sports
medicine orthopedic surgeon at Hospital for Special Surgery. “When time is made,
it is usually limited and therefore we tend to focus on the muscles that give us
the biggest bang for our buck – namely the biceps, triceps, pectoralis major,
and deltoid. But taking this abbreviated approach to strengthening can lead to
muscle imbalances that cause pain.”
Workout enthusiasts know that if you strengthen one muscle, you should also
build comparable strength in that muscle’s antagonist – or the muscle that works
in the opposite direction. For example, most people understand that biceps
strengthening should be balanced with triceps strengthening in order to keep the
muscles around the upper arm that flex and extend the elbow at comparable
strength and tone.
But when it comes to the shoulder, the antagonist muscles become less
obvious, because many of them are buried beneath other structures and cannot be
seen by just looking at the shoulder.
Learning More about How the Shoulder Works
In the shoulder, the deltoid muscle elevates the arm to the level of the
shoulder and above; while simultaneously, the rotator cuff muscles contract to
keep the head of the humerus (the ball of the joint) from elevating and tightly
centered in the shoulder socket as the arm is lifted.
The deltoid and the rotator cuff are antagonists - that is, they perform
actions that are opposite of each other. When the deltoid muscle gets stronger
than the rotator cuff muscles, the head of the humerus is not pulled to the
center of the joint, migrates up out of the socket, and pinches (or “impinges”)
the rotator cuff tendon and surrounding soft tissues (the bursa) that cross
above the humeral head. The rotator cuff tendon is pinched in the limited space
between the shoulder joint and the boney “roof” of the joint (the acromion).
This repeated impingement causes progressive inflammation, swelling of the
tendon and bursa, and pain, the combination of which is called impingement
syndrome.
Treating and Preventing Impingement Syndrome
A key to treating or preventing impingement syndrome is to train the rotator
cuff muscles as effectively as you train the deltoid muscle, so that strength
around the shoulder remains in balance. You would never work your biceps without
triceps, or quads without hamstrings – so why work the deltoid and not the
rotator cuff?
The number one piece of advice
Russell Warren, M.D., team physician
for the Giants, provides to aspiring footballers echoes similar advice heard
from doctors and strength coaches everywhere: “Get in shape. Work out hard, but
always learn good techniques.”
Athletes should always listen to how their body responds to the activity they
engage in, and if they do have problems, they should adjust to them. “Just don’t
push through them,” advises Dr. Warren, who is a sports medicine orthopedic
surgeon at Hospital for Special Surgery. “It works the same way with a rehab
program – if something bothers you, shorten the duration, change the angle, or
give it up entirely. There are many different ways to do these exercises. A good
trainer or therapist will help make those adjustments.”
“At Hospital for Special Surgery we’re not only concerned with patient care,
but with bringing our knowledge of new conditions and treatments to others
involved in both professional and amateur sports medicine. It’s a large part of
why I became interested in doing this,” said Dr. Warren.
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