Weekly Wellness: Shoulder Health

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COLUMBIA - One of the most common joints to become injured is the shoulder joint. Almost 7.5 million visits were made to physicians' offices due to shoulder problems in 2006. (Source: National Ambulatory Medical Care Survey 1998-2006. Data obtained from: U.S. Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Health Statistics).

I see shoulder injuries a lot in my profession. I spend a lot of time helping to strengthen shoulders before and/or after a surgery, in many cases. Golfers tend to be the largest "shoulder issue" population for me.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) reports that many shoulder problems are caused by the breakdown of soft tissues in the shoulder region. Using the shoulder too much can cause the soft tissue to break down faster as people get older. Doing manual labor and playing sports may cause shoulder problems.

Doctors diagnose shoulder problems by using:

  • Medical history
  • Physical examination
  • Tests such as x rays, ultrasound, and magnetic resonance imaging (MRI).

Everyone who experiences shoulder pain should learn the word RICE. This should be your initial treatment when experiencing shoulder pain. RICE is Rest, Ice, Compression and Elevation:

  • Rest. Don't use the shoulder for 48 hours.
  • Ice. Put an ice pack on the injured area for 20 minutes, four to eight times per day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice wrapped in a towel.
  • Compression. Put even pressure (compression) on the painful area to help reduce the swelling. A wrap or bandage will help hold the shoulder in place.
  • Elevation. Keep the injured area above the level of the heart. A pillow under the shoulder will help keep it up.

So you're experiencing shoulder pain. What could it be? This is a list of the most common shoulder problems:

Dislocation: Dislocation occurs when the ball at the top of the bone in the upper arm pops out of the socket. It can happen if the shoulder is twisted or pulled very hard. To treat a dislocation, a doctor performs a procedure to push the ball of the upper arm back into the socket. Further treatment may include:

  • Wearing a sling or device to keep the shoulder in place
  • Rest
  • Ice three or four times a day
  • Exercise to improve range of motion, strengthen muscles, and prevent injury

Once a shoulder is dislocated, it may happen again. This is common in young, active people. If the dislocation injures tissues or nerves around the shoulder, surgery may be needed.

Separation: A shoulder separation occurs when the ligaments between the collarbone and the shoulder blade are torn. The injury is most often caused by a blow to the shoulder or by falling on an outstretched hand. Treatment for a shoulder separation includes:

  • Rest
  • A sling to keep the shoulder in place
  • Ice to relieve pain and swelling
  • Exercise, after a time of rest
  • Surgery (if tears are severe)

Rotator Cuff Disease: (Tendinitis and Bursitis): In tendinitis of the shoulder, tendons become inflamed (red, sore, and swollen) from being pinched by parts around the shoulder.

Bursitis occurs when the bursa (a small fluid-filled sac that helps protect the shoulder joint) is inflamed. Bursitis is sometimes caused by disease, such as rheumatoid arthritis. It is also caused by playing sports that overuse the shoulder or by jobs with frequent overhead reaching. Tendinitis and bursitis may occur alone or at the same time. Treatment for tendinitis and bursitis includes:

  • Rest
  • Ice
  • Medicines such as aspirin and ibuprofen that reduce pain and swelling Ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow
  • Gentle stretching and exercises to build strength
  • Injection of corticosteroid drug if the shoulder does not get better
  • Surgery (if the shoulder does not get better after 6 to 12 months)

Rotator Cuff Tear: Rotator cuff tendons can become inflamed from frequent use or aging. Sometimes they are injured from a fall on an outstretched hand. Sports or jobs with repeated overhead motion can also damage the rotator cuff. Aging causes tendons to wear down, which can lead to a tear. Some tears are not painful, but others can be very painful.

Treatment for a torn rotator cuff depends on age, health, how severe the injury is, and how long the person has had the torn rotator cuff. Treatment for torn rotator cuff includes:

  • Rest
  • Heat or cold to the sore area
  • Medicines that reduce pain and swelling
  • Electrical stimulation of muscles and nerves
  • Ultrasound
  • Cortisone injection
  • Exercise to improve range-of-motion, strength, and function
  • Surgery if the tear does not improve with other treatments

Frozen Shoulder: Movement of the shoulder is very restricted in people with a frozen shoulder. Causes of frozen shoulder are:

  • Lack of use due to chronic pain
  • Rheumatic disease that is getting worse
  • Bands of tissue that grow in the joint and restrict motion
  • Lack of the fluid that helps the shoulder joint move

Treatment for frozen shoulder includes:

  • Medicines to reduce pain and swelling
  • Heat
  • Gentle stretching exercise
  • Electrical stimulation of muscles and nerves
  • Cortisone injection
  • Surgery if the shoulder does not improve with other treatments

Fracture: A fracture is a crack through part or all of a bone. In the shoulder, a fracture usually involves the collarbone or upper arm bone. Fractures are often caused by a fall or blow to the shoulder.

Treatment for a fracture may include:

  • A doctor putting the bones into a position that will promote healing
  • A sling or other device to keep the bones in place
  • After the bone heals, exercise to strengthen the shoulder and restore movement
  • Surgery

Arthritis of the Shoulder: There are two types of arthritis that can affect the shoulder. They are osteoarthritis (a disease caused by wear and tear of the cartilage) and rheumatoid arthritis (an autoimmune disease causing one or more joints to become inflamed).

Osteoarthritis of the shoulder is often treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. People with rheumatoid arthritis may need physical therapy and medicine such as corticosteroids.

If these treatments for arthritis of the shoulder don't relieve pain or improve function, surgery may be needed.

So what can you do to prevent or improve your shoulder health?

Shoulder Blade Squeezes:
Begin sitting or standing tall with your back straight. Squeeze your shoulder blades together until you feel a mild to moderate stretch. Hold for 5 seconds and repeat 10 times provided the exercise is pain free.

Shoulder Flexion:
Begin standing tall with your back and neck straight. Gently raise your arm forwards and up until you feel a mild to moderate stretch pain free. Repeat 10 times.

Shoulder Abduction:
Begin standing tall, with your neck and back straight. Gently raise your arm to the side, leading with your thumb until you feel a mild to moderate stretch pain free. Repeat 10 times.

Shoulder External Rotation:

Begin standing tall, with your neck and back straight, your shoulders should be back slightly. Keeping your elbow tucked into your side and bent to 90 degrees, gently take your hand away from your body until you feel a mild to moderate stretch pain free. Repeat 10 times.

More shoulder stretches are available on the Physioadvisor website.