People go the physiotherapists for many reasons. The two most common are lower back injuries (47%) and shoulder injuries (33%). At least 50% of the population experiences a shoulder injury in their lifetime. Shoulders are easily overloaded with repetitive movements in work or training. Also, getting rid of a shoulder injury is not always easy. 40% of people consulting a general practitioner for shoulder injuries still have the same injury one year later.
In this article, we will discuss the 5 most common shoulder injuries (since there are so many). In our next article (part 2), we will provide information on the shoulder anatomy and how to lower your risk of obtaining injuries in the first place.
1. Sub-acromial Pain Syndrome (SAPS), a.k.a. Impingement Syndrome
This problem is usually the result of overload, such as repetitive movements above shoulder height. Painting a wall or common shoulder exercises like shoulder press can easily overload your shoulders.
Most people with SAPS will recognize a short sharp pain when they lift up their arms between 60-120 or > 160 degrees abduction. They also feel pain when putting on a jacket, getting something from the back of their trousers or in spontaneous reaching movements. In a resting position, most people with SAPS don’t have pain or problems.
When you overload your shoulder joint, the space in the joint reduces. There can be a swollen tendon or bursa causing pain. In this case, rest can help reduce the pain. Coordination in the shoulder blade for a long period of time, in combination with overload, can cause the pain as well. In that case, you need to rebuilt the coordination of these muscles. We will discuss this later.
2. Bursa Inflammation
In the shoulder joint sits the subacromial bursa. It is like a soft sac structure filled with liquid. It’s under the supraspinatus tendon and prevents the tendon from sanding against the joint. Bursa inflammation is often a result of overloading the joint, but can also arise spontaneously. The bursa will then swell up so will hit other structures when you move. Symptoms are pain in the evening and at night, a dull pain somewhere around the shoulder and a lot of symptoms like in the case of SAPS syndrome. Usually, a GP will give you some medication and advice rest for this injury.
3. Rotator Cuff Rupture
There are 4 muscles that provide most stability for the shoulder. Supraspinatus, infraspinatus, teres minor and subscapularis. In high explosive sports in which the shoulder joint is used optimally – like handball, badminton or volleyball – there is pressure on the tendons of these muscles. An unfortunate movement or great resistance could lead to small or big ruptures of the rotator cuff. You will usually feel this in the end positions of the shoulder joint or when giving a lot of power.
Additionally, after 50 years of age your tendons will change and start degenerating (sorry, it’s not our fault). Even without doing any sports, a rotator cuff muscle might tear simply due to wear. It is important that you immediately see a physiotherapist when you have this kind of injury.
4. Dislocated Shoulder
This mostly occurs to people who are hyper mobile. Hyper mobility is having a bigger range of motion (ROM) than is common for people. For example extending the knees far beyond 0 degrees or easily moving the shoulder above 180 degrees. Having a bigger ROM usually comes with lower stability, especially in the shoulder. This is because the shoulder muscles that provide stability and the other shoulder structures are far more flexible than is usual. These people need to have a higher than normal stability strength in their muscles to be on par with lower mobile people.
You can recognise a dislocated shoulder as follows: a visibly deformed or out-of-place shoulder, swelling or bruising, intense pain and or inability to move the joint. If you dislocate a shoulder it can tear the shoulder tissue. This could result in an even lower stability and dislocating the shoulder more often. It is highly recommended that you see a doctor or physical therapist. They can examine your shoulder and try to train the stability. If training does not work and dislocating keeps happening an operation can help as a last resort.
5. Weight Lifter Shoulder
This injury often occurs in exercises where the elbows are lowered behind the shoulders (bench press, dumbbell fly’s, etc.). This motion places extra stress on the top of the shoulder (acromioclavicular joint). Over time this can cause tears or little fractures. You may feel pain on the top of your shoulder. Rest a couple of days/weeks until the pain is away. Also, change your exercises or adjust the weight you’re lifting.
Take Home Message
For most shoulder injuries rest is a good first method to see if the body cures itself naturally. Working or exercising with a lot of repetitive motions or a lot of weight is a risk for getting these problems. If you have a shoulder injury, rest one week and see if it gets better. Be aware if the same injury comes back every few weeks or months. If it doesn’t get better, contact your phisotherapist to examine you. The faster they find the cause, the easier it is to get rid of it. If you want to know more about decreasing the risk of injury or train your shoulder stability check out out next article in this blogseries.
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