My Aching Shoulder

Similar to elbow injuries, the most common mechanism of injury to the shoulder is overuse. Specifically, it is most often injured when the upper limb ranges excessively in an “over the head” motion. While many of you are thinking of baseball pitching as the most common culprit…the sport that actually sets the stage for this injury is swimming. The elite female swimmer can tally up 750,000strokes/season and the seasoned male swimmer 400,000 strokes/season. This can be appreciated if related to driving a car with several hundred miles on you cars tire. Likely, those tires are worn out. Why is the shoulder so vulnerable to injury? The answer is reflective of the shoulders anatomy. Unlike most joints that have a limited direction of motion and many whose bones are well aligned, the shoulder (described as a Ball and Socket joint) is a loose and free-floating joint. The two main bones of the shoulder, the humerus and the scapula, are held together by ligaments (a tissue structure that holds bones together) and muscle (a tissue that moves bones). In addition, the joint has limited inherent stabilizing support (labrum). Specific injuries of the shoulder include: Rotator Cuff tendonitis and Little League Shoulder (an injury of the shoulders growth plate and due to overuse). When one suffers with Rotator Cuff tendonitis, weakness when raising the arm above the head may be noted. In addition, one may complain of shoulder pain in the evening and when trying to reach the affected limb behind the back. For Little League Shoulder, one of the first signs of injury is a subtle loss of velocity of the pitch. 

Treatment for these requires a period of relative rest. If a certain movement or position induces pain, it should not be done. Typically the minimum healing time is two-three weeks. Liberal use of ice massage helps (5 minutes on, applied through a towel onto the skin and five minutes off). Once the pain is significantly reduced, a program of strengthening the rotator cuff and associated muscles begins. This program should begin through the guidance of a skilled medical clinician. 

Another injury of the shoulder but not of the overuse variety is Instability. This injury is almost always accompanied by direct trauma. Usually it results from falling onto an outstretched upper limb. The child may complain of a “loose” feeling in the shoulder and when he places the upper limb in a certain reproducible position, there is pain. If the fall to the ground is significant, the child may suffer a frank dislocation, in which case the child will not willingly move the upper limb voluntarily. For instability, a short period of rest is recommended. Once the pain subsides, a rigorous therapy program to strengthen the muscles that support and stabilize the shoulder, namely the rotator cuff muscles, is recommended. Finally, there is the Separated Shoulder. This is almost always traumatic in origin and due to a direct blow to the shoulder. Pain is noted in front of the shoulder along the collarbone (Clavicle). There may even be a “step-off” felt where the joint (AC=acromiclavicular) is separated or along the clavicle, where there may be a fracture. For either, a visit to the orthopaedist is recommended.