Common Causes of Shoulder Injuries

The shoulder is one of the most mobile joints in the body, capable of moving up to 180 degrees in a variety of planes, such as front to back and across the body. This versatility of movement aids performance in many activities and sports but leaves the shoulder uniquely vulnerable to painful and often debilitating injuries. In fact, shoulder problems account for 35% to 40% of all orthopedic injuries.

Shoulder troubles among athletes are common—but everyone is vulnerable. Even daily activities, such as household chores and yard work, can put tremendous strain on the shoulder joint.

Example: When carrying heavy boxes, people typically hold them well in front of the body, sometimes shoulder height or higher. These positions strain the shoulder and can result in soreness—or, in some cases, even permanent damage.

The most common shoulder injuries include rotator cuff tears (damage to the muscles/tendons that connect the upper arm bone, or humerus, to the shoulder blade). ..dislocations (in which the humerus separates from the socket)... and impingement syndrome (the tendons of the rotator cuff get trapped between the roof of the shoulder, or acromion, and the head of the humerus).

Some injuries, such as a partial rotator cuff tear, near dislocation and impingement syndrome, improve when treated with ice for 20 minutes every three to four waking hours (do not put ice directly on the skin-use a towel) and/or over-the-counter anti-inflammatories, such as ibuprofen (Advil) or naproxen (Aleve). Follow label directions.

If these strategies don't relieve your acute shoulder pain within 72 hours, see an orthopedist or other sports medicine-trained physician. You may need a prescription painkiller, such as hydrocodone and acetaminophen (Vicodin) or acetaminophen and codeine (Tylenol with codeine)...physical therapy. ..and/or surgery to correct the problem.

Even though shoulder injuries can occur during virtually any activity that requires overhead or extensive shoulder movements, overexertion during exercise is still the most common trigger. The changes associated with aging, such as loss of muscle mass and diminished tendon flexibility, increase the risk for such joint damage.

Most common traps-and how to avoid them…

Trap 1: Intermittent exercise. Injuries often occur after people take a hiatus from a sport or start a new exercise or activity-for example, in the spring, when people who have been sedentary all winter spend long hours on the tennis court or working in the yard.

Muscles have "memory"—when skeletal muscle activity is repeated, the muscles remember that activity and can continue to perform at that level. That's why people who exercise regularly are not as prone to injury as "weekend warriors'' (sedentary people who exceed their muscle memory on weekends).

Muscles and tendons require a longer warm-up time if you don't exercise daily, A good warmup includes five minutes of a gentle version of the exercise you're planning to perform.

Example: Talking before jogging...simulating a tennis serve...swinging a golf club without hitting a ball.

My recommendation: Before exercising, also be sure to stretch your shoulders. To do this, take a long towel and place it over your shoulder. Grip the top end with your right hand, and the bottom end with your left hand. Pull it up and down 10 to 15 times, bringing your right elbow up tov/ard the ceiling. Switch sides and repeat. This internal rotation stretch works the main muscles in the shoulders and helps prevent many injuries, including rotator cuff tears.

Important: Stretching before and after exercise is particularly important for people age 40 and older, regardless of their overall activity level. Stretching and warming up before exercise gets muscles ready for the activity. Stretching after exercise increases blood flow to help muscles heal and recover.

Trap 2: Lifting weights overhead. This is among the most popular exercises for strengthening the shoulders. It's also one of the most dangerous. Lifting heavy weights straight overhead while standing-often called a military press exerts tremendous stress on the shoulders. This exercise is a common cause of impingement.

My Recommendation: Use the incline press (which allows you to lift weights overhead while lying on an incline). It works the same muscles, but without placing so much stress on the shoulders. Even patients with a history of impingement usually can do incline lifts without discomfort or risk.

Trap 3: Hands out of sight. Studies show that when the hands and/or fingers are out of your peripheral line of vision when doing strength training, the benefits of the exercise are minimized and the risk for injury to shoulder muscles is greatly increased.

Example: You'll often see people lowering the bar on a pull-down machine behind the head. It's during that phase (when the hands disappear from sight) that the risk for subluxation (movement of the shoulder out of the joint) increases.

My recommendation: When exercising, always keep your hands in your direct or peripheral line of vision when looking straight ahead. When doing pull-downs, lower the bar in front of your head.

Trap 4: Too-wide grip. Most upper-body exercise equipment includes some sort of bar with handles. The handles are typically positioned for a man of average height, shoulder- spread and reach length. For women and smaller men, the handle grips are usually too far apart. This puts excessive stress on the rotator cuff, which can cause damage and/or possible dislocation of the shoulder joint.

My recommendation: Grip the bars on exercise equipment no more than shoulder-width apafi, regardless of where the handles are. The narrower grip reduces shoulder stress.

Trap 5: Overtraining. Performing exercises that work the same muscles every day leads to injuries, because muscle fibers don't have a chance to recover.

My recommendation: Give the shoulders time to recover by doing a different kind of workout-aerobics, weight-lifting, sports, etc.- every other day. On weekends, pick an activity you haven't done during the week. If you were sedentary, vary the workout (for example, work the upper body for a half hour and then the lower body for a half hour. Giving specific muscles a day of rest promotes muscle healing and faster recovery-and reduces risk for soreness or injuries.

RED FLAGS

If you experience any of the following signs of shoulder injury-or any kind of acure shoulder pain and/or restricted movement for more than a few days-see an orthopedic physician…

• Pain when you are putting on a coat or when you're reaching around to the backseat of a car could be signs of impingement or rotator cuff irritation.
• Inability to lift your arm from your side and raise an object above shoulder height without arching your back. This can indicate a serious rotator cuff tear.
• Inability to sleep on one shoulder due to pain. It is often a sign of early-stage rotator cuff damage.
• Pain when reaching for objects overhead. This can indicate impingement or other shoulder problems.

Caution: If you experience severe shoulder pain, go to the hospital right away. You could have a dislocated shoulder.