Shoulder Injury

coracromial+ligamentEach year, millions of people see orthopedists with some kind of shoulder injury. Out of these, more than 60 percent are rotator cuff problems. The remaining forty percent are predominantly upper arm sprains and strains.

Shoulder injuries are frequently caused by activities that involve excessive, repetitive, overhead motion, such as swimming, tennis, pitching, and weightlifting. However, injuries can also occur during everyday activities such as washing walls, hanging curtains, and gardening.

Contrary to the popular view, the weaker the shoulder, the more prone to injury. I state “popular” because most physicians recommend a complete rest when the patient reports any pain. Pain, however, can be “good” and “bad.” The former is the kind of pain that strengthens you. Unfortunately, you often need to go through the former to avoid the latter. Thus, even “doing nothing” – and especially doing nothing – can cause you some form of injury and pain.

Indicators that something is not in order: stiffness, limited rotation, popping sounds, lack of strength to carry out everyday activities.

Most problems in the shoulder involve the muscles, ligaments, and tendons, rather than the bones. Most pain results from the “rubbing” of the bones due to the inflamed coracoacromial ligament, which is a strong triangular band extending between the coracroid process and the acromion, part of the protection of the head of the humerus.

This ligament is sometimes described as consisting of two marginal bands and a thinner intervening portion, the two bands being attached respectively to the apex and the base of the coracoid process, and joining together at the acromion. Most of our shoulder pain originates from the scraping of this ligament and its inflammation. This is referred to as IMPINGEMENT.

Impingement is caused by excessive rubbing of the shoulder muscles against the top part of the shoulder blade, called the acromion. Impingement takes place when we are not warmed-up and make a sudden extensive motion, “overreach” with the arm. It can happen after sitting in the office for a long time and then swinging a heavy bag on the seat or into the trunk of your car.

INSTABILITY and DISLOCATION constitute one type for problems. These are indicated when raising your arm causes you pain or when you feel as if the joint was “slipping out of place.”

The ROTATOR CUFF is one of the most important components of the shoulder. It is comprised of a group of muscles and tendons that hold the bones of the shoulder joint together and enable you to lift your arm and reach overhead.

Shoulder Exercises
Any push-ups and press-ups (on the floor or against the wall) focus on the front deltoid. They do not strengthen and repair impingement, in fact, in my experience, may make it worse. They can aid instability and dislocation though.

The only exercise, guaranteed to help impingement, the pain you probably suffer from, is simply hanging from a horizontal bar, which extends the gap for the coracoacromial ligament. In conjunction with lateral dumbbell raises (high rep, low weight), it is definitely worth trying before you decide for any surgery. Give it 4-6 weeks, 10 minutes a day.

Anti-inflammatory medication (Ibuprofen) also may be prescribed to reduce pain and swelling, thus facilitate recovery. I do not recommend complete rest, unless you have suffered from a torn rotator cuff or a severe injury (result of an accident) or when otherwise indicated by your orthopedist.

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