The shoulder is formed from three bones; the humerus, clavicle and scapula. These three are all connected with muscles, tendons and ligaments whilst the movement of all these structures is facilitated by a sack of fluid acting as a cushion.
The shoulder joint is very complex and unique in that it allows for a wide range of movement, allowing the hand to be placed in almost any point of space. However, the downside to this freedom is that shoulder injuries cause individuals an enormous amount of discomfort and difficulty of movement.
Here are some of the most common injuries:
- Broken Collar Bone
- Shoulder Dislocation
- Frozen Shoulder
- Rotator Cuff Injury
- Shoulder Bursitis
- Shoulder Seperation
A fractuerd clavicle is commonly referred to as a broken collarbone. A broken collarbone frequently occurs when someone falls onto either onto an out stretched hand or elbow or onto the tip of a shoulder. The force transmitted up the arm is often enough to break the clavicle
The symptoms of such a break are usually excruciating pain in addition to an audible snapping or cracking sound. Depending on the severity of the fracture, there could be an obvious bump where the collarbone has broken.
Immediate care of a broken collarbone is to first stop any movement of the arm. A sling or a figure-of-eight harness is a good way of immobilising the clavicle. Ice application is advsied to reduce any impeding inflammation. An x-ray can determine the extent of damage.
After a few weeks in a sling, an Osteopath can help to gently mobilise stiff muscles around the injury and also prescribe a series of exercises to help rehabilitate the shoulder to full strength and function.
A dislocated shoulder is a common shoulder injury in contact sports such as rugby and martial arts. A dislocated shoulder is characterised by severe shoulder pain and hospital treatment is required to restore normal shoulder anatomy.
Active physical therapy rehabilitation is usually started after two to three weeks immobilisation in a sling. The goals of Osteopathic treatment for a dislocated shoulder are to restore shoulder stability by strengthening the rotator cuff muscles, before increasing shoulder range of movement.
Frozen shoulder or ‘adhesive capsulitis’ is a common cause of shoulder pain. It refers to inflammation and scarring of the capsule which surrounds the shoulder joint. It tends to affect people aged between 40 and 60, with women affected more than men.
The two main symtpoms of frozen shoulder are pain and a gradual loss of range of movement in most directions. The reasons for this injury are largely unknown but ‘adhesion’ (scar tissue) begins forming in the joint capsule.
The most important thing to do with a frozen shoulder is not to ingnore it. The injury can last for over 12 months in some circumstances and the sooner treatment and rehabilitation exercises are started, the quicker the recovery time.
Rotator Cuff Injury
The rotator cuff are four deep muscles which extend from the shoulder blade to the arm bone. They control movement in the shoulder joint. They attach to the bones via tendons. Both the tendons and the muscles are susceptible to tearing and inflammation.
Rotator cuff tears occur due to injury or overuse. Actvities that require overhead movements such as swimming, weight-lifting and throwing tend to cause such problems. One of the most common injuries is to the supraspinatus tendon which runs through a small space between the top of the armbone and the tip of the shoulder. The tendon is susceptible to wear and tear here and can often tear.
The symptoms of a rotator cuff injury are pain at the top of the upper arm. Lifting the arm up to the side is usually painful, particularly around 90 degrees.
Early management of a rotator cuff injury involves activity modification. Applying ice every few hours for 20 minutes can also help. After this, an Osteopath will determine whether an MRI is neccesary to highlight the severity of the injury.
If the pain is severe enough, a consultant may give a localised cortico-steroid injection to reduce the inflammation. Following this, it’s important to begin a thorough rehabilitation programme to regain full range of motion and strength in the shoulder.
Shoulder bursitis is a common cause of shoulder pain that is often related to rotator cuff injury and tendonitis. This condition is sometimes called shoulder impingement syndrome. Shoulder bursitis can occur as a result of the subacromial bursa being squashed or ‘impinged’ between the rotator cuff muscles and the bone, during repeated overhead shoulder movements.
An Acromioclavicular joint sprain or ‘shoulder separation’ is a common cause of shoulder pain. A shoulder separation usually occurs when there is either a fall onto an out stretched hand or direct contact to the tip of the shoulder. This shoulder injury occurs frequently in rugby, Australian Rules and American football.
A shoulder separation produces damage to the Acromioclavicular (AC) joint ligaments, which causes shoulder pain and a restriction of shoulder movement. Ice therapy can be very helpful to provide shoulder pain relief.