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Shoulder Problems / Shoulder Injuries

by Joe F de Beer

Introduction

Shoulder injuries are common in all different ages. These injuries can occur from sporting and other accidents as well as from repetitive actions (e.g. factory workers and certain everyday activities where repeated movements lead to wear of the structures around the shoulder) and thirdly in older people where minimal force can damage degenerated structures.

1. Injuries:

Shoulder injuries can occur from direct falls onto the shoulder or indirect forces where the arm is outstretched and causes an injury to the shoulder- the force is applied to the lever of the arm which injures the pivot (the shoulder joint).

2. Falling directly onto the shoulder may cause:

Tears of the rotator cuff
AC joint injuries (AC joint is the joint between the collar bone and shoulder bone)
Fractures of the collar bone or the shoulder bones (ball and socket) themselves

3. Indirect forces onto the shoulder:

Falls where the arm is forced outwards and backwards can lead to a dislocation of the shoulder. If this happens the stabilising ligaments can be torn and this may result in repeated (recurrent) dislocations.

4. Specific sports shoulder injuries:

In certain sports shoulder injuries are more common than in other sports. For instance, in rugby and football direct contact and indirect forces causing shoulder dislocations are not uncommon. In rugby the most common shoulder injuries are to the AC (acromio-clavicular) joint. This can usually be treated conservatively without surgical intervention.

5. Repetitive throwing in sports:

In throwing sports like baseball and cricket, the repetitive nature of the injury leads to failure of certain structures like the rotator cuff and labrum (cartilage in the joint). This may lead to “acquired instability” of the joint and “SLAP lesions”

6. Repetitive shoulder injuries:

In certain occupations and sports a repeated motion may lead to wear and tear, swelling and even failure (tearing) of structures. An example would be a person that is a painter having to reach up all day during overhead motion. The rotator cuff might swell and become severely inflamed resulting in a condition referred to as rotator cuff “tendonitis” for “bursitis”. Certain gym exercises may also injure structures like the AC joint, rotator cuff and biceps tendon.

7. Degenerative shoulder injuries:

In older people when the tendons and ligaments start becoming weak injuries may occur with minimal force. It is well known that rotator cuff tears may develop with almost no force at all and in fact tear spontaneously. This is due to poor blood supply to the tendon making the tendon more vulnerable. In some instances there may slight degenerative arthritis not causing any symptoms and the activity may them bring the pre-existing condition to the fore.

Many of the above mentioned shoulder injuries can be treated conservatively but some, especially rotator cuff tears, may require surgical repair.