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1. Rotator cuff tendinopathy

The rotator cuff refers to a group of four small muscles which run from the shoulder blade to the top of the arm bone. They support and move the shoulder joint. The rotator cuff muscles attach to the arm bone by tendons. Rotator cuff tendinopathy refers to inflammation and swelling within one or more of these tendons. Rotator cuff tendinopathy results from overuse or injury to a rotator cuff tendon. The most commonly involved tendon is that of the supraspinatus muscle. This muscle helps to raise the arm into the air. Its tendon passes through a small space between the top of the arm bone and the point of the shoulder. In this space the tendon is susceptible to ‘wear and tear’. Repetitive use of the supraspinatus muscle and, therefore, the supraspinatus tendon can rub the tendon against the edges of the bony space resulting in microscopic tears within the substance of the tendon. Rotator cuff tendinopathy results in pain felt in the top of the upper arm. This is usually felt when you try to lift your arm into the air and typically develops gradually. Initially, the tendon may only be painful following exercise. For example, it may be first felt on rising the day following participation. Associated with the pain may be stiffness or tightness in the shoulder. Typically, these initial signs of rotator cuff tendinopathy are ignored, as they disappear quickly with use of the arm or applying heat (i.e. a hot shower) over the shoulder. However, as you continue to participate, the tendinopathy progresses and the pain within the tendon becomes more intense and more frequent. For example, it may begin to be present during participation. In the earlier stages, this pain during participation may initially disappear as you warm up, only to return when you cool-down. However, as you continue to participate, the tendinopathy worsens and your pain may begin to be present for longer periods during participation until it is present each you lift your arm. This may interfere with your performance.

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2. Shoulder instability

Shoulder instability refers to when the capsule and ligaments supporting the shoulder joint become loose, enabling the bones forming the joint to move excessively on one another. This most commonly occurs following a shoulder dislocation. This overstretches and injures the capsule and ligaments surrounding the shoulder joint, reducing their ability to support the joint and making the joint ‘unstable’. Similarly, the capsule and ligaments supporting the shoulder joint may be overstretched and damaged if they are repetitively stressed. This can occur, for example, during throwing which stretches out these structures. If performed repetitively, this can make the capsule and ligaments loose and the shoulder joint ‘unstable’. Shoulder instability may also result from ligament laxity you were born with. People with this type of laxity are often referred to as ‘double jointed’ and have loose ligaments and instability at most joints in the body. How does it feel? Shoulder instability may cause a number of sensations. In certain positions of the arm, the bones within the shoulder joint may slip or ‘sublux’. This is often felt as a clunking sensation as the bones within the shoulder joint move excessively on one another. This clunking may be associated with pain which is felt deep within the shoulder. This may create a situation where you don’t like moving the arm into the position where it clunks. In some situations you may also experience a ‘dead arm’ where the arm feels momentarily numb and weak after the bones slip or ‘sublux’. When the capsule and ligaments supporting the shoulder joint are extremely loose, the shoulder joint may continually dislocate.

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3. Adhesive capsulitis (frozen shoulder)

Often referred to as ‘frozen shoulder’, adhesive capsulitis refers to inflammation and scarring of the capsule which surrounds the shoulder joint. The exact reason why adhesive capsulitis develops is not known. However, it tends to occur in the middle- aged or older athletes and is believed to result from some form of irritation to the shoulder joint and its surrounding capsule. Irritation to the shoulder joint capsule results in an inflammatory response. This inflammation of the shoulder joint capsule is referred to as ‘capsulitis’. Associated with the capsulitis is the formation of adhesions or small scars between folds within the capsule. Consequently, the condition is referred to as adhesive capsulitis.

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4. Rotator cuff strain

The rotator cuff refers to a group of four small muscles which run from the shoulder blade to the top of the arm bone. They act to both support and move the shoulder joint. A rotator cuff strain refers to a tear in one or more of these muscles. A rotator cuff muscle may be strained when it is forcibly contracted or overstretched. This can occur in any activity which requires movement of the shoulder. A tear of a rotator cuff muscle is usually felt as sudden pain or a ‘twinge’ felt in the shoulder area. In minor tears you may be able to continue participating with minimal hindrance. However, as the muscle cools down following participation the pain may gradually worsen as bleeding and swelling around the injured muscle takes place. In more severe tears, pain may be exaggerated such that you are unable to continue participating immediately following injury. In these cases the shoulder may also feel weak.

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