Introduction:

The shoulder is a remarkable joint, allowing for an incredible range of motion and flexibility. However, this flexibility also makes it susceptible to various injuries. Understanding common shoulder injuries and adopting preventive measures can significantly contribute to maintaining a healthy and pain-free shoulder. In this post, we'll delve into the anatomy of the shoulder, main categories of shoulder injuries, and practical ways to reduce your risk of experiencing them.

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What makes up the shoulder?

The shoulder is a ball and socket joint that consists of your humerus (arm bone) ending in a ball that attaches to the socket on your scapula (shoulder blade). Often referred to as  a golf ball on a tee, this is a very mobile joint which allows us to do things like reach overhead, reach behind us, and even throw objects with high velocity. To make the ball and socket joint more stable there are multiple structures that play a role. The labrum is a thick tissue that is around the rim of the socket which helps to hold the ball more securely. The shoulder capsule is outside of the labrum and is a fibrous tissue that surrounds the joint providing stability and allowing for lubrication of the joint. Finally, there are multiple muscles crossing over the shoulder joint which not only help with moving your arm but they also help to hold the ball more tightly into the socket.

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Muscles of the shoulder:

There are a variety of muscles that cross the shoulder joint with differing sizes that perform different roles.

Pectoral muscles:

• The pectoral muscles, or pecs, are the muscles on the front of your chest.
• These generally help to push your arms away from you like in a bench press.

Latissimus dorsi:

• Also known as your “lats” these muscles are on your back along the sides of your body.
• They can help to extend your arm behind you and pull them back down to your side like in a pull up.

Rhomboids:

• These muscles are also on your back but are much closer to your spine.
• They attach to your shoulder blade, so they do not directly cross the shoulder joint.
• Their function is to pull the shoulder blades together such as in a row exercise which is an essential shoulder exercise.

Rotator cuff:

• The rotator cuff is actually made up of 4 separate muscles with three of them on the backside of the shoulder blade and one on the front of the shoulder blade.
• They are responsible for things like rotating your arm as well as helping lift it out to the side.

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These are some of the muscles that cross the shoulder joint. While there are others that contribute to motion at the shoulder joint this should help to paint a clearer picture of the anatomy of the shoulder.

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What are common injuries at the shoulder joint?

There are three broad categories that encapsulate most of the injuries that can occur at the shoulder.

1. Injury to muscle and tendon:

• The main injuries that occur with muscles and tendons are either tears or tendinopathy. Tendinopathy is a broad term for irritation and pain at a tendon while tears usually occur as an acute injury, possibly accompanied by a snap or pop sound and sudden pain. Tendinopathies usually occur as a result of repeated excessive loading to a muscle and tendon which will lead to a slow increase in pain over time.
• The most common tearing injury would be a rotator cuff tear while less common injuries include things like a pec tear. These can occur either in the muscle or in the tendon itself.
• Tendinopathy is most commonly seen in the rotator cuff tendons as well as the bicep tendon.

2. Excessive stiffness of the shoulder

• Increased stiffness of the shoulder is usually caused by stiffness of the shoulder joint capsule. This is called frozen shoulder or adhesive capsulitis. Generally, this occurs slowly over time as people notice they can not move their arms as far overhead or behind their back without causing pain. This generally lasts for at least 6 months and can linger for 2 years or longer

3. Instability of the shoulder

• Shoulder instability generally refers to either shoulder dislocations, where the ball is completely out of the socket, or subluxations, where the ball comes out of the socket but goes back in immediately without any treatment.
• Shoulder instability generally occurs for one of two reasons; either a traumatic event or due to hypermobility of the shoulder.
• A traumatic event is when the shoulder is hit, usually in a compromised position. One example is when a quarterback is throwing a ball and his arm is hit, especially from behind, when it is brought all the way backwards.
• Hypermobility of the shoulder refers to increased laxity or “looseness” of the capsule around the shoulder joint. Some people have this naturally; it allows them greater flexibility than the average person but also can increase the risk of dislocation. For some of these people, shoulder dislocations become a frequent occurrence in both shoulders which can require either physical therapy or surgery to address.

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What can be done to prevent shoulder injuries?

While there are no guaranteed ways to prevent all shoulder injuries, there are some steps that you can take to decrease your risk and improve the overall health of your shoulder.

Strengthening:

• Building up the strength in your shoulder muscles is a great way to make it more resilient.
• Using exercises that strengthen the rotator cuff, pecs, lats, and rhomboids will help to provide more stability to the shoulder.
• Improving your strength will also help to improve the loads your shoulder can tolerate which may decrease your risk of injuries like tendinopathy and tears.
• Exercises that strengthen these muscles include things like pushups, bench press, lat pull downs, pull ups, and rows.

Mobility:

• Improving the flexibility of your shoulder can make your shoulder more tolerant of end range positions, which is especially helpful if you need this for sport or work.
• This can be done with stretching exercises or strengthening exercises through a full range of motion.

Load Management:

• One of the most helpful ways to decrease your risk of injury is to be mindful of the load that you are placing on your shoulder.
• This can be in the form of time spent playing a sport, time spent working on a project around the house, or the amount of times you pick up a young relative around the holidays.
• Luckily, our bodies are very adaptable and they get used to the stresses that we put onto them. However, this process does take time to occur.
• When starting a new sport, like pickleball, it may be wise to only play for an hour 1-2 times a week at the beginning if you aren’t used to swinging a racket. As your body adapts to your new sport you can always increase the frequency, time, and intensity if you are enjoying yourself.

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Conclusion

A proactive approach to shoulder health involves a combination of strength training, mobility exercises, and load management. By understanding the common categories of shoulder injuries and implementing preventive measures, you can significantly reduce the risk of experiencing pain and discomfort. Remember, a healthy shoulder is a strong and mobile shoulder – invest the time and effort, and your shoulders will thank you for it in the long run. If you need assistance with how best to handle a shoulder injury the Doctors of Physical Therapists at Maven are happy to assist you.