These are all signs of the same thing; a shoulder
injury. Whether you want to call it a frozen shoulder, a rotator
cuff tear or tendinitis shoulder, it's really all the same.
A tear or strain in the rotator cuff muscles and tendons.
The shoulder joint is a truly remarkable creation.
It's quite a complex formation of bones, muscles and tendons
and provides a great range of motion for your arm. The only
downside to this extensive range of motion is a lack of stability,
which can make the shoulder joint vulnerable to injury.
Lets have a quick look at the shoulder joint
in a little more detail. The shoulder is made up of three bones,
and the tendons of four muscles. (Remember, tendons attach muscle
to bone.) The bones are called the "Scapula," the
"Humerus" and the "Clavicle." Or, in layman's
terms, the shoulder blade, the upper arm bone and the collarbone,
respectively.
The four muscles which make up the shoulder
joint are called, the "Supraspinatus," the "Infraspinatus,"
the "Teres Minor" and the "Subscapularis."
It is the tendons of these muscles, which connect to the bones,
that help to move your arm.
In the picture to the right, three of the four
muscles are visible, the supraspinatus, the infraspinatus and
the teres minor. These are the muscles which are viewed from
the rear, or posterior. The subscapularis is not visible because
it can only be viewed from the front, or anterior and this particular
view only shows the muscles from the rear, is if looking at
someone's back. Anyway, enough of the technical stuff.
Causes
There are two major causes of most shoulder
injuries. The first being degeneration, or general wear and
tear. Unfortunately, the shoulder is a tendinous area that receives
very little blood supply. The tendons of the rotator cuff muscles
receive very little oxygen and nutrients from blood supply,
and as a result are especially vulnerable to degeneration with
aging. This is why shoulder problems in the elderly are common.
This lack of blood supply is also the reason why a shoulder
injury can take quite a lot of time to heal.
The second cause of most shoulder injuries is
due to excessive force, or simply putting too much strain on
the tendons of the shoulder muscles. This usually occurs when
you try to lift something that is too heavy or when a force
is applied to the arm while it's in an unusual or awkward position.
Symptoms
There are two common symptoms of a shoulder
injury, pain and weakness. Pain is not always felt when a shoulder
injury occurs, however most people who do feel pain, report
that it's a very vague pain which can be hard to pinpoint.
Weakness, on the other hand, seems to be the
most reliable symptom of a shoulder injury. Common complaints
include an inability to raise your arm above your head or to
extend your arm directly to the side or in front. In most cases,
the larger the tear or damage to the tendons, the harder it
is to move your arm and the injured area.
Treatment
The earlier a shoulder injury is treated, the
better. The first 48 to 72 hours are crucial to a complete and
speedy recovery. The first and most important course of action
is the R.I.C.E.R. regime. Rest, Ice, Compression, Elevation
and Referral. For the time-being, I'm not going to go into the
specifics of the R.I.C.E.R. regime. It's a very important topic
and I've decided to dedicate the entire next months issue to
it.
After the initial injury has been treated with
the R.I.C.E.R. regime, (for at least 48 to 72 hours) it's time
to move onto the next stage of treatment. As mentioned before,
the shoulder joint receives very little blood supply. So, what
can you do to increase blood flow, and oxygen and nutrients
to the injured area?
Firstly, heat! Heat is extremely good for increasing
blood flow to a particular area. Heat lamps are the most effective
way to increase blood flow, while heat based creams are probably
a distant second choice.
Secondly, massage! Massage is one of the best
ways to increase blood flow to an injured area, and of course
the oxygen and nutrients that go with it. The other benefit
of massage is that it helps to reduce the amount of scar tissue
which is associated with all muscle and tendon, strains and
tears. (I'll also discuss scar tissue in next months issue along
with the R.I.C.E.R. regime.)
Lastly, don't stop moving. Some doctors will
often tell patients to keep the injured area still, and this
is not always the best advice. Gentle movement will help to
keep the blood flowing to the injured area. Of course, if pain
is present, limit the amount of moving you do, but don't stop
moving all together.
Prevention
Mark my words, "Prevention is much better
than Cure." Anything you can do to prevent an injury from
occurring is worth it. The prevention of shoulder injuries comes
down the conditioning of the shoulder muscles and tendons, which
ultimately involves both stretching and strengthening of the
shoulder joint.
Also, don't forget the common injury prevention
techniques like, warming up properly and using a bit of old-fashioned
common-sense. However, for the most part, stretching and strengthening
are going to be your best defence against shoulder problems.
Even if you don't have a shoulder problem now, the following
stretching and strengthening exercises could save you from a
major headache in the future.
Firstly, below you'll find two good stretches
for the shoulder area. The first is quite a basic stretch, while
the second is a more advanced stretch, specifically for the
rotator cuff muscles and tendons. Please be careful, if you
haven't been stretching your shoulder joint, the second stretch
will put quite a lot of stress on the rotator cuff tendons.
Warm-up first, then gently and slowly is the best way to proceed.
In the stretch to the left, simply stand upright
and clasp you hands behind your back. Keep your arms straight
and slowly lift your hands upwards. Hold this stretch for about
15 to 20 seconds, then repeat it 3 to 4 times.
