Health & Exercise Forum

Part 1 OF 3

The shoulder, working as a ball and socket, is most flexible joint in the human body. It is comprised of two separate joints, the union between the glenoid fossa, (the socket at the end of the scapula or shoulder blade, and the ball at the end top of the humerus, or upper arm bone. The second articulation at the shoulder involves the acromioclavicular joint that connects your scapula to your collar bone. While it is held together by various ligaments, the muscles of the shoulder, namely the rotator cuff, generate the force that allows it to move in multiple directions. The flexibility of the shoulder is thought to be an evolutional advancement as it permits the upper arm to place the hand, and more importantly, the opposing thumbs, in uncountable positions, allowing humans to function at a higher level than other mammals. The ability to paint, draw, play musical instruments, cook, clean, be creative, build, cultivate food, etc. are all directly related to the beautiful and complex cooperative effort between the shoulder, arm and hand.

When the shoulder is compromised by loss of motion or strength, so too is the function of the arm and hand. It becomes difficult to dress, groom, work, play sports, etc. Therefore, it is imperative that we maintain shoulder health through range of motion and strength exercises. However, it is equally important that we exercise in a manner that does not compromise the integrity of shoulder motion or strength. With this in mind, this series of 3 columns will present a list of common shoulder injuries and exercises to maintain or regain range of motion and strength without compromising the joint and muscles.

The most common problems in the shoulder joint include:

Arthritis – inflammation and degeneration of the ends of the bones that form the joint either caused by trauma such as falling of the shoulder or due to a disease such as osteoarthritis or rheumatoid arthritis.

Shoulder Dislocation/Subluxation – when the bones “slide out of position” either caused by trauma or a genetic predisposition.

Torn Rotator Cuff – the rotator cuff is made up of muscles which hold the joint together.  A rotator cuff can become torn due to trauma such as falling on the shoulder or following wear and tear from years of overhead activities.  Rotator cuff tears are common both in athletes and in the older population.

Impingement – when one or more of the rotator cuff muscles gets pinched between two bones.  This is very common and very painful especially when you attempt to raise your hand over your head.

Bursitis – inflammation of a fluid filled sack that tries to protect the shoulder from impingement.

Frozen Shoulder – when the connective tissue that holds the shoulder together becomes too tight.  This limits the shoulder‘s freedom of movement. If you have shoulder pain from trauma, tendonitis, or bursitis and the arm is protected at your side for an extended period of time, which allows it to tighten and lose the ability to raise your shoulder.  This is more common in middle-aged females, and diabetics.

This is just a partial list of some of the more common problems, which can result in shoulder pain. All of these conditions are uniquely different and need to be treated differently.   Some of these conditions respond well to oral medications, others to injection, others to physical therapy and still others may need surgery.

If you have shoulder pain that lasts for more than three days or you notice that you cannot raise your hand over your head, you need to see either your family doctor or an orthopedic surgeon.

Many people have a tendency to at first ignore the problem shoulder thinking that it will get better on its own. This rarely happens.  With many shoulder problems the condition just gets worse with time.  The longer one waits the greater the chance for greater complications.  The sooner one gets medical intervention the quicker the recovery.  The bottom line is …DON’T IGNORE SHOULDER PAIN!

If shoulder pain persists, see your physician. However, while waiting for your appointment?  There are things that you can do:

1. The best thing to do is to put an ice pack on the sore shoulder.  While many people may be tempted to reach for a heating pad, ice usually works much better.  One should put ice on the shoulder for no longer than 20 minutes at a time.
2. Try to avoid overhead and side movements or actions that cause shoulder pain.  You might have to give up vacuuming, washing the car, painting the bedroom ceiling or throwing the ball from third base to first for a while.  You may want to get help bringing in the groceries and even putting on your coat.  Pain is the body’s way of telling you that you are causing damage to yourself.
3. Try to sleep on your back with pillows under your elbow to cushion or support your arm.  This may help those individuals who can not sleep at night due to shoulder pain.
4. Ask your family physician if you can take an anti-inflammatory medication such as Advil, Aleve, or even aspirin.  This may help alleviate swelling and pain in the shoulder.  Read Dr. Mackarey’s Health & Exercise Forum – every Monday next week “Part II of III on Shoulder Exercises”This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.comPaul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.

Contributions: Gary Mattingly, PT, PhD, Professor Emeritus, University of Scranton, Physical Therapy Department.