By Jonny Kelly
THE shoulder is the most flexible joint in the body, making it more prone to injury when compared to other more stable joints such as the hip or knee. The joint depends heavily on a group of muscles called the rotator cuff. They hold the ball of the shoulder, snug within the socket of the joint.
There is also a thick ring of cartilage attached to the socket, called the labrum. This makes the socket deeper, providing some stability. Research has indicated that shoulder injuries account for between 5.7-8.8 percent of all injuries in hurling, and 1.7 percent of all injuries in Gaelic football.
Traumatic and non-traumatic Shoulder injuries in sport can be classified as traumatic or non-traumatic. Traumatic meaning the injury occurred as a result of an impact, such as a tackle or falling to the ground.
Non-traumatic indicates an injury that occurred with no impact, such as a shoulder strain when lifting weights in the gym. We will discuss the six most common shoulder injuries and how to overcome them.
1. Rotator Cuff Strain
The rotator cuff muscles provide strength and stability to the shoulder joint. These injuries often present with a sudden twinge. Minor strains resolve with rest and rehabilitation exercises. Moderate to severe strains will take more time to recover and may require an MRI scan to investigate the degree of injury. The shoulder consultants we work with recommend surgery for full thickness tendon tears, or tears that are more than one centimetre wide.
2. Rotator Cuff Tendinopathy
When the stress and strain of activity on rotator cuff tendons gets too much, the tendons grow thicker. This reduces the size of the gap the tendons pass through. Players will complain of impingement type symptoms, such as pain when lifting the arm above head height. A physiotherapy assessment will identify why the tendons are being over stressed and prescribe specific rotator cuff strength exercises.
The top of the shoulder joint, has a gap between the end of the collar bone (clavicle) and the ball of the shoulder (humeral head). This is called the sub-acromial space. As well as the rotator cuff tendons passing through this gap, there is a bubble of fluid call the bursa. It acts to prevent friction between these structures. The bursa can become inflamed, throb and limit general movement of the shoulder. Physiotherapy treatment usually resolves this issue but some people may require a cortisone injection.
Shoulder dislocations are very obvious on the pitch and they usually occur when a player falls onto their arm, forcing the ball of the joint out of the socket. The player experiences a lot of pain and is unable to move their arm. This requires immediate medical attention in an Accident and Emergency department to get the joint put back in place, and to check for any fractures on an x-ray. A comprehensive rehabilitation programme must be followed for several weeks to ensure a full recovery, and prevent it from happening again.
5. Labral Injury
The labrum is a thick ring of cartilage inside the shoulder. It makes the joint deeper and provides stability. Injury to the labrum often results in an ache when reaching overhead, or a feeling of popping or clunking on movement. Depending on the degree of injury, rehabilitation is recommended for minor injuries. However, surgery is required for unstable labral injuries or for those who do not recover with rehabilitation.
6. Acromioclavicular Joint Injury
The acromioclavicular joint (ACJ) is where the end of the collar bone (clavicle) meets the shoulder. It is held together by several ligaments. The joint can get sprained when a player falls onto the tip of their shoulder. Severe sprains result in the end of the clavicle popping up and this may be visible to look at. Rehabilitation is required to restore the movement and strength of the shoulder. Rarely, surgery is required to stabilise the joint and this is usually a last resort, as this option limits future movement of the shoulder.
Other Shoulder Injuries:
Referred pain from the neck
Joints and discs of the neck can refer pain to the shoulder area.
The front of the shoulder socket gets damaged from a shoulder dislocation.
The ball of the shoulder may get compressed during a dislocation, resulting in a compression fracture of the humeral head.
The clavicle, humerus and scapula can break from trauma.
Long head of biceps injury
This tendon attaches to the front of the shoulder and can tear, become inflamed or thickened.
Adhesive capsulitis (frozen shoulder)
More common in an older age group, the capsule of the shoulder becomes inflamed, resulting in pain and restricted movements.
Referred pain from organs
Organs such the diaphragm, gall bladder, heart and spleen can refer pain to the shoulder and mimic shoulder problems.
Steps You Need to Make To Overcome Common Shoulder Injuries
The first step in your recovery is to get a diagnosis. This can be done in the form of a Physiotherapy assessment, scan or x-ray. Most shoulder issues resolve with a rehabilitation programme, but in rare cases, a cortisone injection or injection is required.
Are you frustrated with injury? Jonny Kelly is a chartered Sports Physiotherapist and owns Physio Performance in Belfast. He has helped get world-class athletes back on the pitch and performing at their best. Contact us for a complimentary Get Back On The Pitch Quick consultation at www.physioperformance.co.uk?