Common Shoulder Impairments
Many sports, including baseball, softball, golf, basketball, and swimming, require highly repetitive movements, which increases the risk for injury. The shoulder is particularly vulnerable when participating in these activities that include constant overhead motion.
Brittany Patterson, DPT, a physical therapist with UPMC Sports Medicine and the Centers for Rehab Services shares common shoulder conditions that athletes typically see, and offers and offers some recommended treatment options.
The shoulder is a ball and socket joint made up of three bones: the humerus (arm), scapula (shoulder blade), and clavicle (collar bone). The head of the humerus is larger than the scapula, allowing for excellent mobility, but not much stability. The four muscles that comprise the rotator cuff provide dynamic stability.
When muscles are overused without adequate rest, they can become inflamed and irritated, altering the normal movement pattern of the shoulder and putting these structures at greater risk for injury.
Rotator Cuff Tendinopathy
Rotator cuff tendinopathy can occur with weakness or dysfunction as the tendons are overused. It may compress within the space between the humerus and scapula, causing inflammation and tearing. The onset may be sudden or gradual, and symptoms may include:
- Pain in the front of the shoulder that radiates to the arm
- Pain with lying on the affected side
- Difficulty or pain with reaching
Symptoms can also develop in the back of the shoulder, resulting from compression during the cocking phase of throwing, similar to a high-five position. High forces required during this phase, combined with the repetitive nature of athletics, can often lead to degenerative changes of the tendons as well as the labrum, which is cartilage around the shoulder blade.
Labral injuries can arise from repetitive movements, compression, or even falling on an outstretched arm. Pain associated with labral tears may be sharp or achy, and tends to worsen with lifting, pushing, and overhead movements. Symptoms include a noticeable clicking sound, as well as a feeling of instability or weakness. Pitchers, swimmers, tennis players, or other athletes may notice a decrease in velocity or performance.
Diagnosis and Treatment
Shoulder injuries can be diagnosed through a clinical examination from an orthopaedic specialist. Diagnostic imaging, such as an x-ray or MRI may be required to confirm the diagnosis. Non-operative management may consist of anti-inflammatory medication or cortisone injections.
Physical therapy is often recommended to help decrease pain and address specific impairments identified during a clinical examination. A physical therapist can prescribe and implement evidenced-based exercises and manual therapy techniques to improve range of motion, strength, flexibility, and muscular imbalances. Postural abnormalities and poor scapular movement are often identified and will also need to be addressed.
Education from a physical therapist on activity modifications, appropriate exercise progressions, and prevention strategies are crucial in the management of overuse and traumatic injuries. For individuals who do not respond to non-operative treatment or have suffered more severe injuries, surgical correction may be required.