Now that the weather is getting colder and snow is in the forecast, I know I’m going to be seeing patients in the office who injure their shoulders shoveling snow and slipping on the ice. Unfortunately shoulder injuries are something we see all the time in the office.
The shoulder is the most commonly injured joint in the body. It is an unstable joint by design and has an enormous range of motion. After all, we are primates and evolved to swing through trees, right? Think of all the directions you can reach with your hands.
You can hurt your shoulder in any number of ways. For example, you can lift something that’s too heavy for you, you can fall on it, or you can perform the same movement over and over until you develop a repetitive-motion injury.
One very common cause of shoulder pain is a rotator cuff injury. This type of injury damages one or more of the tendons of four muscles that act to support and stabilize the shoulder joint. There are excellent diagrams of the rotator cuff at the American Academy of Orthopedic Surgeons’ patient-information website.
When I was in Denver a few weeks ago for my conference, I listened to a really excellent lecture about upper-extremity injuries and one of the topics was rotator cuff injury. The speaker described it as the shoulder “committing suicide.” This is a great description and highlights why it’s so important to get a shoulder injury addressed quickly.
The big muscles of the shoulder girdle largely act to pull the arm UP. The deltoid and trapezius are the muscles that pull your arm out to the side and let you work overhead. The rotator cuff muscles act to pull the upper arm bone (the humerus) DOWN and keep the head of the humerus sitting in its socket.
When your shoulder hurts, your brain naturally tells you to rest your arm. Don’t use it, right? The problem with this is that the little muscles of the rotator cuff get weak VERY quickly. This weakness makes the stability of the shoulder worse. The head of the humerus tends to be pulled up and out of place more and more, which puts stress on the cartilage and makes pain worse.
As the pain gets worse and worse, you tend to avoid using the arm more and more, to the point that the capsule of the shoulder joint shrinks and the shoulder gets stiff. This is called adhesive capsulitis or “frozen shoulder.” Can you see why a rotator cuff injury can be described as the shoulder “committing suicide?” Pain makes you use it less, which makes it weak, which makes it more and more unstable, which makes it hurt more. Like a snowball rolling downhill.
The treatment for a rotator cuff injury is NOT rest. The treatment is exercises to strengthen the muscles of the rotator cuff. Anti-inflammatory medication and cortisone shots can help, but exercise is the main treatment. It is important to get a shoulder injury evaluated right away. The longer the injury goes untreated, the longer it will take to get the shoulder healed and the pain resolved.
If you have pain in your shoulder please see the doctor right away. It may not be a rotator cuff injury, but if it is, the longer you wait the more it will hurt and the more work it will take to heal it.
QUESTION: Have you had a rotator cuff injury? How long did it take to get it healed?