Keeping Your Shoulders in Top Form

 

While not as common as lower extremity problems, shoulder injuries can be persistent and activity limiting.  For cross training and overhead athletes, a shoulder problem can negatively influence technique and performance.  As an example, an efficient running gait requires healthy upper extremities to initiate and sustain kinetic propulsion.

 

Functionally, the shoulder is the most mobile joint in the body.  As an approximate ball and socket joint, the shoulder positions the hand in space.  This substantial flexibility and range of motion provides the athlete with the ability to perform a variety of overhead activities including climbing, swimming, and throwing.  The shoulder is responsible for maintaining aerodynamic body positioning while road biking and delivering energy to the torso and lower body in times of greatest fatigue.

 

Anatomically, the shoulder joint is controlled by a variety of muscles and tendons.  The large muscles such as the deltoid, pectorals, latissimus, and trapezius are the most visible, but the least likely to be involved in shoulder pain.  The small muscles such as the subscapularis, supraspinatus, and infraspinatus comprise portions of the rotator cuff, and while not as visible as their larger counterparts, are the suspected culprit of shoulder pain in most athletes over forty years of age.

 

In the younger athlete, shoulder disorders may involve the rotator cuff, but typically follow a pattern of cartilage or connective tissue injury.  Cartilage injuries referred to as “SLAP tears” involve a structure called the shoulder labrum.  The substance of one’s connective tissue or collagen may also contribute to symptoms of instability and pain.

 

A poorly functioning shoulder joint often manifests as shoulder pain, weakness, and decreased motion.  Occasionally, shoulder problems present as neck pain or arm pain.  These referred pain patterns can make diagnosing a shoulder disorder challenging and require a comprehensive approach and understanding of upper extremity mechanics.

 

Determining the actual cause of shoulder pain may be difficult.  X-ray pictures are often normal and MRI scans must be interpreted based on a patient’s specific circumstances.  An accurate physical exam is often the most reliable method for elucidating normal from abnormal.  Many times, specific functional tests must be performed to understand an athlete’s symptoms in the context of his or her activities.  One’s coach or personal trainer is a great resource for assessing specific form and function deficits.

 

Once a proper diagnosis is established, a recovery plan can be recommended.  Many shoulder problems are successfully addressed via nonoperative techniques and methods.  Every athlete should have a specific plan tailored to their specific functional deficits and activity goals.  The upper body kinetic chain from the core spine muscles to the hand must be optimized using the guidance of an experienced coach, trainer, or therapist.

 

When surgery is pursued, it is after the shoulder has not responded to constructive nonoperative interventions.  Modern shoulder surgery techniques are often arthroscopic and generally allow return to all athletic goals.  Recovery from most shoulder procedures may take between one and four months depending on one’s age and injury.  Obtaining more than one opinion before shoulder surgery is reasonable and ensures that the primary benefits, risks, and alternatives of a recommended procedure are considered.

 

Ultimately, all interventions for shoulder injuries should address rebuilding the shoulder’s purpose as the body’s most mobile and functional joint.  When faced with a shoulder injury, one should create and follow through with a specific recovery plan.  Endurance intensive sports require healthy shoulders to enhance performance and may be one’s edge in a winning effort.

Shoulder Injury Management

 

Allston J. Stubbs, MD

 

 

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The North Carolina Sports Medicine Institute is an orthopaedic sports medicine clinic based in Winston-Salem, North Carolina.  Its philosophy is to provide premium orthopaedic treatment “For the Athlete in All of Us”.  Allston J. Stubbs, M.D., an attending surgeon at the clinic, has the highest level of adult and pediatric orthopaedic sports medicine training.

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Endurance Magazine

June 2007

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