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Whether bowling, rowing a canoe, lifting boxes or pushing furniture, we rely heavily on our shoulder to do a number of daily activities.  Normally, shoulder has a wide range of motion, making it the most mobile joint in the body.  But because of this flexibility, it is not very stable and is prone to injuries.

The term soft tissue refers to muscles, ligaments and tendons that surround and support our joints.A soft tissue injury is an injury that is sustained to the muscles, tendons and ligaments.Injuries to the soft tissue around the shoulder can occur due to falling on an outstretched hand, overuse or direct impact.

Most of the people who seek treatment for a musculoskeletal problem are for injuries that have occurred to the shoulder.  The shoulder is made up of four separate joints:

Glenohumeral joint - the ball and socket joint that connects the humerus bone (upper arm bone) to the scapula (shoulder blade)

Acromioclavicular joint - attachment between the end of the clavicle (collarbone) and the scapula

Sternoclavicular joint – where the sternum (breastbone) and the clavicle join

Scapulothoracic joint  - the joint between the scapula and the ribcage 

All of these are connected by a multitude of ligaments and function by various muscles which are attached by tendons.  Let’s go through some of the common soft tissue injuries in the shoulder.

Rotator cuff tear:

The rotator cuff is a group of four muscles of the upper arm. They allow you to raise and rotate the arm.  The tendons attach the muscles to the bones.  If the tendons tear, the humerus can't move as easily in the socket, thus making it hard to move the arm up or away from the body.

As we age and become less active, tendons start to degenerate and lose its vigor.  This can cause rotator cuff tear.  Rotator cuff tears are mostly seen among middle-aged and elderly population who has pre-existing shoulder problems.  As for younger people, overhead use of the arm, repetitive movements and stress to the tendons can lead to rotator cuff injuries.

Shoulder sprain:

Shoulder sprain refers to separated shoulder or acromioclavicular joint injury.  The AC joint is the area where the acromion (the bony projection at the top of the shoulder blade)meets the clavicle or collarbone.  In shoulder sprain injuries, ligaments that support and stabilize the shoulders are stretched the shoulder are stretched or torn, and the bones of the AC joint become dislocated or separated.

Trauma to the shoulder is the primary cause of shoulder sprain injuries.  For e.g. car accident and fall onto an outstretched arm.

Shoulder strain:

A shoulder tear occurs because of the injury to the soft tissues that provide the joint range of motion and stability.  A tear can occur in the tendons, the muscles or the labrum.  A tear can be either partial or full where it can cut through tendon, muscle or the labrum completely.If small tears are ignored, it can get worse and become bigger tear over a period of time.

Years of repetitive arm motions performed during sports, chores or jobs can pave way for a tear. Athletes who play sports that require repetitive motions, such as baseball, tennis, and weightlifting, may experience a shoulder tear.

Shoulder instability:

Shoulder instability is seen predominantly in young people and athletes.  When muscles and ligaments that hold it together are stretched beyond their normal limits, the shoulder becomes unstable.  For youngsters, this health issue can be a normal part of growth and development.  Shoulders often stiffen and tighten with age.

In people who are sporty in nature, shoulder instability is triggered by certain motions used in tackling, pitching and bowling.  These movements put great strain on the shoulder, stretching the shoulder ligaments over time.  Occurrence of pain can be either quickly, gradually or the feeling that the shoulder is loose and a feeling of weakness in the shoulder.

Treatments include rest, physical therapy or surgery.

Frozen shoulder:

Frozen shoulder refers to extreme stiffness in the shoulder.  It is generally seen between 40 and 60 years of age.  People with diabetes, thyroid disease, heart disease or Parkinson disease have a greater chance of getting affected with this.  The predominant symptom is not being able to move the shoulder in any direction without pain.

Overuse/Strains:

A sudden increase in activity can put great pressure on shoulders and lead to loss of flexibility.  It is generally among middle-aged population who is not very active physically and don’t do regular exercise, but go out all of a sudden for a physically-demanding sport or work.  It is to avoid this type of injuries, sports people do proper warm up before going out on to the field.

Arthritis:

Arthritis can also lead to soft tissue injury to the shoulder.  This happens as the smooth surfaces of the cartilage that line the bones of the shoulder joint are worn away and joints start to wear out.  Treatment for arthritis-related shoulder injury depends on the severity of the pain.

Usual treatments are rest, non-steroidal anti-inflammatories (NSAIDs).

Shoulder dislocation:

A dislocated shoulder occurs when the humerus gets dislodged from the glenoid, which can pull muscles and tendons out of place and cause them to tear. Bony growths in the joint called bone spurs can rub against tendons, causing friction that may lead to a tear.

Prominent symptoms are pain, a decrease in range of motion, and instability, which can feel like the shoulder may shift out of place.

Labral tear:

Labrum is a rim of fibrous tissue that lines the glenoid (shoulder socket).  Labral tear refers to tear in the labrum. The head of the humerus is wider than the socket and the labrum deepens the socket, helping it fit better, which stabilizes the joint. Several ligaments attach to this area of the shoulder. Injuries here can result from a single trauma or repetitive use of the shoulder.

When the labral tear affects the top half of the socket, where the biceps tendon connects to the shoulder, it is called a SLAP (superior labrum anterior and posterior) tear.

Symptoms of labral tear include, slight clicking or popping noise when you move your arm, catching sensation in the joint as though it can’t move any farther.  This happens when a piece of labrum gets stuck between the bones of the joint.

For questions related to shoulder injuries and their treatment options, send a message to www.BangaloreShoulderInstitute.com/contact

Soft tissue injuries of the shoulder
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