Every year in our clinic we see patients who have shoulder pain. Some report it started from a specific incident, while others report it has worsened over a period of time.
What a physician needs to determine is what caused the pain or loss of function. In order to determine the cause, you have to factor in what structures make up the shoulder.
The shoulder is a ball-and-cup joint that provides much motion. Joint stability is sacrificed in order to achieve the range of motion, which increases the risk of injury.
The ball is the head of the upper arm bone, or humerus, and the cup is called the glenoid of the shoulder blade, or scapula.
To give a visual on how the joint looks, picture a golf ball sitting on a tee. The head of the upper arm bone is the golf ball, and the tee is the cup of the shoulder blade. A ring of cartilage, called the labrum, serves as a bumper to help deepen the cup and help the ball sit better in the joint.
The cartilage is a structure in the shoulder that can be injured by a single or repetitive motions. A common single incident injury to the cartilage can result from a shoulder dislocation. As the ball of the upper arm bone head dislocates from the cup, it can tear the cartilage.
Repetitive motion injuries are a result over time of the cartilage being torn down due to the ball moving around in the cup. Examples of repetitive motion injuries are those similar to the injuries sustained by many baseball pitchers due to repetitive, overhead throwing action.
There are two types of cartilage injuries. The main difference between the two is the first is when the cartilage is torn or frayed but still attached, and the other results when the cartilage is torn off the bony cup.
Typical symptoms of a cartilage injury are pain, clicking or a feeling that the shoulder is unstable. The symptoms may increase when a person reaches overhead, behind or attempts to throw a ball.
A visit to an orthopedic specialist involves taking a detailed history, hands-on clinical exam and X-rays to rule out possible bone injury. If a cartilage injury is suspected, a MRI arthrogram - a special MRI done with an injection of dye into the shoulder joint - typically is ordered because it provides the most accurate assessment of the cartilage.
Prescribed treatment depends on the type and extent of the injury to the cartilage. Initial treatment involves a period of rest, ice and anti-inflammatory medications. A minor injury to the cartilage may respond well to physical therapy.
The goal of such therapy is to restore motion and improve the strength of the rotator cuff and the muscles that help stabilize the shoulder blade.
Advanced injuries may require surgery to re-attach cartilage that is torn off, or shave and smooth torn or frayed cartilage. Once surgery is performed, an extensive course of physical therapy follows. Patients typically return to sport activities within three to four months.
It is possible to prevent repetitive motion cartilage injuries by building the strength of the rotator cuff and muscles that stabilize the scapula. Using appropriate range of motion for sporting activities, in addition to practicing good throwing techniques, are common practices to deter long-term injuries.
Developing core strength also is a key component to ensure a stable throwing base. Poor throwing technique and poor shoulder strength inevitably will result in shoulder or elbow injuries.
For more information about the prevention of shoulder injuries or have a shoulder injury due to physical activity, call the Sport Medicine Injury Clinic at 320-7456.
Carey is a sports-medicine fellowship-trained orthopedic surgeon at Susquehanna Health Sports Medicine.
