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Shoulder Injuries

The shoulder is the most flexible joint in your body. You take advantage of that flexibility every time you scratch your back, throw a ball, or stretch to reach the top shelf in the kitchen cabinets. Healthy shoulder joints allow you to move your arm into all sorts of positions, but this flexibility comes with a price: It's easy to push the joint farther than it should go, resulting in a strain, tear, or dislocation. According to the American Academy of Orthopaedic Surgeons (AAOS), about 7.5 million Americans went to the doctor for a shoulder problem in 2006.

Shoulder injuries are common among athletes, especially those who have to swing their arms. The sports pages are full of pitchers, quarterbacks, tennis players, and weightlifters who are fighting through one shoulder injury or another. But you don't have to be on the playing field or in the gym to hurt your shoulder. You could strain the joint while hanging curtains, or dislocate it in a fall.

However shoulder trouble happens, you should take it seriously. According to the AAOS, too many people try to "play through the pain," often turning a minor annoyance into a serious injury. If your shoulder feels stiff and you can't move your arm normally, or if your shoulder feels weak or ready to pop out of its joint, schedule an appointment with your doctor or an orthopedic specialist. If the pain is intense, or if you can't move your arm at all, call your doctor right away.

Here's a rundown of the most common types of shoulder injuries:

Dislocated shoulder

When the head of your upper-arm bone (the humerus) slips partially or completely out of the shoulder joint, you have a dislocated shoulder. This injury can happen any number of ways -- from pitching a baseball to falling and landing hard on your shoulder. In any case, the injury is impossible to ignore. Your arm will feel like it's hanging loose, and the pain will be intense. Dislocations call for immediate medical help. A doctor or other medical professional can push the arm bone back into the shoulder joint, providing dramatic and immediate pain relief. (As tempting as it may be, it's not a good idea to try to pop it back in yourself -- you could easily injure yourself further.)

But your shoulder problems aren't over just because your arm is back in place. You may have to wear a sling for several weeks to rest and protect the joint. You may also have to ice the shoulder three or four times a day to reduce pain and swelling. After the swelling goes down, you can start daily exercises to strengthen your shoulder and reduce the risk of further injuries. (Ask your doctor to recommend an appropriate workout.) If your arm bone continues to dislocate, you may need wear a brace, or have surgery to repair or tighten the ligaments that hold it in place.

Separated shoulder

A separated shoulder isn't the same as a dislocated shoulder, but it can be just as painful. If you have a separated shoulder, the ligaments that connect your shoulder blade to your collarbone have become either strained or torn. Your shoulder will feel loose and your arm may feel weak or even numb. The pain in your shoulder can be intense, especially if the ligaments are torn. If you only have a mild strain, you may feel moderate pain when you throw a ball or lift your arm.

The treatment for a separated shoulder depends on the extent of the injury. If you have a mild strain, your doctor may advise you to ice the joint for the first 48 hours and take over-the-counter anti-inflammatory medications such as aspirin or ibuprofen. You may also have to wear a sling for a few days. If your ligaments are torn, you may need surgery to repair them. After surgery, you'll probably need to keep your shoulder in a sling for about a month.

Whether your injury is mild or severe, your doctor will recommend daily exercises to start once you've recovered. These will help to strengthen your shoulder and prevent future problems.

Injured rotator cuff

The "rotator cuff" is the collective name for a group of muscles and tendons that connect your upper arm bone to your shoulder blade. The rotator cuff is a vital part of the shoulder. It's also prone to injury. If you injure or overwork your shoulder -- perhaps by repeatedly throwing a ball or lifting heavy objects -- the tendons in the rotator cuff can become inflamed, a condition called tendinitis. Likewise, bursae -- fluid-filled sacks that help cushion the joint -- can become inflamed, a condition called bursitis. In more extreme cases, the tendons and muscles in the rotator cuff can actually tear.

Any rotator-cuff injury will greatly affect the function of your shoulder. You'll probably feel pain, especially when you try to reach overhead. Your shoulder may also feel weak or stiff.

Minor rotator cuff injuries will often heal on their own, especially if you avoid heavy lifting or other sources of strain. You can speed relief by taking anti-inflammatory drugs, such as ibuprofen, and putting an ice pack on the sore spot for 20 minutes at a time, every couple of hours. After two or three days, when the pain and swelling are gone, you can retire the ice pack and switch to a heating pad. If the pain lingers for more than a week, it's time to get medical help. Your doctor can recommend exercises to increase the strength and flexibility of your shoulder joint without putting any more unnecessary strain on your tendons and muscles. If x-rays reveal a tear in the muscles or tendons, your doctor may talk to you about the possibility of surgery.

Injury Prevention

To avoid injuries to the shoulder, start each weightlifting session with a brief cardiovascular warmup to loosen up muscles and joints. Make sure to stretch the upper body after lifting weights to prevent tight muscles and ligaments that are vulnerable to tears and sprains.

Swimmers, who are often plagued by rotator cuff injuries and sprains, can do gentle shoulder rolls, shrugs, and upper body stretches before getting into the pool. (Outdoor pool swimmers can warm up in the Jacuzzi before their workout.)

You can also prevent future injuries with weight training to strengthen the muscles that connect to your shoulders. Dips and push-ups are good ways to strengthen the whole shoulder girdle. Even abdominal exercises can help to prevent shoulder injuries. Whether pitching a baseball or reaching into a closet, a strong abdominal core supports the torso and offers more overall control.

References

American Academy of Orthopaedic Surgeons. Common Shoulder Injuries. July 2009.

American Academy of Orthopaedic Surgeons. Dislocated shoulder. October 2007.

American Academy of Orthopaedic Surgeons. Separated shoulder. August 2000.

Mayo Clinic. Rotator cuff injury. August 2006.

American Academy of Family Physicians. Shoulder instability: When your shoulder "goes out." March 2003.

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