Prevention of Shoulder Impingement & Bursitis

When the shoulder is injured, inflammation occurs causing pain and weakness in the shoulder. This can greatly impact a person’s quality of life. Shoulder Impingement, Tendonitis and Bursitis are two common conditions that can cause pain and discomfort. 

In order to understand shoulder pain and injury, it is important to learn about the anatomy of this joint. The shoulder is a ball-and-socket joint made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The head of the humerus fits into the glenoid (a rounded socket in the scapula). These bones are held in place by muscles, tendons and ligaments. The ligaments hold the bones together and create stability, while the tendons connect the muscles to the bones and the muscles make movement possible.

Three common shoulder conditions are: shoulder impingement, tendonitis and bursitis. Shoulder impingement occurs when the space between the acromion and rotator cuff narrows and the acromion rubs on the tendon or bursa.  This results in pain and irritation. Tendonitis occurs when the rotator cuff tendons and/or the bursa become irritated and inflamed and bursitis occurs when the bursa becomes inflamed and swollen with fluid. It is common for these conditions to occur in conjunction with one another since they are adjacent structures.

Symptoms of shoulder bursitis, tendonitis and impingement include:  

• Pain while performing an activity and at rest
• Pain that radiates from the front of the shoulder to the side of the arm
• Pain with throwing
• Pain with overhead motion 
• Sudden pain when lifting/reaching
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Shoulder bursitis, tendonitis and impingement are often caused by overuse and improper lifting techniques. To help prevent these common shoulder injuries, follow these helpful tips:

• Exercise regularly and strengthen the muscles of the shoulder joint
• Focus on upper body strength and flexibility
• When lifting and reaching overhead, pay attention to the position and form of your back
• When lifting, keep back as straight as possible, bend and lift with your legs
• When reaching to place or retrieve heavy objects, use a stable platform or stool
• Know when to say when – when you are tired and fatigued; take a break!

Depending on the severity of the injury, shoulder impingement or bursitis can be treated non-surgically through rest, cortisone injections and physical therapy. In some cases surgery may be required.  If surgery is indicated, minimally invasive, arthroscopic surgery to is the best method to repair the injury, followed by a rehabilitation program to get you back to full activity as quickly as possible. For more information or to schedule and appointment with John Vitolo, MD, please call 973-300-1553 or visit advocareorthosportsmed.com

Looking At the Whole Picture

Medical tests have evolved dramatically over the past 50 years. MRIs are revealing details of the anatomy that we could not see historically. The advances are incredible and valuable, but as physicians, we must remember the importance of looking at the full picture.

In my experience, each tool we use fits a piece of a puzzle that reveals the most appropriate treatment protocol. We cannot and should not depend solely on imaging to determine if surgery is needed. The imaging tools today are advanced and may show an injury that is not necessarily the root of the pain. In order to determine the most appropriate treatment we must also rely on the physical exam and medical history of the patient.

Exams

Traditional physical exams are vital to identifying the appropriate course of action when treating patients. For example, a patient complaining of shoulder pain may have an MRI showing multiple injuries. However, it is possible that one injury was pre-existing and not the root of the pain. By utilizing physical exams, such as the Hawkins-Kennedy Impingement Test or the Neer’s Test, we can identify the injury causing pain and then use the MRI to gather more information. 

History

It is vital to talk to patients and gather information about their personal medical history. By understanding the type of work they do and the lifestyle they lead, we can determine the treatments that will be most effective. For example, certain surgical procedures may be more appropriate for athletes, while a more conservative approach may be the better option for someone who works a desk job. 

Imaging

Imaging provides physicians with the ability to see inside the body and identify the scope of the injury or condition. X-rays give us a way to see bones and diagnose fractures and arthritis, while MRIs allow us to see the soft tissues. CT scans provide images of internal organs, bones, soft tissue and blood vessels and are able to provide greater detail than traditional x-rays, particularly of soft tissues and blood vessels.

In this technologically advanced world we live in, it is important to remember that all the diagnostic tools tie together to create the most appropriate treatment plan for each patient. If we as physicians solely relied on one piece (i.e. imaging) we may be doing a disservice to the patient and miss a detail that could be vital to that person’s recovery. In an upcoming series, we will review tests that are used during orthopedic physical exams and describe what each test is used to diagnose.

What is Swimmer’s Shoulder?

Swimming is one of the few, if not only, sports that utilizes the upper body and shoulders to move the entire body forward. Swimmers, both male and female, tend to be very flexible and have more range of motion in their shoulders than the average athlete. Swimming is also unique because the water gives resistance that the air does not. The reliance on the upper body, coupled with the resistance of the water and repetitive use of the shoulder can lead to a spectrum of overuse injures termed “swimmer’s shoulder”. 

Swimmer’s shoulder rarely results in permanent injury requiring surgical intervention. The most common swimmer’s injury found on MRIs of the shoulder is tendonitis. Tears of the rotator cuff or labrum are much less common. 

Anatomy

In order to better understand swimmer’s shoulder, we need to review the anatomy of the shoulder. The key muscle group of the shoulder is the rotator cuff, which consists of the subscapularis, supraspinatus, infraspinatus, and teres minor. The primary role of the rotator cuff is to function as the dynamic and functional stabilizer of the glenohumeral joint.

The muscles and the attached tendons of the rotator cuff can be overused and injured in shoulder dominant activities such as swimming. The most commonly injured portion of the cuff is the supraspinatus. On the other hand, the "power muscles" of the shoulders, including the latissimus dorsi, pectoralis, and deltoid, are responsible for moving the arm through space or water, but rarely sustain significant injury.

Treatment

Treatment protocol for swimmer’s shoulder is as follows:

• Oral anti-inflammatories to decrease inflammation of the shoulder
• Strength training of the shoulder and rotator cuff
• Maintaining range of motion in the shoulder

The above is normally achieved with physical therapy or a physician directed home exercise program. It is important to consult a physician before adopting a treatment plan. Without guidance, one can potentially make the injury worse. 

Prevention

Swimmer’s shoulder may be avoided with a regimented dry land program in the off-season. Training programs should focus on strength training and flexibility of the rotator cuff and other shoulder blade muscles.  

For more information on shoulder injuries and conditions, please visit our website, www.advocaredoctors.com/orthosportsmed