Health & Safety Resources

MAINTENANCE REQUIRED - A SHOULDER CARE GUIDE

The shoulder has the greatest range of motion of any joint in the body.  It is a dynamic and complex piece of machinery.  Its design allows us to reach and use our arm in many different positions.  However, the trade off for the shoulder joint’s great range of motion, it that it is not very stable.  This makes the shoulder vulnerable to injury.  Athletes who compete in sports which requires a lot of overhead activity must maintain the right balance of strength, flexibility and stability to produce their best performance and avoid injury.
           
The shoulder is a rudimentary ball and socket joint.  It is surrounded by a capsule of ligamentous tissue.  Surrounding the capsule are 4 tendons from the muscles that make up the rotator cuff.  The rotator cuff muscles are: the Supraspinatous, Infraspinatous, Teres Minor and Subscapularis, or “SITS” for an easy way to remember them. These muscles/tendons, along with the large deltoid muscle help keep the shoulder’s joint in place.  The rotator cuff can get injured from 1) Sudden impact-a fall or high velocity movement, 2) overuse, with certain sports such as throwing or swimming, 3) repetitive movements, such as factory jobs, painting or routine chores like cleaning windows, waxing a car, 4) training with too much weight such as bench press, overhead press or lat pull-down without working opposing muscle groups.
           
Rotator cuff tears usually occur from a sudden impact or trauma.  They can also occur due to the degeneration of the tendon from long term participation in overhead sports such as throwing, tennis, or swimming.  Sitting just above the shoulder joint is a section of the shoulder blade (Scapula) bone.  If the space between the rotator cuff and the bone above it is narrowed, the rotator cuff tendons and the overlying bursa can be repeatedly “pinched”.  This is called impingement.  Impingement can commonly be caused by an overly loose/unstable shoulder joint or a weak rotator cuff.  Tendonitis occurs because of inflammation to the tendon due overuse and repetitive movements.  If these conditions go unchecked and worsen, the tendon will deteriorate and could tear as a result.
           
Another way for the rotator cuff to become damaged is when a ligament that holds the shoulder joint together becomes stretched or torn.  This can lead to instability which can cause dislocation or subluxation of the shoulder.  This in turn can tear and damage of the labrum which is deep within the shoulder that also provides stability.  The more unstable the joint the more the tendons have to work to keep the joint stable.  This can also lead to a tendonitis and damage to the rotator cuff.
           
The rotator cuff tendons are small, and have a very limited blood supply which makes it more difficult for healing and scarring of tissue.  It is important not to train with too heavy of a weight when starting to rehabilitate or strengthen the rotator cuff.  When performing the rotator cuff exercises you want to be controlled with your movement and make sure the movement is performed in a pain-free range of motion.  You can use hand weights or theraband tubing to isolate this muscle group.  Start with simple movements with elbow at side and pull the band inward toward your body and then away from your body.  You can then progress to 90/90 positions with the shoulder.  Placing your shoulder in a 90/90 (throwing position) is much more sport specific and challenging.
           
There are several other ways to strengthening the rotator cuff and scapular muscles.  Using physioball, bodyblade, plyoball, or your body weight are great ways to create stabilization in the rotator cuff and scapular musculature.  For an example of these exercises you  visit www.asmi.org/SportsMed/throwing/thrower10 (The Thrower’s Ten Exercise Program).  This program was designed and developed to strengthen the rotator cuff and shoulder musculature.

Remember if you start to get discomfort or pain in your shoulder it is best to apply ice and consult your school’s athletic trainer or team physician.

For further information on this article or for priority appointments for sports injuries please contact Henry Ford Center for Athletic Medicine at 313-972-4216.

Henry Ford Health System’s Center for Athletic Medicine offers a comprehensive approach to sports medicine, including surgical and non-surgical care, sports rehabilitation, injury prevention, and performance enhancement programs.  The HFHS treatment team includes sports medicine fellowship trained orthopedic surgeons, sports medicine fellowship trained primary care physicians, as well as certified athletic trainers and physical therapists.  These health care professionals are supported by the HFHS nationally recognized bone and joint research facility, including the prestigious Herrick Davis Motion Analysis Lab.  HFHS is proud to be health care providers to the Detroit area’s premier sports programs including professional, collegiate, and high school athletes.