Most Common Shoulder Injuries: Diagnosis, Management, and Treatment Strategies

by Proclinix, October 2, 2018

By Andrew Levine, MS, ATC, CSCS, PES

Among common orthopedic injuries that one may suffer, complaints about shoulder issues are some of the most common. The glenohumeral joint (ball and socket joint in the shoulder, GH joint for short) is the most free-moving and mobile joint in the human body.  This is a great attribute when considering all of the different actions and motions that can be performed by the joint in both an ordinary and athletic environment. The caveat is that this increased mobility can make the GH joint very unstable and vulnerable to injury relative to joints like the knee and hip, especially if all of its structures are not working effectively and in-synch.  The purpose of this article is to discuss some common issues that occur in the shoulder and to help you understand some different treatments and management strategies before making the leap into more invasive procedures that can potentially be painful, debilitating, and expensive.

Shoulder Impingement/Rotator Cuff Tendinopathy/Bursitis:

Sub-acromial impingement, or impingement of the rotator cuff and/or bursa sac underneath the acromion process of the scapula, is commonly referred to as shoulder or rotator cuff impingement.  The tendon of the rotator cuff muscle called the supraspinatus runs through a small space (imagine a small tunnel) between part of your scapula (“shoulder blade”) and the head of your humerus (forms the “ball” portion of the GH joint and is part of the long bone that runs between your shoulder and elbow).  When this tendon becomes inflamed and swollen due to overuse or injury and becomes too big for its “tunnel”, friction/compression can occur on the bone above and cause pain and loss of function. This compression also commonly results from poor posture causing abnormal alignment of the “ball” inside the “socket” and subsequent friction on the tendon. Overtime the repeated friction to the supraspinatus tendon can cause chronic inflammation, commonly referred to as tendonitis, or a tear in the tendon.  Tears due to chronic compression are often present as micro-tears or partial rotator cuff tears, whereas full-thickness rotator cuff tears often occur due to acute trauma such as a fall with the shoulder in a compromised position, lifting a heavy object, or a dislocation/subluxation episode.

Treatment/Management:

If there is one silver lining to having and injury such as this, it’s that treatment and management could be as easy as fixing your posture!  While this ailment is often seen in athletic populations who are using their shoulders for lifting weights, blocking, shooting a basketball, etc., it is also very common in the average person, especially if they are hunched over at a desk for a living.  If this sounds like it may pertain to you, start by following these simple steps and see if you notice any relief.

Start by fixing your standing/sitting posture.  Sit and walk with your shoulders back, chest high, and head back so your ears are over your shoulders.  Pulling your belly button back into your spine and engaging your core while walking and sitting will also help keep you upright.  Modifying your daily tasks may also be beneficial. If you are sitting at a desk, rearrange it so that everything is close to you and you don’t need to reach for your keyboard, mouse, or phone.  Also make sure that your computer monitor is positioned directly in front of you so you don’t need to keep your head/neck turned to one side for prolonged periods to look at it. The same goes for driving; adjust your seat and steering wheel so that you are not reaching for the wheel for long periods of time and taking some stress off of your shoulders. The other side of management and treatment will likely involve some degree of medical professional, be it a medical doctor, orthopedist, physical therapist, or athletic trainer.  Conservative management by any of these disciplines or any combination will likely include an initial evaluation and diagnosis followed by rehabilitative exercise and activity modification.  Supervised exercises and mobility programs will serve to strengthen weak muscles in the upper back and rotator cuff and provide mechanical balance/alignment to the joint, allowing for restoration of function and reduction of pain.  This conservative course of action can be followed for any range of previously mentioned injuries, from mild impingement to rotator cuff tears.

If conservative treatment of these ailments fails, other more invasive options may be considered to ease the patients discomfort and restore function.  Different types of injections into the area have both been shown to provide relief in some cases, most notably corticosteroids (or cortisone) or platelet rich plasma (PRP).  If conservative management with therapeutic exercise and/or PRP injection still do not provide relief for the patient, they may want to consider surgical intervention to correct the problem.  This may come in the form of a complete re-attachment of the tendon to the head of the humerus, or a procedure to trim and smooth out the torn section of tendon called a debridement.

Everyone’s body is different and reacts differently to different treatments!  This piece was meant to be strictly informative, so please be sure to consult with a physician, physical therapist, or athletic trainer for further information or referral before beginning any rehabilitation or course of treatment.