Common Summertime Orthopedic Injuries: Shoulder

Here comes Spring and Summer! With the warmer weather, people of all ages begin to enjoy participating in outdoor sports and activities, exercise, and vacation. Sports such as baseball, softball, tennis, swimming and volleyball and activities that involve a lot of repetitive arm and shoulder motion (ie, painting, roofing, yard work, and gardening) can often lead to the development of common shoulder conditions.

As an Orthopedic Surgeon and Sports Specialist, I see an increased incidence of injuries associated with these endeavors during the warmer months of the year. A large number of these injuries can be prevented and cured if risk factors are recognized early, if the signs and symptoms are properly identified, and if quick and appropriate diagnosis and treatments are provided. My goal for this article is to describe some of these common injuries that occur in people of all ages during these warmer months, and hopefully point out what to watch for regarding the signs and symptoms of these conditions, and what we can do to effectively treat these problems.

Shoulder Conditions/Injuries:

Some of the most common shoulder conditions that occur in the warmer months include Impingement Syndrome, Bursitis, Tendinitis, and Tendon Ruptures or Tears. These conditions are often associated with repetitive activity, new onset of activity, change in activity, overhead activity, injury from a fall, or heavy lifting. All of these conditions can cause significant pain and disability in the shoulder and upper extremity. Very commonly, individuals can develop these conditions and not really be aware of the severity of the condition, and in an effort to “work or play through the pain,” they tend to brush it off and keep participating, therefore aggravating the shoulder even further. The most common activities that lead to these conditions are as follows:

Common Activities That Cause Shoulder Injury

• Sports (tennis, baseball, swimming, volleyball)
• Yard work (digging, planting, raking, weed-eating, spreading straw)
• Painting
• Hammering
• Moving heavy objects
• Repetitive overhead lifting/movements (spring cleaning)

Impingement Syndrome:

Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or “impinges” on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement. Over time, severe impingement can even lead to a rotator cuff tear.

Bursitis:

Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.

Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis. Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult.

Tendinitis:

A tendon is a cord that connects muscle to bone. Most tendinitis is a result of a wearing down of the tendon that occurs slowly over time, much like the wearing process on the sole of a shoe that eventually splits from overuse.

Generally, tendinitis is one of two types:

• Acute. Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis.
• Chronic. Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.

The most commonly affected tendons in the shoulder are the four rotator cuff tendons and one of the biceps tendons. The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability.

Tendon Ruptures or Tears:

Splitting and tearing of tendons may result from acute injury or degenerative changes in the tendons due to advancing age, long-term overuse and wear and tear, or a sudden injury. These tears may be partial or may completely split the tendon into two pieces. In most cases of complete tears, the tendon is pulled away from its attachment to the bone. Rotator cuff and biceps tendon injuries are among the most common of these injuries.

What to watch out for:

• Minor pain that is present both with activity and at rest
• Pain radiating from the front of the shoulder to the side of the arm
• Sudden pain with lifting and reaching movements
• Athletes in overhead sports may have pain when throwing or serving a tennis ball
• Pain at night and difficulty sleeping on the affected side
• Loss of strength and motion
• Difficulty doing activities that place the arm behind the back, such as buttoning or zippering

Treatment:

Initial treatment usually includes rest, ice packs, medication such as ibuprofen, aspirin, naproxen, etc, and range of motion exercises.  For more serious injuries physical therapy may be helpful. For severe pain, your doctor may suggest a cortisone injection.

Fortunately, most of these conditions can be treated very successfully without needing surgery. However, for those severe injuries where the rotator cuff is torn, or injuries that do not respond to conservative treatments, surgical repair may be required.

‍