Problems with the Shoulders
Posted: Sunday, October 31, 2010
by John Laurusonis
Doctors Medical Center
The shoulder joint is comprised of three bones and the muscles and tendons which connect them, and the nerves and blood vessels which pass through it. The bones are the humerus (arm), the clavicle (collar bone), and the scapula (wing bone). The ball-like head of the humerus sits inside the cavity-like structure of the scapula which is called the glenoid cavity. Any of these bones can be broken, though the scapular body is usually resistant to fracture except under extreme impact injuries, as in a motor vehicular accident. Any of the muscle and tendons is subject to strains or ruptures, again dependent upon the mechanism and forces of injury. The muscles are intricately located and coordinated to allow the arm to be raised straight out, swung from front to back, and rotated in a large arc; any damage to one or more of these muscles can affect strength and range of motion. The complex nerve switching structure called the brachial complex, as well as the veins and arteries are subject to stretching or contusive injuries.
These same conditions can occur in childhood or adulthood. The difference lies primarily in the mechanisms of injury. Most of these injuries happen when a person falls onto their shoulder, elbow, or extended arm. The arm can act as a lever and actually concentrate the force to a certain part of the joint. Falling forward or backward onto the extended arm often dislocates a shoulder joint. This happens due to an injury to a functional group of muscles called the rotator cuff. It is an extremely painful injury until the dislocation can be reduced. Once reduced, it is supported by a sling and a swath bandage which binds the joint to the upper chest. Another injury which often occurs from falling onto the elbow is called an AC, or acromioclavicular injury. There is a sturdy ligament which connects the acromial process of the wing bone to the collar bone. It can be stretched and sprained or totally disrupted. This is called an AC separation. Again it is usually treated with a sling for several weeks, though sometimes it has to be surgically repaired. Another type of shoulder injury is, indeed, a rotator cuff tear. As mentioned, this is a specific functional muscle group which rotates the shoulder. This is the type of injury that ends the career of a promising young pitcher. There are surgical procedures for rotator cuff injuries but the results are often less than optimal. Falling forward on the extended arms can actually fracture the humeral head. These injuries can require a nail or other fixation device to allow it to heal if the head is separated from the rest of the humerus. If there is just a crack in the head, it may be treated with a sling for several weeks. Finally, the glenoid cavity can be cracked or shattered by the humeral head being driven up into it. This may be treated with a sling, but sometimes requires open surgical reduction.
The problem with most of these injuries is that they are a set-up for osteoarthritis after the injury. There is damage to cartilage and there of bone on bone contact. Spurs may form which can dig into the tendons and muscles as they move. The shoulder becomes more and more stiff, and may require anti-inflammatory medicine. The problem is that most people don't know that the shoulder joints are almost always in motion, moving as they do to maintain balance. Arthritis in the shoulder can be a very uncomfortable condition. Other forms of arthritis can set up in the shoulder joint, too. One such arthritis is gout, where uric acid crystals, shaped like tiny needles, are deposited in the joint. Psoriatic arthritis and rheumatoid arthritis can affect the shoulder joints. Treatment is directed at the underlying arthritic condition.
When one has a dysfunctional shoulder, whether it is traumatic or arthritic, physical therapy can be a very important treatment. The idea is, above all else, to avoid a frozen shoulder. The concomitant goal is to restore and maintain the maximal strength and range of motion possible. Once one finishes with physical therapy for a shoulder injury or for arthritis, it is important to keep doing the exercises every day at home. The body has a wonderful way of healing even the most frustrating conditions if one is diligent in pursuing a more healthful condition.
John Drew Laurusonis M.D
Doctors Medical Center
This Article has been viewed 543 times. (Not updated in real-time.)
No comments yet.We want your comments! If you can read this, you don't have javascript enabled, so you can't use this comment system. Please enable javascript.