COMMON SPORTS MEDICINE CONDITIONS

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Location

Although the shoulder is the most mobile joint, the range of motion that the shoulder is capable of also means it is prone to injury, being the most frequently dislocated joint in the body. The ball and socket joint of the shoulder is anchored by its muscles, tendons and ligaments, each of which may be disrupted by injury or over-use, whether from excessive or poorly managed training, or trauma. The joint and surrounding tissue also may be affected by degenerative damage.

Symptoms

Shoulder pain may be localised or may be referred to areas around the shoulder or down the arm. Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder.

Diagnosis

Medical history and physical examination should identify causes of the pain, which may include:

• Dislocation - which may be accompanied by swelling, numbness and bruising of the surrounding ligaments or tendons, possibly with nerve damage.
• Separation - the ligaments that secure the collarbone (clavicle) to the shoulder blade (scapula) tear allowing the clavicle to dislocate.
• Tendinitis and bursitis - overuse and aging may wear down the tendons, muscles, and structures surrounding the shoulder. Pain and discomfort in the upper shoulder or upper third of the arm may be slow to develop but can also affect the biceps tendon, with pain travelling down to the elbow and forearm.
• Torn Rotator Cuff - common in sports involving repeated overhead arm motion (like tennis). The pain is felt over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position.
• Frozen shoulder - the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm. Pain and stiffness tend to be worse at night. The condition is unusual in people under age 40 but if there is limited shoulder movement, an arthrogram may confirm diagnosis.
• Fracture - a fall or blow to the shoulder may cause a partial or total crack, usually of the clavicle or neck of the humerus. There will be severe pain, redness and bruising around the area and the bones may appear out of position.
• Arthritis - this degenerative disease is caused by wear and tear of the cartilage (osteoarthritis) or inflammation of one or more joints (rheumatoid arthritis). This can affect the shoulder joint and surrounding muscles, tendons, and ligaments.

Diagnostic tests may include arthrogram (x-ray after injection of a contrast fluid), MRI or CT scan.

Treatment

As examination can show a wide range of possible causes of shoulder pain, treatment will likewise extend from simple rest and rehabilitation through to surgery to replace the shoulder joint. As mentioned above, shoulder pain can also indicate other health issues which may need early attention.

Further information can be found by visiting The Wellington Shoulder Unit.