The Remarkable Shoulder Joint

We never think about our shoulders until there is an incapacitating injury. The shoulder is an amazing complex of bones, tendons and muscles. They all work together with a seeming ease of meshing, which allows for our extensive range of motion with our arms.

But there is also a real vulnerability to the shoulder, because it is not as effective in promoting stability. When injured, the entire system breaks down in a grand and terrible way.
The 3 bones which make up the shoulder are the scapula (we think of as the shoulder blade), the humerus (the upper arm bone)  and the clavicle (or collarbone). However, the majority of shoulder problems involve not the bones but the muscles, ligaments and tendons.

The shoulder joint gets a lot more vulnerable with aging. Even before the accident, there is often a generalized wearing and tearing. This degeneration of the shoulder is often little noticed. But after sudden trauma, the entire joint can become a serious problem.

The Difficulties of Shoulder Injuries

Shoulder injuries are notorious for their slow healing, and the degree of pain during convalescence. This anatomical mechanism is a ball-and-socket type of joint, and it serves many functions. Because the shoulder is a joint of crucial importance, high-level medical care is essential. It is a mistake to stoically endure pain while continuing with daily affairs.

Shoulder injuries have an immediate and drastic impact on jobs and family life. Many careers, even those beyond the industrial variety, demand much lifting. Raising the arms above the horizon of the shoulder is required for even the simplest tasks at home, such as reaching into the kitchen cabinet. The consequences of compromise to this upper-body region are felt immediately.

Shoulder pain often radiates, into the back and neck, resulting in a more complex situation. An impact to the shoulder can re-activate an underlying, pre-existing back ache which has been comfortably dormant. This is a common problem. In fact, the American Society of Physical Therapists has stated that over 80% of Americans can expect to suffer back pain in their adult lives. This can keep them from work for extended periods and also result in job dismissal.

Immediate Care is Needed for Shoulder Injuries

Even more than other injuries, those involving the shoulder require fast action, if later complications are to be avoided. The first 48-72 hours are critically important. If the shoulder receives effective treatment during that tight time frame, then the odds of a quicker and more complete recovery are greatly improved.

During evaluation, the orthopedist will attempt to categorize the shoulder problem as one of instability or impingement. Instability results when the joint is forced out of its normal position. When this occurs it is unstable, and can advance to the more troubling condition of dislocation. This constant feeling, that the shoulder is slipping out of place, is also psychologically disturbing.

If the shoulder disorder is an impingment, then there is excessive rubbing of the shoulder muscles against the most top part of the shoulder blade, known as the acromion.

Frontline physicians know the acronym RICER. This stands for the customary modalities which make up the best treatment regimen. RICER stands for:

  • Rest
  • Ice
  • Compression
  • Elevation
  • Referral

RICER is grounded in the fundamental physiology of this anatomical area. The shoulder receives comparatively little blood flow. In order to stimulate healing in the injured area, the strategy is to promote blood traffic, carrying oxygen and nutrients.

This is best accomplished by applications of heat and massage. Heat serves the purpose of rushing blood to the shoulder region. This is better accomplished by a heating pad than by heat-based creams, such as BenGay or Icy Hot. Those topicals are beneficial, but studies suggest that the relief they offer is not sustained.

Massage is a very good way to increase oxygenation through blood flow. Repeated applications are needed, and they should be with a seasoned and gentle touch. Properly executed, massage will actually reduce scar tissue. Generally some degree of scarring is the inevitable residual of all varieties of muscle and tendon traumas tears.

Physician consult during convalescence will guide as to the degree and type of shoulder movement which is best. Most physicians will not advise to stop moving altogether. There is, however, variability of medical opinion on this issue.

Rotator Cuff Damage

The American Academy of Orthopedic Surgeons has stated that about 8 million people a year can be expected to visit a doctor for shoulder and upper arm problems. And well over half of these medical consultations will be about rotator cuff problems.

The shoulder, a complex joint, is made up of 4 tendons. And the rotator cuff is a shoulder component of great importance. When one or more of these tendons is injured, there is rotator cuff damage. And with this tearing, the bones which hold the shoulder together become dysfunctional.

The pain of rotator cuff damage is uniquely miserable. Those who suffer from it are the only ones who really understand the degree of hardship. The symptoms include not only extensive pain and stiffness, but swelling which is hard to control. When raising the arm, a painful pop can be heard.

If problems persist, it can be expected that imaging will be ordered, customarily a MRI or an Ultrasound. If there is compromise from a pronounced tear, surgery will often be recommended. Although rotator cuff surgery is sometimes unsuccessful, the point often is reached where that risk must be taken.

Injuries to the Arm

Arm injuries which are the result of an accident may be caused by a penetrating laceration, a direct blow or the result of a bending-twisting motion. The most injured arm sites are the forearms, wrists and hands. For older adults, there may be an underlying osteoporosis. This usually will exacerbate new problems which are the result of the vehicle mishap.

If there are no fractures, there will be treatment to address the bruising and edema which can be expected to develop. Bruises (contusions) happen when the tiny blood vessels are damaged or even tear. When blood seeps into the surrounding tissue, there results the distinctive black-and-blue appearance.

Strains happen when the ligaments, which are ropelike fibers that connect muscle to bone, are torn and pulled. They require time to heal.

This pain is significantly worsened if bursitis develops. This is pain and swelling in the sac of fluid that cushions and lubricates the joint area. It is located between two adjacent bones.
If there is pain and swelling, of the strong fibers that connect muscles to bones, then tendinitis will be diagnosed and treated. The related condition of tendinosis is the result when there are micro-tears of the connective tissue wrapped around the tendons.