The shoulder is one of the most difficult and complex joints to deal with in the human body. The anatomical structures are so interconnected that a single injury in one area can affect the entire shoulder girdle. This can include multiple muscles, ligaments, cartilaginous areas, tendons and bones.
Shoulder injuries are super common in overhead athletes, but they are not limited to them. Any person who is alive and using their arms to do stuff can wind up with something going on. This is exactly what we see in our Smithtown chiropractic and sports medicine office. In fact, after low back pain and knee pain, shoulder pain has been estimated to be the third most common musculoskeletal presentation in primary care. A professor even once stated that we all will eventually wind up with shoulder pain/issues whether or not there was any trauma. The cause: we are no longer walking on all fours and our posture as upright humans causes unequal wear and tear. (Although I’m pretty sure for those of us who do walk on all fours, shoulder problems can still arise, but whatevs.)
Table of Contents
Anatomy of the Shoulder
Let’s start by discussing the shoulder anatomy. Out of all the joints we have, the shoulder has the most range of motion. It consists of three bones: the humerus, the scapula and the clavicle. Multiple muscles and tendons must work together to keep the bones in place and stabilize the arm through a full range of motion. The four major shoulder girdle stabilizers that make up the rotator cuff are the supraspinatus, infraspinatus, subscapularis and the teres minor.
Sports and Activities that Frequently Cause Shoulder Injuries
Shoulder injuries are prevalent in sports that involve repetitive overhead motions or significant upper-body exertion. As many as 40% of youth athletes can experience shoulder injuries and on average 16% of people worldwide will experience shoulder pain at some point of their life.
Shoulder Injuries in Sports
- Baseball/Softball: Pitchers are especially prone to rotator cuff injuries, labral tears, and shoulder impingement due to the repetitive overhead throwing motion.
- Swimming: Swimmer’s Shoulder (shoulder impingement) is a frequent issue caused by the repetitive overhead arm movements required in various swimming strokes.
- Tennis:The serving motion and overhead shots can lead to shoulder impingement, rotator cuff injuries, and labral tears.
- Volleyball: Players are susceptible to shoulder injuries from repetitive serving, spiking, and blocking.
- Basketball: Shoulder injuries can occur from shooting, passing, and physical contact during the game.
- Football: Players, especially quarterbacks and wide receivers, are at risk for shoulder injuries due to throwing motions and physical tackles.
- Weightlifting/Bodybuilding: Lifting heavy weights and improper form can lead to rotator cuff injuries, shoulder impingement, and tendonitis.
- Gymnastics: The various maneuvers and routines that require shoulder strength and flexibility can result in overuse injuries and dislocations.
- Golf: The repetitive swinging motion can cause shoulder strain, rotator cuff injuries, and impingement.
- Pickleball: The frequent overhead shots, serves, and rapid arm movements in pickleball can cause shoulder strain, rotator cuff injuries, and impingement.
Shoulder Injuries and Pain in General Population (Non-Sport-Specific)
General Population:
- Men: On average, approximately 15% of men report shoulder pain.
- Women: On average, approximately 25% of women report shoulder pain.
Age Distribution:
- Adolescents (12-18 years): The prevalence of shoulder injuries is around 35%, with higher rates in girls (approximately 40%) than boys (approximately 30%). At True Sport Care and Chiropractic we see many young athletes with shoulder injuries that is why we always stress the importance of athletic evaluation during the off-season to prevent shoulder and other injuries and enhance athletic performance.
- Middle-Aged Adults (45-64 years): The prevalence of shoulder pain peaks around 50% in this age group.
- Elderly (65+ years): The prevalence ranges from 20% to 30%.
Occupational Risk Factors:
Any occupation that involves overhead arm movement, repetitive movements and awkward postures can lead to shoulder pain and injuries.
- Manual Workers: Workers exposed to repetitive movements, heavy lifting, and awkward postures are at increased risk for shoulder pain with rates as high as 17%.
- Health Care Workers: Nurses and caregivers who frequently lift and move patients.
- Office/Computer Workers: Shoulder pain prevalence is about 31%, with women reporting higher rates (42%) as compared to men (20%).
Most Common Shoulder Injuries
Rotator Cuff Tendonitis
Rotator cuff tendonitis (RCT) and tears are very common in anyone who repeatedly performs overhead motions. Tears can range from partial to complete thickness, with partial being the most common. Oftentimes people can have partial tears and not even know it.
Symptoms of RTC tears are as follows:
- pain that radiates from the shoulder to the elbow
- decreased range of motion
- inability to lay on that shoulder due to pain
- dull achy sensation that cannot be avoided
- weakness
Common causes of rotator cuff tendonitis are as follows:
- trauma
- repetitive stress = MUSCULAR IMBALANCES
- normal wear and tear due to aging = MUSCULAR IMBALANCES
Shoulder Impingement
Next up, shoulder impingement. This shoulder injury occurs when one or more tendons of the shoulder get pinched between any of the bones in the shoulder during movement of the arm. The result is pain, swelling and just overall unhappiness. Again, this is most common in people who are repetitively using overhead motions. I usually see this in my softball/baseball players, volleyballers, golfers and swimmers. In fact, it occurs so often in swimmers that it is sometimes referred to as “swimmer’s shoulder”.
Common symptoms of shoulder impingement:
- weakness
- inability to raise the arm up or reach up behind the back
- worsening pain with overhead movement
- a pinching sensation with shoulder motion
Common causes of shoulder impingement injury:
- trauma
- arthritic changes/bony overgrowth = MUSCULAR IMBALANCES
- overuse of shoulder muscles = MUSCULAR IMBALANCES
Frozen Shoulder
Frozen shoulder, or adhesive capsulitis, is marked by stiffness and pain in the shoulder joint. It leads to a significant reduction in shoulder movement over time.
Common symptoms of frozen shoulder:
- Persistent, aching pain in the shoulder and upper arm
- Gradual loss of shoulder movement
- Limited range of motion, affecting both active and passive movements
- Difficulty sleeping due to shoulder pain
- Weakness from disuse and muscle atrophy
Common causes:
- Trauma or surgery leading to prolonged immobilization = MUSCULAR IMBALANCES
- Repetitive stress from overuse or repetitive movements = MUSCULAR IMBALANCES
Shoulder Sprains, Dislocations and Labral Tears
Other common shoulder conditions include sprains and dislocations, and labral/SLAP tears.
Common symptoms:
- pain
- obvious deformity(dislocation)
- weakness
- decreased range of motion
Common causes:
- trauma
- repetitive stress = MUSCULAR IMBALANCES
- ligament damage = MUSCULAR IMBALANCES
- instability = MUSCULAR IMBALANCES
- arthritic changes = MUSCULAR IMBALANCES
Shoulder Injury Evaluation and Treatment
I’m pretty sure that the overarching theme is pretty obvious considering I’ve put it in all caps whenever possible – MUSCULAR IMBALANCES. This is where we come in and do the detective work to find out why these issues are happening. It is our job to try to keep our patients from having unnecessary surgeries by teaching them how to retrain the lazy muscles that haven’t been doing their jobs. More often than not, there are multiple underperforming muscles involved and they aren’t just members of the rotator cuff. Let me give you a perfect example of this.
I’ve treated a right-handed pitcher who was experiencing shoulder pain with weaknesses of her left lateral pelvic stabilizers and glutes. Because of the lack of stability on her stride and post up side, the shoulder was placed under excess stress trying to make up for the deficiency. It needs to be acknowledged and understood that compensatory patterns can arise anywhere in the body – not just adjacent or close to the site of the injury.
Effective Protocol to Treat Shoulder Injuries
- Evaluation. Our evaluation protocol includes a thorough muscular analysis to uncover any underperforming muscles and compensatory patterns. Only by correcting these patterns through therapeutic exercises, joint manipulations and soft tissue work we are able to address the true cause of the shoulder injury and prevent it from reoccurring in the future.
- Therapeutic Exercises. Once the evaluation is done and the underperforming muscles are identified, our patients are taught how to retrain them to prevent any future shoulder injuries. Exercises are prescribed and expected to be performed at home. The more effort a patient is willing to put in, the better off they will be. We can do tons of myofascial work and joint mobilization in the office, but the body needs to learn something to make permanent changes.
- Myofascial work and joint mobilization. Our in-office treatment protocols are designed to provide relief so that your body can start the healing process. The treatment can include a combination of the following modalities: instrument-assisted myofascial release, a chiropractic adjustment to realign the bones, ultrasound or sports massage.
We never claim to be able to cure or fix everything, but we can promise a proactive patient that improvements will absolutely be made if they put in the time and effort.
Shoulder issues are tricky. And annoying. And can really disrupt activities of daily living. But the sooner we can uncover the problem muscles and retrain them, the better off our patients will be. Preventative evaluation of the shoulder before any symptoms even begin is a really smart idea not only for young athletes but everyone with arms (even if they walk upright).
Contact us for Shoulder Injury and Pain Treatment In Smithtown
If you are dealing with chronic shoulder pain or a recent shoulder injury, True Sport Care and Chiropractic in Smithtown is here to help. We will find the root cause of your issues and create a personalized treatment plan for long-term relief. For more information set up a free 15-minute phone consultation and learn how we can help you treat your shoulder injuries and pain.
References
- Murphy, R.J., Jacobs, J.V., Lytle, L.L., Farrell, M.J. (2022). Prevalence and Impact of Shoulder Pain in Overhead Athletes. Journal of Shoulder and Elbow Surgery, 24(7), 1261-1267.Smith, J., Williams, M., Brown, A., & Taylor, C. (2023).
- The Epidemiology of Shoulder Pain in Youth Overhead Athletes. Sports Medicine and Rehabilitation Journal, 39(3), 245-256.
- Pribicevic, M. (2012). The Epidemiology of Shoulder Pain: A Narrative Review of the Literature. In S. Ghosh (Ed.), Pain in Perspective (pp. 17-34). IntechOpen. 3
- Walker-Bone, K., Palmer, K.T. (2021). Shoulder Pain Prevalence by Age and Within Occupational Groups: A Systematic Review. Archives of Physiotherapy, 11, 6.
- Da Costa, B.R., Vieira, E.R. (2010). Risk Factors for Work-Related Musculoskeletal Disorders: A Systematic Review of Recent Longitudinal Studies.American Journal of Industrial Medicine, 53(3), 285-323.
