Shoulder Sports Med

The shoulder is a ball (humeral head) and socket (glenoid) joint, and it is the most mobile joint in the body. However, the socket (glenoid) is shallow, covering less than half of the ball (humeral head) and provides little stability.

The shoulder joint is held in place by muscles and bands of connective tissue called tendons and ligaments. Four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons connect the upper arm bone (humerus) with the shoulder blade (scapula).

There are many different types of shoulder injuries and tears; however, there are a few that are more common than others. Common types of injuries are rotator cuff tears, biceps tendon rupture, Bankart Lesion, and Superior Labrum from Anterior to Posterior (SLAP) lesions.

Many of these injuries can occur from long-term overuse, such as repetitive lifting, pushing, pulling and throwing. For this reason, athletes and skilled workers are particularly prone to shoulder injuries.

Sports Shoulder Injuries

Most shoulder damage involves the muscles, ligaments, and tendons, rather than bones which make it difficult to decide if the shoulder pain is from muscle soreness or a tendon injury. Common Types of Sports Shoulder Injuries

  • Rotator Cuff Tear
  • Bicep Tendon Rupture
  • Labral Tear
  • Bankart Lesion Tear
  • SLAP Lesion Tear
The group of muscles and ligaments in the shoulder is called the rotator cuff. It is located near the under part of the shoulder blade and provides stability and range of motion to the joint whenever it moves. Rotator cuff injuries are very common sport related injuries, especially in sports that require repetitive overhead arm motions.
Symptoms usually include pain, weakness and tenderness in the shoulder when reaching overhead, behind the back, when pulling and when lifting items. Symptoms may show up immediately or gradually, depending on the extent of the injury.

Bicep Tendon Tear

A bicep tendon rupture occurs when the tendon attachment separates from the bone. After this happens the muscle cannot pull on the bone and certain movements may seem weak and painful.

There are two types of ruptures:

  • Proximal bicep rupture, which is an injury at the shoulder joint
  • Distal bicep rupture, which is an injury toward the elbow joint
    A distal bicep tendon rupture is characterized by sharp pain over the front of the elbow. Swelling and bruising around the elbow are also symptoms. A proximal rupture usually isn’t as painful.
Labral Tear

The socket of the shoulder joint is extremely shallow and inherently unstable. The shoulder joint has a ring of cartilage around the socket called a labrum that forms a deeper cup for the ball portion of the upper arm bone (humerus) to compensate for the shallow socket. This ring of cartilage increases stability of the shoulder joint, yet allows for a wide range of movements.

There are two types of labral tears:

  • Bankart Lesion Tear
    The bankart lesion is a common cause of instability in the shoulder. This kind of tear can occur from stress on the front of the shoulder when performing overhead activities like throwing or serving a tennis ball. Another way to develop a bankart lesion is when a shoulder dislocates. Symptoms of a bankart lesion often include a sense of instability and aching in the shoulder. The patient usually experiences repetition of the dislocation or a catching sensation in the shoulder.
  • SLAP Lesion Tear
    SLAP is short for Superior Labrum from Anterior (front) to Posterior (back). This type of labral tear is usually seen in overhead throwing athletes such as baseball players and tennis players. An injury to this part of the body typically happens due to overuse, trauma and accidents such as falling onto an outstretched hand. Symptoms of a SLAP Lesion include pain and soreness in the front of the shoulder when bending the elbow or turning the wrist. Some also experience a click or snap with movement of the shoulder and it may feel like the shoulder is being dislocated.

The group of muscles and ligaments in the shoulder is called the rotator cuff. It is located near the under part of the shoulder blade and provides stability and range of motion to the joint whenever it moves. Rotator cuff injuries are very common sport related injuries, especially in sports that require repetitive overhead arm motions.

Symptoms usually include pain, weakness and tenderness in the shoulder when reaching overhead, behind the back, when pulling and when lifting items. Symptoms may show up immediately or gradually, depending on the extent of the injury.

The socket of the shoulder joint is extremely shallow and inherently unstable. The shoulder joint has a ring of cartilage around the socket called a labrum that forms a deeper cup for the ball portion of the upper arm bone (humerus) to compensate for the shallow socket. This ring of cartilage increases stability of the shoulder joint, yet allows for a wide range of movements.

There are two types of labral tears:


Bankart Lesion Tear
The bankart lesion is a common cause of instability in the shoulder. This kind of tear can occur from stress on the front of the shoulder when performing overhead activities like throwing or serving a tennis ball. Another way to develop a bankart lesion is when a shoulder dislocates.Symptoms of a bankart lesion often include a sense of instability and aching in the shoulder. The patient usually experiences repetition of the dislocation or a catching sensation in the shoulder.


SLAP Lesion Tear
SLAP is short for Superior Labrum from Anterior (front) to Posterior (back). This type of labral tear is usually seen in overhead throwing athletes such as baseball players and tennis players. An injury to this part of the body typically happens due to overuse, trauma and accidents such as falling onto an outstretched hand.Symptoms of a SLAP Lesion include pain and soreness in the front of the shoulder when bending the elbow or turning the wrist. Some also experience a click or snap with movement of the shoulder and it may feel like the shoulder is being dislocated

Bicep Tendon Rupture

A bicep tendon rupture occurs when the tendon attachment separates from the bone. After this happens the muscle cannot pull on the bone and certain movements may seem weak and painful.

There are two types of ruptures:

  • Proximal bicep rupture, which is an injury at the shoulder joint
  • Distal bicep rupture, which is an injury toward the elbow jointA distal bicep tendon rupture is characterized by sharp pain over the front of the elbow. Swelling and bruising around the elbow are also symptoms. A proximal rupture usually isn’t as painful.

Sports Shoulder Non-Surgical Treatment Options

Treatment for shoulder injuries depends on the severity of the injury. The patient’s activity level and overall health are also important factors to consider before treatment begins.

Partial tears to these shoulder muscles and ligaments can typically be treated with rehabilitation and bracing. However, specific treatment for a shoulder ligament/tendon injury will be determined by your physician based on age, overall health, medical history, extent of the injury, the patient’s tolerance for specific medications, procedures and therapies.

Treatment may also include muscle-strengthening exercises, protective shoulder brace, or RICE (rest, ice, compression and elevation).

Recovery

This type of recovery may include resting of the muscle and limited activity or rehabilitation therapy, which involves range of motion and strength exercises to help restore the shoulder to full function. These include flexibility and muscle strengthening exercises targeting the muscles around the rotator cuff and scapula. Depending on the injury, physical therapy may last anywhere from a few weeks to a few months. The surgeon may have you perform different exercises in order to help regain strength to the ligament.

Arthroscopic Surgery for the Shoulder

If the ligament has been completely torn or if the patient is not healing from physical therapy, then the doctor may suggest a complete reconstruction of the ligament in order to prevent further damage and stabilize the shoulder.

Arthroscopic surgery may be performed. Surgery involves the repair, reconstruction and removal of the damaged tissue. A physical therapy program will usually follow the surgery in order to strengthen the muscles and restore full joint mobility.

Arthroscopy is a technique that allows surgeons to visualize, diagnose and treat a variety of joint problems. Rotator cuff tears, ligament tears, tendon tears, damaged and loose cartilage, and many other conditions can all be treated arthroscopically. Arthroscopy is performed using an arthroscope, a small optic instrument that enables a close look at the inside of a joint through a small skin incision.

Arthroscopic surgery was developed as a way to avoid making long skin incisions. While the long incisions allowed surgeons to fully visualize the joint, the subsequent disruption of tissue created long healing times, increased risk of infection and resulted in long scars.

Procedure

Arthroscopic surgery avoids long, invasive incisions by using an arthroscope, a small tube-like instrument that allows the surgeon to see inside the joint. The arthroscope is inserted into the joint through a short incision generally less than 1/4″ – 1/2″. Several small incisions may be made to see other parts of the joint or to insert instruments. The arthroscope uses a camera that projects the image of the joint onto a monitor. The surgeon is able to view the joint, and its structures, including cartilage, ligaments and surrounding tissue. Once the problem is identified, the surgeon may be able to use specially designed instruments and/or implantable fixation devices to repair conditions or remove any damaged bone or tissue.

All patient education materials are provided by OrthoPatientEd.com and have been reviewed by our Advisory Board of leading Orthopedic Surgeons to ensure accuracy. All materials are provided for informational purposes only and are not intended to be a substitute for medical advice from your orthopedic surgeon. Any medical decisions should be made after consulting a qualified physician.
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