The shoulder joint consists of the humerus (arm bone), the glenoid (part of the scapula bone), the labrum, and the surrounding tendons and ligaments. The humeral head sitting in the glenoid can be thought of as a “golf ball on a tee” because of the large humeral head and small labrum. As a result, the shoulder has a very large range of motion, but in exchange loses stability and is easily injured or dislocated. The four most important muscles and tendons that surround and stabilize the shoulder are the rotator cuff muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles are covered by a bursa that helps lubricate the tendons and allow them to glide freely during motion. Together, these muscles with the help of the labrum, a ring of cartilage around the glenoid, hold the humeral head into the shoulder “socket” and stabilize the shoulder. It is important to recognize that unlike other joints that have strong bone and ligament stabilizers, the shoulder is primarily stabilized by muscles and tendons.
Injury to ligaments, muscles, tendons, ligaments, bursa, and nerves in the shoulder are common. Overuse injuries or irritation of the rotator cuff muscles are called “tendonitis” and irritation to the bursa is called “bursitis.” These types of injuries may cause minor pain with activity that is worse with reaching activities and sports. In addition, sleeping on ones shoulder can often exacerbate these symptoms. Weakness is not uncommon. Injuries to the nerves that cross the shoulder or innervate the surrounding muscles commonly occur during contact sports and are called “burners” or “stingers.” They usually last for a few minutes, but can occasionally last longer resulting in a shock-like sensation and weakness in the arm.
Most cases of sprains, strains and inflammation to various muscles, tendons, and bursas around the shoulder can be treated with the RICE protocol (rest, ice, compression, and elevation). Avoiding the exacerbating activity is the first and most important step. Drugs such as ibuprofen and aspirin can help reduce pain and swelling. In addition, rehabilitation with strengthening and physical therapy can often improve symptoms and enhance recovery. Lastly, your doctor may suggest a steroid injection to reduce inflammation in an inflamed bursa or tendon, which can often relieve pain.
Your physician may recommend a specific rehabilitation protocol to enhance your recovery to activities and decrease pain. The importance of physical therapy in the shoulder cannot be overstated since it is the muscles and tendons that primarily stabilize the joint. Exercises will consist of exercises for improving strength, maintaining motion, and re-training your muscles. Exercises should be performed in a supervised setting, as well as at home on your own time. Your commitment to rehabilitation is key to a successful outcome.
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