Arm, Shoulder Injuries
Julie Mayberry, M.D.
I wanted to open a discussion regarding association of wrist pain and exercise that requires increased weight bearing on upper extremities. In my practice, I see patients from mixed demographics with complaints of wrist pain. In fact, wrist pain happens to be one of the most searchable conditions on the Internet.
A large number of patients associate wrist pain with increase or change in exercise activity—sometimes, a newly developed love for yoga or Pilates.
With multiple benefits comes the unfortunate side effect: pain in the least expected locations such as wrist, elbow and shoulder joints. While this phenomenon is more common in women, we are beginning to see an increasing occurrence in men. How can physical activity that has been praised for thousands of years for bringing emotional and physical well being cause its followers pain and injury?
Justin Shaginaw, M.P.T., A.T.C.
For statistics on common baseball injuries, click here.
It’s that time of year. Spring sports are in the air, even if the spring weather isn’t. Let’s head to the ballpark and start with baseball.
Robert Senior, Sports Doc blog Editor
This Saturday, the Phillies and Rothman Institute will host the 6th annual Sports Medicine Symposium at Citizens Bank Park.
The event, which begins with registration and continental breakfast at 6:30 a.m., is targeted for sports medicine physicians, physical therapists, certified athletic trainers and other professionals. Sports Doc panelist Dr. Michael Ciccotti, Director of the Sports Medicine team at Rothman Institute and head team physician for the Phillies, will present along with fellow Rothman Institute sports physicians and Phillies Certified Athletic Trainers and strength/conditioning coaches.
“We’ll be looking at common sports injuries—specifically, those in the overhead and the throwing athlete,” says Dr. Ciccotti.
Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
Poor swimming mechanics may be a contributing factor in many swimming injuries. But assessing these mechanics is beyond the expertise of most sports medicine. Your swimming stroke should be assessed by your coach, taking into account your specific injury, in order to eliminate an underlying biomechanical cause. A team approach should be taken with swimming injuries incorporating these stroke changes along with a specific rehabilitation program from your athletic trainer or sports medicine provider.
Brian Cammarota, M.Ed., ATC, CSCS, CES
Throwing a baseball or softball is one of the most difficult activities in sports and requires extreme accuracy and skill. It is also one of the most unnatural motions in sports and leads to many injuries, especially among baseball pitchers.
The speed of the pitching shoulder in baseball has been shown to reach 6900 degrees per second in youth pitchers (and higher speeds in adult pitchers). That is equivalent to spinning your arm in a circle approximately 19 times in 1 second (or about half the time it took to read this last sentence). With speeds that fast, it is no surprise that shoulder and elbow injuries are common. One way to decrease injury risk is to perform an off-season throwing program that gradually builds arm strength and prepares a thrower or pitcher for their season.
Two common mistakes among baseball and softball players are:
Alfred Atanda, Jr., M.D., Nemours/Alfred I. duPont Hospital for Children.
For those of us that follow baseball, it seems like every time we turn around another pitcher is going down with a major injury. The most recent notable name is Matt Harvey from the New York Mets. Like many before him, he started having pain with pitching while experiencing decreased velocity and poor control of his pitches.
After visiting with several doctors, he was eventually diagnosed with an Ulnar Collateral Ligament (UCL) tear of his elbow. After seeking advice from several other pitchers with a similar injury, including the Phillies’ Roy Halladay, he eventually decided to undergo “Tommy John Surgery” or UCL reconstruction. Rather than try non-operative treatment, he elected to undergo surgery to maximize his chances at returning to the mound and be as competitive and dominant as he once was.
These clinical scenarios are not only common, but they can get a lot of media attention depending on the caliber of the pitcher involved. With increased attention, increased misconceptions are developed as well usually because a lot of the medical information is interpreted out of proper context. Lately, in my office, I’ve been seeing a lot young pitchers with minimal elbow pain and discomfort terrified that they may need Tommy John Surgery and miss a year of pitching. I’ve had other pitchers, and even parents and coaches, ask if they should have Tommy John Surgery in the absence of an injury, in efforts to try to increase velocity and control.
Heather Moore, PT, DPT, CKTP, Owner of Total Performance Physical Therapy, North Wales, Pa.
“What should I do? Heat or ice?”
The amount of times I have been asked this could qualify for the Guinness Book of World Records. The most confusing part for people is that if you ask 20 different health care professionals, you will get 20 different answers because the literature varies on this—as do most people’s experiences and preferences on what to tell their patients.
There are a few general rules that I tell my patients to follow as guidelines for when to use heat or ice. The first—and this most, if not all healthcare practitioners will agree upon—is that 24-48 hours after sustaining an injury, ice should be applied. This is where RICE (Rest, Ice, Compression and Elevation comes into play. After the 48 hours, we enter that gray area.
Desirea Caucci, PT, DPT, OCS
Shoulders take a lot of abuse in our daily lives. We lift and carry heavy objects, reach in awkward ways, hang bags from them, throw things and undoubtedly stress them with the repetitive tasks demanded by our professions. Additionally, the misguided workout positions, routine recreational pursuits and participation in sports unintentionally lead to the most common shoulder injuries.
I usually see people in my office by the time things have gotten so bad that they can no longer participate in their sports, workouts, and many of their regular daily activities.
One injury that involves the shoulder is rotator cuff dysfunction. Whether in the form of tendonitis, weakness, or tears, the muscles that make up the rotator cuff are usually part of the problem.
Four shoulder blade muscles work together to make up the rotator cuff. These muscles are responsible for all of the motions involved with throwing (lifting the elbow out to side, rotating the forearm backward, forward and extending the arm behind back). When these muscles are working properly they do more than just allow us to throw. They help keep the shoulder in the correct position to allow for pain-free reaching in all different directions. When rotator cuff weakness or dysfunction develops, an imbalance of the forces at the shoulder occurs with reaching and the shoulder joint position is altered. Over time, this causes friction on the tendons when we reach in different ways and “tendonitis” or "bursitis" is a common result.
Similarly, since the shoulder is not being held in proper alignment, the tendons may also become ‘pinched’ between the shoulder bones, resulting in impingement syndrome. I see this develop commonly in people who lift weights to strengthen the larger muscles of the front of the body (chest, biceps, deltoids), but neglect the smaller mid-back and shoulder blade muscles. This muscle imbalance at the shoulder is similar to many of the dysfunctions I have written about previously that also develop at other joints (low back, knees/hips/ankles) due to an imbalance of forces where the larger muscles dominate without the control of the smaller stabilizing muscles.
Other common shoulder injuries involve separations, dislocations and generalized laxity of ligaments. In all cases, the ligaments, which are responsible for joint stability, have been injured and are less effective at holding the bones in place. The surrounding shoulder muscles need to compensate for the ligament damage with proper strength and stabilization training to control large shoulder movements in addition to quick, smaller arm motions.
Another common problem involving the shoulder is ‘frozen shoulder’ or adhesive capsulitis. This may occur secondarily to painful dysfunctions like the ones described above, after periods of immobilization (i.e. with fracture healing) or due to an unknown cause. In any case, significant loss of shoulder range of motion develops as the capsule of the shoulder tightens due to disuse over time. A cycle of pain and dysfunction develops, consciously or not, in which pain with shoulder movements causes one to stop performing the painful movements. This lack of movement and disuse allows the capsule to tighten and the surrounding muscles to weaken. Further attempts at use of the shoulder cause more pain so, over time, lack of movement takes over and people end up with a shoulder that is “frozen.”
With traumatic injuries or slowly progressing shoulder pain, it is always beneficial to seek treatment sooner than later. I have seen some people fully recover within days after initiating a rotator cuff strengthening program. This quick recovery will not happen, though, if months or years worth of damage is already done. Symptoms can still be alleviated and even fully abolished, but the rehab will be much longer.
Be kind to those hard working shoulders, be aware of pain with any shoulder movements and be sure to seek treatment should the need arise.
Below are links to a few basic videos of shoulder strengthening exercises that target the posterior muscle groups, rotator cuff and postural muscles:
- Alfred Atanda, Jr.
- Arm, Shoulder Injuries
- Ashley Greenblatt
- Back Injuries
- Brian Cammarota
- Broad Street Run
- Cassie Haynes
- Children, Teens
- David Berkson
- David Rubenstein
- Desirea D. Caucci
- Eugene Hong
- Head Injuries
- Heather Moore
- In The News
- Jim McCrossin
- Joel H. Fish
- John Quinn
- Julie Coté
- Justin Shaginaw
- Kelly O'Shea
- Kevin Miller
- Knee Injuries
- Michael G. Ciccotti
- Other Sports
- Performance Enhancement
- Peter F. DeLuca
- Philadelphia Marathon
- Philly Marathon
- Physical Therapy
- R. Robert Franks
- Robert Cabry
- Robert Senior
- Rock 'n' Roll Half Marathon
- We Tried It
- Working Out