Shoulder injuries are common in sports. The category of rotator cuff injuries has numerous names ranging from painful arc syndrome, bursitis of the shoulder, or rotator cuff tears, to just name a few—all usually present with decreased range of motion and pain in the shoulder area.
There are three groups of people who are most vulnerable to these types of shoulder injuries: athletes younger than 25, the “weekend warrior” athletes that are 25 to 40 years of age, and workers over the age of 40. It is rare before the ages of 10 to 11 years.
The most common mechanism of injury is overhead stress from participating in swimming, tennis, or throwing, all of which involve overhead mechanisms. Continuous repetitive stresses can lead to inflammation, necrosis and calcification of involved soft tissue and bone structure.
On postural examination, we may notice one shoulder to be lower than the other and/or the patient may hold the shoulder complex in a protected or guarded posture. Ranges of motion may note an aberrant movement instead of a smooth rhythmic motion. Noticing apprehension in facial expression during flexion, extension, abduction, adduction, internal and external rotation can all clue us into possible rotator cuff injuries that may identify structural or neurological problems.
Having an understanding of some simple tests can also help us identify underlying causes. If pain is at the beginning or end of a range of motion, it could indicate an impingement syndrome. You could perform an Apley scratch test, which externally rotates and abducts the shoulder. Dislocation of the glenohumeral joint can be identified by pain on the apprehension test. The drop-arm test could be an indicator for a possible rotator cuff tear. Yergason test, for biceps tendon instability or tendonitis, is performed by having the patient flex the elbow against resistance while the examiner rotates the humerus externally.
Treatment would include chiropractic manipulative therapy to reduce resulting subluxation complexes of the spine and possible extremities, rehabilitation to help strengthen a weakened shoulder musculature or laxity of the joint, or use of stretching exercises for conditions that are more in line with a repetitive stress that results in tightness of the capsule and supporting musculature. A side note with rehabilitation: Be careful not to overload the joint too quickly and make sure proper patterns of movement are employed. Remember to also include both eccentric as well as concentric strengthening.
A very important and commonly overlooked aspect of rehabilitation is making sure proper technique is used. Whether the sport is swimming, tennis or pitching, improper technique can add additional stresses on the joints, resulting in injury. In sports like baseball, also keep in mind that Little League Baseball has incorporated rules that went into effect starting with the 2008 season that limit the amount of pitches a pitcher is allowed to throw in a given contest. These rules also include required days of rest which are based on the amount of pitches that the pitcher throws in a given contest. The following are the requirements established by Little League Baseball.
It’s important that, when caring for your patients (especially those under the age of 18), you take time to explain their need to rehab and rest. Both rehab and rest are vitally important to the recovery from a shoulder injury and prevention for future injuries.
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan