Southwest Florida's Health and Wellness Magazine Health and Wellness Articles
By Debra K. Brinker, RN
The shoulder is a unique joint providing an incredible range of motion for daily living and sports. The downside to all that motion is shoulder instability, if this ball and socket joint becomes injured, it can lead to shoulder instability. As the shoulder becomes unstable, it can start making a clunking or clicking noise. It is not normal to have a clunking shoulder! When this occurs with every stroke or swing motion in athletics, it can indicate a more severe, multidirectional shoulder instability which commonly results in pain, weakness, popping, or other symptoms. (See figure 1.) Pitchers, quarterbacks, tennis players and swimmers, are athletes who are especially prone to shoulder injuries. These sports all require repetitive overhead movements. Even golfers suffer from shoulder injuries due to the positioning in the backswing, commonly affecting the non-dominant shoulder.
Aggressive, repetitive use can cause ligaments to elongate. Ligaments have a poor blood supply and, when they are damaged, they need time to remodel and repair. For instance, swimming training hours may need to be reduced or altered to allow for proper rest time between workouts. The same is true for the golfer and the pitcher! Inadequate repair can lead to joint instability, which is the underlying cause and missing diagnosis in most cases of chronic shoulder pain conditions. (See figure 2.)
Labral tears
One of the afflictions common to the shoulder is a glenoid labrum injury. The glenoid labrum is a very important stabilizing structure of the shoulder. Basically, the shoulder socket is the glenoid, and the labrum is soft tissue surrounding the socket. (See figure 3.) Tears to the labrum are a prevalent injury suffered by athletes and by workers who do a lot of manual labor. These injuries can occur due to trauma, repetitive motion or recurrent dislocations. If the labrum is torn, it is important to keep in mind that the forces involved in the injury were most likely significant enough to also injure the ligaments and tendons surrounding the shoulder. When seeking treatment, the entire shoulder and all structures involved, need to be evaluated and treated, in order to have a completely healed shoulder joint. When healing is incomplete, a cycle of joint instability and long-term degeneration is set in motion.
Rotator cuff injuries
Another common cause of shoulder pain involves the rotator cuff. The rotator cuff is a group of four muscles and tendons surrounding the glenohumeral joint. It provides the motion for activities above the waist and shoulders. (See figure 4.) Because of this, it is vulnerable to injury with overhead activities. Persistent instability causes strain and weakness in the rotator cuff muscles, fatiguing the muscles and altering their functional abilities, which can lead to the injury of other shoulder structures. With continued use of poor form, or with repeated overuse, instability increases and the rotator cuff weakens further, eventually resulting in tears and degeneration.
Treatment options for shoulder pain
Surgery, including arthroscopic treatment, involves the removal or debridement of the shoulder structures, leaving the joint more unstable, and prone to re-injury. Chronic shoulder instability eventually results in the development of osteoarthritis, as the body overgrows bone to try and stabilize the joint. Some doctors may choose to treat these injuries more conservatively by prescribing non-steroidal anti-inflammatories (NSAIDs) and performing corticosteroid injections. While these are designed to reduce swelling and provide short-term pain relief, by limiting blood flow to the injury, they actually inhibit healing and can have far-reaching, damaging effects on the shoulder joint.
Regenerative injection treatments, such as Prolotherapy, treat chronic pain and repair shoulder injuries non-surgically. Even in cases where pain has just started to become a nagging issue, Prolotherapy is often beneficial to start sooner rather than later. (See figure 5.) Prolotherapy restarts the healing cascade directly at the ligament and tendon level, giving the area another chance to repair. It provides an ideal option to correct the underlying shoulder instability and naturally alleviates pain. As the tissue strengthens, the shoulder can handle the original level of athletics or activity that used to cause pain, clunking, and weakness.
Prolotherapy can involve a traditional dextrose solution that mimics the substances released by the immune system when there is an injury. It can also be strengthened to include a person’s own growth factors or stem cells. These treatments are known as Platelet Rich Plasma and Stem Cell Therapy, but all fall under the Prolotherapy umbrella. Regenerative injection options are ideal for athletes who need to continue training and the weekend golfer who doesn’t want to stop their beloved sport.
Regenerative Medicine Specialists
CaringMedical.com
239-303-4546 with locations in Fort Myers and Chicagoland
