Keeping your shoulder healthy
NORMALLY, the shoulder has a wide range of motion, making it the most mobile joint in the body. Due to this flexibility, however, it is not very stable, is easily injured and can deteriorate with constant use over time. To keep shoulders healthy and pain-free, it’s important to know how to spot and avoid common injuries.
Rhys Williams, a senior orthopaedic surgeon specialising in shoulder and knee surgery, who practises privately at the Nuffield Health Cardiff & Vale Hospitals and in the NHS at the University Hospitals of Wales and Llandough in Cardiff, is well placed to remove the mystery of conditions that affect the shoulder. Having a father who was a radiologist, he has a healthy respect for the role of imaging in confirming diagnoses, but taking a history and examining the patient is the first way of determining what may be the cause.
Mr Williams explains: “Basically the shoulder is a girdle with lots of muscles which need to function in a co-ordinated manner. It is important to take ageing and the person’s occupation and lifestyle into account when making the diagnosis. As tendons age, they are less able to tolerate stress, are less elastic, and are easier to tear.
“Shoulder instability happens most often in young people and athletes. When muscles and ligaments that hold it together are stretched beyond their normal limits, the shoulder becomes unstable. The acromio-clavicular joint, or AC joint, is a joint at the top of the shoulder. It is the junction between the highest point of the shoulder and the clavicle. Problems occur due to overuse which causes tenderness of the AC joint. Treatment often involves resting and applying ice to the joint for it to heal. Sometimes injections, antiinflammatories or arthroscopic surgery will be required.
“Adhesive capsulitis, often called frozen shoulder, is very painful stiffness and so this condition needs to be given time to settle down before therapy exercises can begin, otherwise it will be too painful to move. Again, steroid injections are useful in dampening pain and allowing the physiotherapists to work.
“Impingement pain is very common in all age groups and this can often be successfully treated with physiotherapy and cortisone injections. If it is more severe, where you are unable to raise your arm, this can be a sign of a rotator cuff tear, which is diagnosed by a series of simple physical tests, followed by a scan to confirm the physical diagnosis.
“Overuse or injury to the joint at work or play can also increase a person’s risk of inflammation and damage. Examples of high-risk activities include gardening, raking, carpentry, painting, cleaning, tennis, golf, skiing and throwing. Incorrect posture at work or home and poor stretching before exercise can also lead to bursitis where the bursa, which a sac filled with lubricating fluid, located between tissues, becomes inflamed.
“Thankfully, osteoarthritis in the shoulder is much less common than in the weight bearing hip or knee. Over time, this uncommon condition in people over 50 may lead to shoulder replacement surgery. Sometimes the cause of shoulder pain is linked to other parts of the body such as neck problems, shingles, lung problems, gall stones, chest and heart pain or myofascial pain– a chronic condition that affects the connective tissue which cover the muscles.
“The principles of managing the shoulder properly are to take a proper history, do a thorough examination then consider appropriate tests.
“As shoulder pain is so common many conditions can be easily diagnosed and managed. Sometimes this leads to surgery but in many cases it can be avoided.”