IN FOCUS: SHOULDER INJURIES

Shoulder health and strength is often overlooked, but that shouldn’t be the case, says Dr.Alan Cheung. Here’s what you need to know about shoulder injuries and what you can do to keep it at bay.

What are the most common causes and types of shoulder injuries?

As Team Doctor for the Wrestling Federation of Singapore, and Events Team Doctor for the Singapore Cycling Federation, the commonest shoulder injuries I see are from a) direct impact from a fall, such as a broken collarbone, shoulder dislocation, and separated acromioclavicular joint, and b) repetitive stress injuries, such as rotator cuff, labral, and biceps tendon injuries. Athletes from all disciplines tend to pick up the latter, particularly those involved in racquet sports like tennis, badminton, squash, and crossfit.

What kind of shoulder injuries need to be attended by a specialist? Is it possible to treat certain shoulder injuries at home?

If you feel pain in the shoulder during sports, which persists despite rest, icing, and painkillers, it’s best to get it checked by an expert. He or she should ask you detailed questions about your condition and perform a thorough physical examination to pinpoint the problem. An MRI scan may then be arranged to confirm the diagnosis. Often, a referral is made to a physiotherapist to strengthen and re-train the muscles around the shoulder.

Are there any unexpected ways that shoulder injuries occur?

Performing any shoulder exercise with bad technique, and overloading it through excessive play and force, and not allowing time for recovery, tends to lead to injury. As we get older, the rotator cuff (a group of muscles attached to the shoulder) tends to tear spontaneously over time.

What kind of exercises would you recommend ensuring good shoulder health?

Most people who go to the gym are obsessed with building big pecs, lats, triceps, and biceps. The muscles that tend to get neglected are the smaller rotator cuff muscles because a) they are not so visible as your ‘big guns’ and b) the exercises tend to involve lower resistances and may not be perceived as being ‘worth it’. These muscles are important to strengthen and stretch, as they are closely involved in shoulder stability and preventing a condition called ‘impingement’ (see below).

Are certain people more prone to shoulder injuries?

• Athletes at risk of falls who practice cycling, martial arts, horse riding, etc. • Athletes who play racquet sports — tennis, badminton, squash, particularly beginners at the sport, or have switched between these sports. • Athletes who perform heavy overhead exercises at the gym repetitively and with poor technique.

What are the most common types of shoulder injuries you attend to?

The shoulder is the most mobile joint in the body and delicately balanced, so when things go wrong it tends to lead to two or three other problems at the same time. Injury to the rotator cuff is extremely common and often leads to shoulder impingement.

One of the functions of the rotator cuff is to keep the ball of the shoulder in its socket (glenohumeral joint). When the cuff is injured, this leads to the ball of the shoulder rising abnormally when you lift your arm. This grinds a rotator cuff muscle (supraspinatus) against the bone (acromion) above it. This leads to a pain at the front and outside of the shoulder, which is called subacromial impingement. Pain at the front of the shoulder can also be linked to a labral tear (lining of the socket of the joint).

For those in the forties and older, problems like the above can also lead to a ‘frozen shoulder’ where the lining of the shoulder joint becomes inflamed leading to pain and stiffness. In summary, if you have shoulder pain for whatever reason, don’t ignore it and get it checked out by an expert.

Dr Alan Cheung is a British Consultant Orthopaedic Surgeon, Events Team Doctor of the Singapore Cycling Federation and Wrestling Federation of Singapore, and Director of the International Orthopaedic Clinic, 05-24 Mount Elizabeth Novena Hospital, 38 Irrawaddy Road, Singapore 329563. www.ioc-ortho.com @dralancheung