The shoulder; a marvel and a menace

FEATURE — We can do marvelous things because of our shoulders. We can reach high above our head or behind our backs. We can write, work at the computer, or paint a ceiling. We can drive a golf ball hundreds of yards, propel ourselves through water, smash a tennis serve, and even throw a fastball ninety plus miles per hour. Truly marvelous.

We can do these things because of the way our shoulder is designed. Most people think of the shoulder as being a simple ball and socket joint. The shoulder is actually quite complex and consists of three bones (scapula, clavicle, and humerus) and a myriad of ligaments, tendons, and muscles that attach and cross these bones and joints to function in such demanding tasks.

The shoulder functions in a constant balance between mobility and stability. It must be loose enough to allow our arms to move in many directions, yet it must also provide power and stability. It is the four muscles called the rotator cuff and the scapular muscles that work in coordination with the big power muscles to provide both mobility and stability. Quite a task.

Consider the mechanics of the shoulder during the overhead fastball pitch. The shoulder joint has been measured to rotate at an amazing four thousand degrees per second. The rotator cuff must assist in generating rotational power while stabilizing so the ball stays centered in the socket. These same demands, though of less intensity, come into play during the golf swing, tennis serve, and even simple daily tasks. Add to this the fact that we perform these tasks repetitively throughout our day, every day. Amazing.

While the shoulder is indeed a marvel, it can easily be injured and cause pain. Common disorders that can affect the shoulder, besides fractures and dislocation, are inflammations such as bursitis, frozen shoulder, and osteoarthritis. Some of the most common shoulder problems involve the rotator cuff.

Rotator cuff disorders can range from minor tendonitis to partial or full thickness tears. They can develop suddenly (acute-traumatic) or more commonly, as a slow wearing of the cuff over time (chronic degenerative). Rotator cuff problems can be painful, usually at night, and weakness may be present with difficulty raising the arm overhead. In spite of potentially being very painful, rotator cuff problems are not emergent and people may not seek medical attention because they fear that surgery may be their only option. However, it is wise to see a medical professional with understanding of shoulder conditions to get proper diagnosis and treatment. Rotator cuff pathologies, if left untreated, can progress and become more difficult to manage over time.

The truth of the matter is that many rotator cuff problems can be managed without surgery. This may include medications, corticosteroid injections, and physical therapy. Two recent studies found that certain types of rotator cuff tears can be successfully treated with physical therapy. A study from Finland published in the Bone and Joint Journal in 2014 found that physical therapy produced results equal to those produced by surgery in patients with atraumatic rotator cuff tears. Another highly regarded study published in Journal of Shoulder and Elbow Surgery, found that non-operative treatment using supervised physical therapy is effective for treating atraumatic rotator cuff tears in approximately 75 percent of patients followed up for two years.

It is important to note that not all rotator cuff problems are the same, and conservative management may be unsuccessful. Numerous factors determine successful treatment such as tear size, tendon and muscle quality, and patient health factors. This is why it is important to seek the advice of medical professionals that understand shoulder conditions. In some cases surgery may be the best option. The good news is that rotator cuff surgery, when needed, has proven to have very good outcomes with over 80 percent of patients reporting being very satisfied with the results.

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Roger Harward
Roger Harward

Written by Roger Harward for St. George Health & Wellness magazine and St. George News.

Roger is a licensed physical therapist treating orthopedic patients with a special interest in shoulder, hip, and knee conditions. He is a member of The American Society of Shoulder and Elbow Therapists and American Physical Therapy Association. He can be reached by appointment at Advanced Physical Therapy, St. George, Utah.


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  • Roy J December 13, 2014 at 2:37 pm

    Throw away those lousy weights and grab a bar for pullups! Then hit the floor for some handstand pushups and watch that shoulder pain melt away. Consult your worn and battered copy of ‘Convict Conditioning’ for how to be the awesome. Thank you,Paul Wade, Pavel Tsatouline and the Kavadlo brothers! 🙂

  • Roy J December 13, 2014 at 3:17 pm

    Tsatsouline. Hem.

  • Steve Goldrick December 16, 2014 at 9:55 pm

    the last phrase here stating that RC repair has “very good outcomes” with 80% of people being very satisfied with the results.. I think you need to check your research. The older the patient, the higher the re-tear rate. Furthermore other studies have shown and overwhelming high rate or re-tear across the life span yet many don’t have pain. This is likely related to the fact that modern pain science research shows that the brain is only tissue in our body that can PRODUCE pain. With the surgery and subsequent immobilization, the chemical inflammation that is increasing nociceptive relay and resulting in the brain producing pain due to the potential threat of constantly getting this nociceptive barrage is reduced, yielding a less painful shoulder despite a repeat failed cuff. There is more than meets the eye with cuff repair and PTs can and do serve a very special role in managing without surgery

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