Professional Massage & Therapy
neuromuscular mobilisation Q & A client references injury zone find us price list promotions Sunday Recovery Service
07896 583297
Book Appointment Now Re-leaf
common sports injuries
Frozen Shoulder
Shoulder impingement
Subacromial Bursitis
Rotor Cuff Injury
AC Joint Sprain
Shoulder/top of arm (deltoid)
Impingement Syndrome, sometimes nick named Swimmer’s/Thrower’s shoulder, is caused by the tendons of the rotator cuff becoming impinged as they pass through the shoulder joint.
Bursa (sack of fluid) which sits under the AC joint (shoulder).
This has similar symptoms to inflammation of the supraspinatus tendon.
Top of Shoulder  joint, muscles and tendons.
Top of shoulder.  The AC joint is short for the acromioclavicular joint. Separation of the two bones forming this joint is caused by damage to the ligaments connecting them usually from a fall with outstretched arm.
what why how
Shoulder stiffness at the Glenhumeral joint, common complaint after a significant trauma (fracture or surgery).  Also follows injury that has occurred to the neural (nerve) structures in the neck.  May be referred to as "adhesive capsulitis" usually effects the left shoulder and is more frequently a female  (possible Hormonal changes responsible for the higher incidence amongst women, particularly around the menopausal period). Symptoms also experienced by patients with diabetes, there is also a link to those who suffer thyroid disorders.  Recent studies have shown that poor posture, particularly rounded shoulders, may cause shortening of one of the ligaments of the shoulder, and lead to this condition.
Pinching of one or more tendons within the shoulder joint, especially on overhead movements, as the supraspinatus rotator cuff tendon has become impinged or trapped between the bones.     Gradual build-up of pain over long period in shoulder (pain at the front and/or side of the shoulder joint) with overhead activity such as throwing or front crawl swimming - most common in external impingements.
Pain at the back and/or front of the shoulder when the arm is held out to the side (abducted) and turned outwards (external rotation) - most common in internal impingements.
Pain when lifting the arm above 90 degrees and reaching behind back
Pain and weakness when the arm is lifted up sideways through a 60 degree arc.
Pain when you press in at the inside front of the upper arm.
If it is the tendon that is injured rather than the bursa there is likely to be more pain when the arm is lifted up sideways against resistance.
The Supraspinatus muscle along the top of the shoulder blade and inserts via the tendon at the top of the arm (humerus bone). This muscle is used to lift the arm up sideways and is also important in throwing sports as it is the muscle that holds the arm in the shoulder when you release what you are throwing. There are massive forces involved in slowing the arm down after you have thrown something but few people bother to train these muscles. A heavy fall onto the shoulder can also result in injuring this muscle.
Over the tendon is a bursa (small sack of fluid used to help lubricate the moving tendon). This bursa can become trapped in the shoulder causing pain and inflammation. The athlete is more prone to this injury if they overuse the shoulder particularly if the arm is at or above shoulder level. Or if the athlete has had a rupture of the supraspinatus tendon.
Rotor Cuff tendinopathy is a common cause of shoulder pain.  The rotator cuff tendons become swollen and hyper cellular with collagen matrix disorganised and the tendon weakens.  Volume (distance) being a potential cause in swimmers, runners.       A tear of one or more of the four rotator cuff muscles or tendons which surround the shoulder joint.  Sudden, tearing feeling in the shoulder, followed by severe pain through the arm. Movement will be limited with damaged and sore muscle. Specific tenderness (“x marks the spot”) over the point of rupture/tear. If there is a severe tear, you will not be able to abduct your arm (raise it out to the side) without assistance.  A chronic tear develops over a period of time. They usually occur at or near the tendon, as a result of the tendon rubbing against the overlying bone. This is usually associated with an impingment syndrome.
Pain is widespread all over the shoulder until the initial pain resolves, following this it is more likely to be a very specific and focused pain over the joint itself.
Swelling often occurs.  Deformity may be visible as there will be an obvious lump where the joint has been disrupted (visible on more severe injuries).
Pain on movement of the shoulder, especially when trying to raise the arms above shoulder height.
This condition has 3 phases, symptoms differ depending on the phase of the condition;
Painful (Freezing) Phase
Gradual onset of aching shoulder developing widespread pain and sometimes worst at night especially when lying on the affected side. (2-9 months).
Stiffening (Frozen) Phase
Stiffness starts to become a problem as difficulty occurs with normal daily tasks such as dressing, cooking, lifting/carrying, working. The muscle starts to waste due to lack of use/movement. There is no pain difference from first phase can last 4-12 months.
Thawing Phase
Pain decrease, movement improvement although there is stiffness but this gradually fades too 5-12 months.
Seek medical advice if you think you may have this condition, early action can prevent severe pain, stiffness and long-term discomfort.  Try to keep the shoulder moving even if only very small rotations/circular movements. If very painful - movements should be under the guidance of a qualified therapist.   This condition is usually managed conservatively, with surgery as a last measure if all other attempts fail.
Arrange a course of physiotherapy or sports therapy, oral steroids and if necessary a direct steroid injection to reduce inflammation.
Nerve block – short term pain relief option, may prove effective. Last course of action is surgery.
The supraspinatus, infraspinatus, teres minor and subscapularis muscles have become 'impinged' as they pass through a narrow bony space called the Sub acromial space. With repetitive pinching, the tendon(s) become irritated and inflamed.  This can lead to thickening of the tendon which may cause further problems because there is very little free space, so as the tendons become larger, they are impinged further by the structures of the shoulder joint and the muscles themselves. YOU NEED TO?
Apply ICE on painful area for 10-15 minutes per 2 hour period. Remember to use an ice bag or a towel wrapped around the ice to protect against ice burn.
Seek advice from a sports injury professional who can develop an appropriate rehabilitation program and return to sport gradually once the pain has eased
What can the sports injury professional do?
Carry out specific tests order x-rays to determine what is causing the impingement
Advise on rehabilitation program (decrease pain/increase range of motion ROM).
Discuss the option of surgery in cases which have failed all rehabilitation efforts AFTER 6-12 months.
What should you do?
Rest until there is no pain.
They must however continue pain free mobility exercises to keep the full range of movement in the shoulder.
Apply ICE AND heat (contrast) ease inflammation.
See a sports injury specialist or doctor who can advise on rehabilitation.
What can a sports injury specialist or doctor do?
Prescribe a full rehabilitation programme.
Operate with persistent problems.
If it is persistent the doctor can aspirate (stick a needle into the bursa and suck out the extra fluid).
What can the athlete do?
Treatment, avoid aggravating activity and apply ICE to area.  Control the pain with medications (Doctor).
You may require X– ray MRI to identify what the problem is and rule out any fractures.
If the injury is quite severe and you are young and active, you might require an operation to fix the tear. Indications include:
Complete tears of the tendon/muscle
Failure of other treatments after 6 weeks
Professional/keen sports people
Sports therapist will;  Compare both shoulders visually and using palpation (feeling).
Your neck, elbows and wrists will be checked (they may be contributing to the problem).
Range of movement ROM will be assessed.  Passive range of movement will be assessed –  (but will not be done if a fracture is suspected).
Sensation and strength in the arm will be assessed.
Classification of AC Joint Injuries
AC joint injuries are graded 1-6 with the Rockwood (looks at extent of ligament damage and the space between the acromion and clavicle).
Grade 1 is a simple sprain to the AC joint
Grade 2 rupture of the AC ligament
Grade 3 rupture of both AC and CC ligaments which often results in a superior displacement.
From this point onwards the scale and grade of injury depends on the degree of displacement of the clavicle.
Grade 4 posterior displacement
Grade 5 superior displacement, to a greater degree than grade 3, with an increase in coracoclavicular space by 3-5 times the norm. A step deformity may be apparent with grade 3, 4 & 5 injuries.
Grade 6 full rupture of both AC and CC ligaments with the clavicle being displaced inferiorly
What you should do?
Rest and apply ice on onset, Immobilise the shoulder in a sling to ease pain by taking the weight of the arm.
What can a Sports Injury Specialist do?
Tape the joint into the correct position to assist with healing. You may need to be taped for 2-3 weeks
Apply ultrasound for minor injuries, or TENS for pain relief in more severe cases
Create client specific rehabilitation and exercise program
Surgery if required (usually grades 4-6)
WARNING - Neglected the injury and it may heal out of place this could increase the wear and tear on your joint causing  problems in the future.
Copyright 2012 - Releaf