Arm and shoulder injuries can be acute (e.g. occur in an instant during an accident, bone fracture) or chronic (e.g. overuse, bursitus) and classified as mild, moderate or severe. Tendon injuries (strains) and ligament injuries (sprains) are classified as first degree, second degree or third degree (worst).
The arm consists of two main parts; the upper arm with one main bone (the humerus) and the forearm that has two bones (radius and the larger ulna). These are connected together by the elbow joint (described in a previous article) and connected to the body by the shoulder. The shoulder is actually composed of five joints that allow a great deal of mobility but also instability. Suffice it to say that there are a multitude of muscles, ligaments and tendons that connect the humerus to the scapula (shoulder blade), clavicle (collar bone) and eventually the sternum (e.g. including the ribs).
With such a complicated joint there are many potential injury mechanisms such as:
1. Fracture of the collar bone usually caused by a direct impact on an outstretched arm when falling over in sports like football.
2. Shoulder dislocation usually occurs in an anterior (frontal) direction when the ligaments connecting the humerus to the scapula are torn or stretched. Subluxation is a partial dislocation of just the main shoulder joint. Typically these may be caused by a strong collision between athletes, falling over with an outstretched hand or a violent twist of the shoulder.
3. Ligament tears in for example, the connections between the collar bone, shoulder bone and sternum (acromioclavicular and sternoclavicular separation). Typical causes include direct blows to the shoulder or sternum and falling over with an outstretched hand.
4. Bicep injuries, including tendon rupture (near the shoulder joint), bruising and muscle strain. Typical causes include overloading (e.g. weightlifting) and direct impacts (e.g. checks in hockey).
5. Impingement syndrome is a chronic injury caused by repeated overhead movements (e.g. in swimming, golf, weight lifting) damaging the long head of the biceps tendon (connecting the biceps to the humerus at the shoulder) and the subacromial bursa (i.e. a fluid filled sack in the shoulder to reduce friction between soft tissues). The space between the rotator cuff (a group of muscles and tendons securing the arm in the shoulder joint) and part of the shoulder bone (acromion) is reduced and this leads to pain and loss of full motion (e.g. in raising the arm or reaching around to the back).
6. Rotator cuff and bicipital tendonitis both involve inflamed tendons, the first usually caused by repetitive overhead movements (e.g. tennis, baseball) and the second by repetitive weight lifting with poor technique.
7. Frozen shoulder (adhesive capsulitis) occurs when abnormal bands of tissue form between joints to cause pain and loss of motion. Typical causes include scar tissue after surgery and repetitive soft tissue tearing around the glenohumeral joint (main shoulder joint).
As with other types of injury in sports, immediate treatment should include RICER (Rest, Ice, Compression, Elevation and specialist Referral) for three days and prompt medical care (e.g. for joint misalignment or bone fracture). More serious fractures or ligament tears may require six to eight weeks of rest and at least three weeks of rehabilitation to restore the function of the shoulder.
To reduce the risk of future injuries and ensure a complete recovery, up to 3 months of conditioning with more strenuous work out routines are then required. The first priority is to get back the full range of motion of the shoulders by using simple stretching exercises. Some of these can also be turned into isometric exercises by actively tensing instead of relaxing. Dumbbells provide a convenient way of progressively adding more weight to lift. A work out routine may include the following:
1. Stand in front of and facing away from, for example, a kitchen work top. Reach both hands behind you and interlock your fingers lightly above the work top. Keep both elbows slightly bent and slowly bend your knees so that both arms are rotated further behind you. Hold a position for 10 seconds and then lower further and repeat until it is no longer possible to go any lower without discomfort.
2. Stand upright with a small towel in your right hand. Place your left hand behind you as if you are trying to scratch the middle of your back. Bring your right elbow above your right shoulder and bend your right forearm down so that your left hand can grasp the other end of the towel behind your back. Hold for 30 seconds and then swap sides.
3. Stand upright next to a kitchen work top with the body facing parallel to it. Rest your left arm on the top and move your right leg forward slightly into a small lunge. Straighten your right arm next to your side and move it away from your side until it reaches about 45 degrees. Then move it straight back as far as possible. Rotate the whole arm about its axis so that your hand rotates inwards and then outwards. Repeat on the other side.
4. Stand upright with the feet slightly apart, knees slightly bent and a light dumbbell in the hand of each straight arm by your sides. Simultaneously slowly raise both straightened arms sideways until the dumbbells reach shoulder height and then slower lower. Repeat at least 15 times.
5. Lying on your back on a weight bench rest a single dumbbell on your chest with both hands grasped around the handle. Straighten your arms so that the dumbbell is held above your groin and then slowly rotate both straightened arms above your face and then behind your head as far as possible. Slowly return to the starting position above your groin and repeat at least 15 times.
6. Standing upright with your hands by your sides and a dumbbell in each hand, slowly curl each arm so that the axis of each dumbbell starts facing forward and ends up at 90 degrees to this. Keeping the elbows stationary and in line with your back alternate each arm at least 15 times.
7. Stand upright with a dumbbell in each hand but this time rest the axis of each one on your thighs in front of you. Without any twisting of the dumbbells slowly and simultaneously raise your elbows until your upper arms are horizontal. Slowly lower and repeat at least 15 times.