SHOULDER PAIN (PART 2)
In this next series, we will discuss
shoulder pain related to instability. If you have dull,
aching shoulder pain with the feeling that the shoulder
is going to pop out of its’ socket in certain
positions, you may have instability. Starting spring
sports without an adequate winter training and conditioning
program can lead to instability. Also excessive weight
while weight-training, before the muscles are adequately
built up can cause looseness of the shoulder. Finally,
some people are just genetically prone to have loose
joints or be "double-jointed", which is a
risk factor for instability.
Instability is different from Impingement
Syndrome discussed previously in that with Instability
there is a provocative position which gives the sensation
the shoulder is sliding out of its’ socket. This
is usually associated with a sharp pain. Occasionally
the entire arm my "go dead" with numbness
and tingling. On occasion the shoulder actually dislocates
and requires reduction either by oneself or an emergency
department physician. Previous dislocations in young
individuals predisposes to instability and has a high
risk of further dislocation. Traditionally, gymnast,
baseball pitchers, swimmers and younger athletes have
loose shoulders.
Treatment for instability is aimed
at conditioning and strengthening the Rotator Cuff
muscles, a group of four strong muscles which encircle
the upper arm and is responsible for all its movements.
Formal Physical Therapy is utilized to aid in the program.
A special elastic band called Theraband is used for
strengthening.
Gradually strengthening is increased
while maintaining the shoulder stable within its’ socket.
Ice to reduce inflammation and relieve pain, followed
in three days by heat to relax aching muscles and increase
the blood flow (with its reparative proteins) to the
shoulder is always indicated. Over the counter pain
relievers such as aspirin, Tylenol, ibuprofen or naproxen
can help reduce pain and inflammation.
Occasionally surgical intervention
is required for repeated shoulder dislocations. These
same-day surgical procedures can generally be performed
arthroscopically through three tiny ½ inch incisions
with special instrumentation. Surgery does allow an
individual to return to his previous level of sporting
activity after rehabilitation. It is best to be evaluated
by an orthopedic surgeon early for this condition as
recent studies have shown better success with timely
intervention.
|
