NEWSTARTHealthcare.com > Radio Scripts >

Email | Print |  Share  Digg Facebook MySpace  Yahoo! Buzz Twitter

Shoulder problems can be among the most disabling and distressing joint problems seen by workers and in recreational activities today. The shoulder is a unique joint in as much as it is a ball and socket joint with a great disparity between the ball and the socket. The ball part of the joint is huge compared to the size of the socket. The socket side of the joint is not only very small, just a fraction of the size of the ball, but the socket side is on a bone that is completely surrounded by muscles with no bony attachment, except to the clavical or collar bone. The shoulder is a metaphor meaning responsibility as in "This is a responsibility that I will shoulder". Sometimes the shoulder is used metaphorically to indicate comfort, as in "He or she cried on my shoulder". The shoulder joints are among the most expressive joints in the body in terms of demonstrating body language. The shoulder level reflects the mood of the individual. Drooping shoulders usually goes along with drooping at the corners of the mouth and feeling blue. Shoulder pain may be caused by problems in internal organs. The diaphragm, the big breathing muscle above the abdomen and below the lungs, when it is inflamed or irritated can give shoulder pain, particularly on the right side. Left shoulder or jaw pain or left arm pain can be a sign of a heart attack. So every shoulder pain is not simple or due to shoulder trouble.

In my practice at this time I see more of the chronic than of the acute shoulder pains. The chronic shoulder pains that I see most often are part of a cluster of shoulder girdle musculo-tendinous pain complexes with no particular shoulder joint pathology. I would say that this shoulder pain is the most common that I see and also the most difficult to treat with standard drug therapy that is commonly used today. However this shoulder pain is often dramatically treated with lifestyle measures.

One of the biggest dangers with chronic shoulder pain that I see is a tendency not to use the shoulder when it hurts, and this results in loss of range of motion which complicates the pain picture. The most important thing is to make a diagnosis. What is the shoulder pain due to? What is causing the shoulder pain and deal with that. Lifestyle treatments will help in any pain problem, but it is imperative to know what is causing the pain.

The shoulder pains that I most often see are those "incurable" shoulder pains that are most often what we call "musculoskeletal" cause of pain. This usually follows a motor vehicle accident or a fall or a sprain where the pain just does not go away and there is not too much to find on examination.

The truth is that it is not clear why some accidents give pain for a short time time and others seem to change a person’s life dramatically and they are never the same again and in some cases people never go back to work after an accident – that other people only have trouble for a week or so. However this phenomenon has been well studied and there are a few things that have been associated with the chronic pains following an accident or injury.

The things that correlate most firmly with chronic pain following an accident or injury are not the degree of damage done at the time of injury but with other things. Job satisfaction, relationship with the boss, the conviction that you have not been treated fairly. These are the things that research has shown that correlates most with the length of pain following an injury.

There is an attempt to explain the cause on physical causes. The history is the most sensitive indicator that we have about the injury. If there was no bruising or no injury in terms of something hitting or striking the shoulder, the physical damage is likely to be minimal. However the history alone is not conclusive, but the most sensitive part of the examination.

What I mean by sensitive is that the history is the most accurate and holds the most value in determining the extent of the physical damage.

There are two other important parts of the examination. The physical examination and the imaging or other tests also important in arriving at an assessment as to the degree of physical damage done at the time of injury or accident.

It is true that the amount of physical damage correlates poorly with the length of time after an injury or accident that pain is felt. But we need to make a very careful assessment of the physical damage done because surgery only corrects physical damage. It is true that surgery has a very great placebo effect, but to depend on the psychological effect of surgery to get good results is not good science and does not usually work too well.

At one end of the spectrum of physical damage is stretching of muscle fibers or of ligaments. This is the damage that is so hard to measure, detect and treat. At the other end of the spectrum of physical damage is a break in the skin, torn ligaments or muscles and broken bones. These physical damages are easily seen, diagnosed, and often have a better outcome than the subtle muscle strains.

I think that it tells us that physical damage is easier to heal than emotional or psychological damaged. I have often been told that physical abuse is easier to bear than verbal abuse. The children’s rhyme "sticks and stones may hurt my bones, but words will never hurt me!" is probably an illustration of whistling in the dark to keep your courage up. What it says is not true in most people’s experience.

There are three muscles that attach to the top of the shoulder joint that are abductors and external rotators of the shoulder.

Lifting the arm up from being by your side, in line with your body is called abduction. The first few degrees of lifting the arm up from the side is done by the rotator cuff. Then the rotator cuff is responsible for keeping the humeral head against the glenoid during arm movements.

You said in the introduction that the head of the humerus was very big in comparison to the very small socket. The socket is called the glenoid. Because the head is so big and the socket or glenoid is so small and the joint capsule so loose to give the great range of motion that the shoulder has, in order for the shoulder joint to work well, it needs something to keep the big head in contact with the small socket. The structure of this ball and socket joint will not do that based on the way it is made in terms of shape. So the Creator has made these three small muscles with a very important job of keeping the big head and the small socket together. These three little muscles are called the rotator cuff.

Supraspinatus, infraspinatus and subscapularis are the names of these three rotator cuff muscles. The body parts all have Latin names. In English their names mean, above the spine of the scapula, below the spine of the scapula and below or under the scapula. We said that the scapula, the shoulder blade, is completely surrounded by muscles. These are three of muscles that are attached to the scapula and work on holding the scapula and the arm bone called the humerus together so that the shoulder joint can work well.

External rotation means that it can twist the arm so that the hand moves in an arc away from the body. Internal rotation means that the hand or arm in rotated towards the body.

Today, the usual and customary way of diagnosing a rotator cuff tear or RCT as it is often referred to, is with an MRI.

An MRI is an imaging modality that will show cartilage, muscle, and tendons as well as bones and joints. It is really a wonderful imaging tool available to us today. It basically shows you a picture of what your insides look like. A tear of the rotator cuff can be seen on MRI.

It can be helped in three ways. First of all is that it can be helped with physical therapy to give it a chance to heal itself and lessen the pain while it is healing. The second treatment is to do surgery and sew the tear back together. The third thing is to take off some of the underside of one of the bones that cover these muscles to give it more space. By giving the muscle more space by doing what is called an achromioplasty, the impingement or rubbing of the shoulder joint on itself is helped.

It depends on the condition of the joint in terms of wear and tear. The other factor besides the wear and tear changes seen with age, is the demand made upon the joint. The younger the patient, and the bigger the rotator cuff tear, the more indicated is surgery. The older the person and the smaller the tear, the less surgery is indicated. The smaller the space for the rotator cuff muscles, the greater the indication for surgery. These are generalizations that are guidelines. Each person is unique and that is the skill or the surgeon to make a diagnosis and be wise in his or her recommendations for treatment.

Three other common things that are found that surgery is often suggested for is what is called shoulder impingement, shoulder subluxation or dislocation and a condition called labral-glenoid tears.

The labrum is a lip of cartilage that deepens the shallow glenoid socket. The glenoid with its attached labrum sort of looks like a suction socket. And indeed that is what it is. Air pressure is partly responsible for keeping the should joint in place. If this cartilage is torn, the suction is lost from this suction socket, and or the cartilage can flap about and get caught just like the cartilage in the knee and give trouble. If the cartilage comes off the rim of the glenoid it can give the same trouble.

That is an excellent summary of the surgeries of the glenoid-labrum.

The head of the humerus sometimes hits against the achromion or the bony arch that covers the rotator cuff. When this happens, taking off some of the underside of the achromion and removing the end of the clavical if the achromio-clavicular joint has gotten too big from arthritis, helps the head of the humerus and the rotator cuff muscles to move and function better.

Many young people can voluntarily pop their shoulders out of joint. They sometimes do that to entertain their friends. That is not a good idea and I have had at least one or two young people use the trick on me to ask for pain drugs. This voluntary dislocation or subluxation is not helped by surgery and usually only makes the people worse. So it takes wisdom and judgment to know what to operate on and what not to operate on.

Studies of adults have found that poor posture at computer workstations is linked to risk of neck, shoulder, back, arm and hand musculoskeletal discomfort. No comparable study has yet been done in school settings, Oates says. Oates points out that about 70 percent of the nation's 30 million elementary schoolchildren use computers in school, with a 10 percent increase each year. The study was supported by the Cornell College of Human Ecology. Copyright 1998 ScienceDaily Magazine

. If you work at a desk, here are some simple tips: - Make sure your computer monitor isn't too low. Eyes need to be mid-level with the screen. - If you're on the phone a lot, invest in a headset. Keeping the phone receiver between your neck and shoulder will, in time, shorten those muscles. It's all these little things that cause us tremendous problems. By paying a little attention to your posture throughout the day, the benefits not only include less back pain, but a healthier and more confident appearance. Keeping good posture projects you as being younger than you are. Most people in the work place do not mind that perception of themselves.

NEW YORK, Oct 14 (Reuters Health) -- A new survey with responses from more than 100 physicians has found that 58% reported seeing youngsters whose back and shoulder pains could be attributed to carrying backpacks that were too heavy for them. The survey, conducted by the American Academy of Orthopaedic Surgeons, also found that pediatricians consider a backpack that weighs more than 20% of the child's body weight to be potentially injurious.