Shoulder Injuries


Shoulder injuries are some of the most common injuries that we treat. The shoulder joint has a very good range of motion but sacrifices stability. Many of the shoulder injuries are caused by repetitive stress, trauma and sports/recreational injuries. Common conditions are: rotator cuff pathologies (tears, strains), impingement syndrome, overuse and sports-related injuries, work-related or repetitive stress, bursitis and referred or radiating symptoms from the neck.

Tendonitis is a painful condition involving the inflammation of tendons. Tendonitis is almost always caused by repetitive movements of a tendon, such as when keyboarding, guitar playing, golfing, baseball pitching, running and tennis. Tendonitis can develop in the wrists, elbows, shoulders, hips, knees, ankles, and feet. Common types of tendonitis show up in the following areas; patella, achilles, shoulder, hip, peroneal (outside part of ankle), plantar and elbow.
Tendons connect muscles to bone, whereas ligaments connect bone to bone in a joint. Tendons are constructed of connective tissue (collagen, elastin) where as muscles are constructed of actin and myosin (specialized protein strands). Tendons, although able to increase in length under a load, do not have contractile properties like muscles do. Tendons also do not have a very good blood supply (vascularization) compared to muscles. Tendons have very strong attachments to bone, so strong that it may pull off a section of bone instead of rupturing when subject to trauma. Some forms of tendonitis involve the tendon actually pulling off the top layer of cells (periosteum) of a bone, resulting in an inflammatory response. Well, known examples include plantar fascitis and shin splints.

When a muscle undergoes a concentric contraction (shortens in length as it contracts) it pulls the tendon towards it. Since a muscle is anchored to bone, its tendon will often contact and slide against the bone. Tendons are encased in sheaths whose function is to allow smooth gliding of the tendon against proximal structures like bone, other tendons, ligaments, and nerves. However, with repeated movements of tendons, especially those under a load (hard gripping, extended vibration/ shocks, lifting, pushing) small tears occur in the tendons resulting in an inflammatory response. The inflammatory response is controlled by the immune system and produces a multitude of biochemical compounds that play critical roles in managing the injury, some of which are pain-generating (arachidonic acid). Sometimes the response "overshoots" turning into a problem of its own. As the inflammatory products build up, swelling takes place. Increased swelling leads to increased pressure in the injured area, which in turn leads to a hypoxic (reduced oxygen delivery) state, perpetuating the problem. This explains why tendonitis can often last for several years (become chronic).

At the first onset of tendonitis, stop the precipitating activity. Rest is the first line of defense. Next, apply an ice wrap to the inflamed tendon. Do not apply heat, heat will increase the inflammatory response in the early stages. Wrap an ice pack around the tendon with the ace wrap, applying firm pressure. Leave on for about 20 minutes. Repeat every two waking hours until the pain subsides. For wrist tendonitis, wearing a supportive wrist brace. Lastly, manual therapies like chiropractic along with physiotherapy modalities can be a good non-pharmaceutical option for treating acute and chronic cases of tendonitis. Modalities are adjunctive therapies such as ice, heat, traction, laser, and ultrasound.
If your tendonitis is caused by too much typing, make sure that your workstation is set up ergonomically: monitor at eye level; keyboard tray to allow arms to fall naturally to your side while typing; and a chair with good back support, and foot stool to take some pressure off your thighs. Keep your elbows at a 90-100 degree bend and keep your wrists straight, inline with your forearms. Keep your mouse and other accessories within a small arc from your keyboard to minimize repetitive reaching. Lastly, stretch your wrists, shoulders, neck and back every hour. If at all possible, try to rotate tasks every other month to avoid repetitive stress to your wrists.
We have several therapeutic approaches to treating acute and chronic wrist pain including joint mobilization, chiropractic extremity manipulation.

Peninsula Spine and Sports Rehabilitation
1740 Marco Polo Way, Suite 4
Burlingame, CA 94010
Phone: 650-347-2225
Fax: (650) 242-8802
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