Shoulder Injury in American Sports, Part 1

Having watched many of the Olympic competitions this summer, it continues to amaze me what the shoulder girdle is able to accomplish. From the millions of strokes that a competitive swimmer utilizes over years of training, to lifting hundreds of pounds overhead, doing not only an iron cross but rotating the body parallel to the floor. These are just a few examples of what the joint can tolerate.

The Shoulder is an Anatomical Masterpiece

To further appreciate this anatomical masterpiece, realize that the only place the arm is physically attached to the axial skeleton is the connection of the collar bone to the sternum. The shoulder blade basically floats over the ribs via muscular force couples. 17 muscles work in collaboration maintaining unique patterns of leverage to maximize force outputs. The shoulder is the most complicated joint system in the body.

Recreational athletes take this for granted. In general, things work great as an adolescent and young adult and we assume the process will continue into adulthood. But just like our cars, we need to keep our bodies tuned up. With the propensity for Americans to be involved in sports using the shoulder, this is even more critical. This article touches on some of the classic upper extremity sports that we continue with as adults, as well as some of the shoulder problems that are likely to evolve if we are not proactive with keeping the shoulder in good condition.

To gain a greater appreciation of what physically changes about the shoulder as the years go by, I’ll start with this paraphrased story – a story that many people in their 50’s and beyond can appreciate.

Stage 1 (age 12-22)

You grow up in a small town with a love of baseball and appreciate that pitching staffs always run thin. There is not an athletic trainer within 100 miles. Before you know it you’re heading to the corner drug store for some Ben Gay just to ease the pain.

Stage 2 (age 22-35)

The game is still in your blood but work just seems to keep you from staying in shape. You show up for the game late and have to gun a guy down at second on the first play of the game as you retrieve a ball deep in the alley. You crumble on the warning track in pain. Multiple cocktails seem to resolve the situation.

Stage 3 (age 35-50)

You get married and the three nights per week softball games are a distant memory. Now you’re dragging the kid’s luggage from gate 5 to gate 40 as you head off to Disney Land. Later that summer you just can’t pass up the opportunity to show the wife and kids how great of a water skier you are. That winter, you feel your shoulders break at the hinges holding pictures against the wall as your wife ponders the location.

Stage 4 (age 45-55)

There is redemption and you join the over 50 softball league. Unfortunately your belly slide is not what it used to be and you shred the shoulder as it impacts against the front of the bag.

Stage 5 (age 55 and beyond)

Sitting in the orthopedist’s office after slipping on the ice and grabbing a railing in attempt to stopping the fall. Your MRI reveals a rotator cuff tear and you’re either headed to a local physical therapist or getting scheduled for surgery.

We see this classic pattern in throwing, swimming, and racquet sports. With sports such as hockey, football, wrestling, and martial arts, there will be a propensity towards macro trauma with either the dislocation of the ball and socket (glenohumeral) joint or acromioclavicular (AC) joint where the shoulder blade and clavicle come together. This will tend to propel the individual into phase 3. Gymnastics has both patterns of micro and macro trauma and a longer career in this sport can hasten the process of moving through the above phases, especially with respect to a hyper-mobile individual. Golf is a relatively safe sport for the shoulder, noting a stable mechanical position at point of impact with the ball. Wrapping your club around a tree is another issue.