You might not be Atlas, but your shoulders still carry a lot of weight. If it weren't for them, you wouldn't be able to pitch a game-winning home run, shovel snow off your front walk, or even comb your hair.
The shoulders' ball-and-socket design gives you great range of motion, but at the expense of stability. The shoulder socket is shaped like a golf tee, fairly flat on top, so the ball of the upper arm bone can easily slip out of it. That instability is why the shoulder joint gets dislocated more often than any other joint in the body.
When you lift weights every day or pitch every weekend, you can put a lot of wear and tear on your shoulder muscles, tendons, and joints. This is especially true if your form or technique is incorrect. Repetitive stress can lead to tears and other injuries, which can take you off the playing field and leave you in serious pain.
Here's a guide to the most common shoulder injuries -- how to spot them, and what to do about them.
What it is: Your rotator cuff is the set of four muscles that sits around the ball of the shoulder joint and allows the shoulder to move.
How it can get injured: Sports that involve lifting your hands over your head -- like pitching in baseball, swimming the freestyle or butterfly stroke, serving in tennis, and weight lifting -- can cause the top part of the shoulder blade to pinch the rotator cuff muscles. This is called shoulder impingement.
Repetitive motion in sports can also overload the tendons of the rotator cuff. Those tendons can eventually swell and get inflamed -- a condition called tendinitis. If you ignore the pain and keep swinging that golf club or tennis racket, the tendon that connects the rotator cuff muscles to the ball part of the joint can eventually tear.
What you'll feel: Pain is the main symptom of a rotator cuff injury. The pain gets worse when you raise your arm, and you might hear a click or popping sound. Eventually, the shoulder will hurt even when you're not moving it. A rotator cuff injury can limit your shoulder movement and reduce your strength.
How it's treated: Your doctor may suggest that you rest your shoulder for a few days, then begin rotator cuff stretching and mobility exercises. Avoid lifting anything above shoulder level until the injury heals. An anti-inflammatory medication or corticosteroid injection may help bring down swelling and reduce pain.
If the pain and weakness do not improve, you might need more formal physical therapy or surgery. The type of surgery done depends on the size, type, and location of the tear. It can take several weeks or even months for a rotator cuff injury to heal.
How to prevent it: Exercise your rotator cuff muscles to keep them strong and improve your range of motion. Be careful when you play sports like golf and tennis that use the same repetitive motions. Switch up your game once in a while. And stop whenever you feel pain.
AC Joint Injury
What it is: The AC (acromioclavicular) joint is located where the uppermost part of your shoulder blade -- a structure called the acromion -- meets your collarbone. When ligaments connecting the acromion and collarbone get torn, you've got a separated shoulder.
How it can get injured: Getting hit hard in the shoulder or falling on an outstretched hand can cause a separated shoulder.
What you'll feel: Pain in your shoulder. You might also see a bump on top of the shoulder where it's separated.
How it's treated: You will need to see your doctor if you suspect you have an AC joint injury. You will likely need to wear a sling to keep your shoulder still. Ice the area for about 20-30 minutes every couple of hours to reduce swelling. Take acetaminophen or a nonsteroidal anti-inflammatory drug like ibuprofen to help with the pain.
How to prevent it: Do range-of-motion and strengthening exercises. Gradually increase the weight and number of reps to strengthen your shoulder.
What it is: A dislocated shoulder happens when the top of the upper arm bone (the ball) slips out of its socket. The ball can slip forward, backward, or downward. Before you fully dislocate it, the shoulder might feel like it's starting to go out of place. That's called instability. When the shoulder slips only partway out of the socket, it's a subluxation.
How it can get injured: A strong hit to your shoulder on the football field or ice hockey rink can pop the ball out of its socket. You can also get a dislocated shoulder if you rotate your shoulder joint too far, like when you're serving in volleyball.
What you'll feel: You can feel when your shoulder pops out of place. The pop will be followed by intense pain. You might also have swelling, bruising, and weakness in the arm.
How it's treated: Sometimes, medical personnel can pull a dislocated shoulder back into place, but don't let anyone work on your shoulder unless you're sure he or she is experienced with the procedure. Otherwise, you could end up with an even worse injury. Instead see a health care provider who will give you a sedative or pain medicine before sliding your upper arm bone gently back into its socket. You'll have to keep the shoulder still for a few weeks afterward in a sling.
If the shoulder is being stubborn and it won't go back in place, you may need surgery to relocate the joint. Surgery can also repair torn ligaments or tendons in your shoulder.
How to prevent it: Check with your doctor to see when and how much you can use your shoulder. Once you've fully healed, he may suggest start exercising your shoulder to keep it flexible. Slowly add in weights and resistance bands to increase shoulder strength if OK with your doctor or physical therapist. If your shoulder has been dislocated before, ease off on the sports until it heals. That can take a few weeks. Anyone who's had a dislocation once has a good chance of it happening again. When you do start playing contact sports again, wear shoulder pads or other protective gear.
If more pressure is put on a bone than it can stand, it will split or break. A break of any size is called a fracture. If the broken bone punctures the skin, it is called an open fracture (compound fracture).
A stress fracture is a hairline crack in the bone that develops because of repeated or prolonged forces against the bone.
1. Check the person's airway and breathing. If necessary, call 911 and begin rescue breathing, CPR, or bleeding control.
2. Keep the person still and calm.
3. Examine the person closely for other injuries.
4. In most cases, if medical help responds quickly, allow the medical personnel to take further action.
5. If the skin is broken, it should be treated immediately to prevent infection. Call emergency help right away. DO NOT breathe on the wound or probe it. If possible, lightly rinse the wound to remove visible dirt or other contamination, but do not vigorously scrub or flush the wound. Cover with sterile dressings.
6. If needed, immobilize the broken bone with a splint or sling. Possible splints include a rolled up newspaper or strips of wood. Immobilize the area both above and below the injured bone.
7. Apply ice packs to reduce pain and swelling.
8. Take steps to prevent shock. Lay the person flat, elevate the feet about 12 inches (30 centimeters) above the head, and cover the person with a coat or blanket. However, DO NOT move the person if a head, neck, or back injury is suspected.
CHECK BLOOD CIRCULATION
Check the person's blood circulation. Press firmly over the skin beyond the fracture site. (For example, if the fracture is in the leg, press on the foot). It should first blanch white and then "pink up" in about two seconds. Signs that circulation is inadequate include pale or blue skin, numbness or tingling, and loss of pulse.
If circulation is poor and trained personnel are NOT quickly available, try to realign the limb into a normal resting position. This will reduce swelling, pain, and damage to the tissues from lack of blood.
TREAT BLEEDING
Place a dry, clean cloth over the wound to dress it.
If the bleeding continues, apply direct pressure to the site of bleeding. DO NOT apply a tourniquet to the extremity to stop the bleeding unless it is life-threatening.
· DO NOT move the person unless the broken bone is stable.
· DO NOT move a person with an injured hip, pelvis, or upper leg unless it is absolutely necessary. If you must move the person, pull the person to safety by his clothes (such as by the shoulders of a shirt, a belt, or pant-legs).
· DO NOT move a person who has a possible spine injury.
· DO NOT attempt to straighten a bone or change its position unless blood circulation appears hampered.
· DO NOT try to reposition a suspected spine injury.
· The person is not responding or is losing consciousness.
· There is a suspected broken bone in the head, neck, or back.
· There is a suspected broken bone in the hip, pelvis, or upper leg.
· You cannot completely immobilize the injury at the scene by yourself.
· There is severe bleeding.
· An area below the injured joint is pale, cold, clammy, or blue.
· There is a bone projecting through the skin.
Even though other broken bones may not be medical emergencies, they still deserve medical attention. Call your health care provider to find out where and when to be seen.
If a young child refuses to put weight on an arm or leg after an accident, won't move the arm or leg, or you can clearly see a deformity, assume the child has a broken bone and get medical help.
Take the following steps to reduce your risk of a broken bone:
· Wear protective gear while skiing, biking, roller blading, and participating in contact sports. This includes using a helmet, elbow pads, knee pads, and shin pads.
· Create a safe home for young children. Place a gate at stairways and keep windows closed.
· Teach children how to be safe and look out for themselves.
· Supervise children carefully. There is no substitute for supervision, no matter how safe the environment or situation appears to be.
· Prevent falls by not standing on chairs, counter tops, or other unstable objects. Remove throw rugs and electrical cords from floor surfaces. Use handrails on staircases and non-skid mats in bathtubs. These steps are especially important for the elderly.
Snapping hip syndrome, sometimes called dancer's hip, is a condition in which you hear a snapping sound or feel a snapping sensation in your hip when you walk, run, get up from a chair, or swing your leg around. For most people, the condition is little more than an annoyance and the only symptom is the snapping sound or sensation itself. But for dancers or athletes, snapping hip syndrome symptoms may also include pain and weakness that interfere with performance.
Snapping Hip Syndrome Causes
In most cases, snapping is caused by the movement of a muscle or tendon over a bony structure in the hip.
The most common site is on the outside of the hip where a band of connective tissue known as the iliotibial band passes over part of the thigh bone that juts out -- called the greater trochanter. When you stand up straight, the band is behind the trochanter. When you bend your hip, however, the band moves over and in front of the trochanter. This may cause the snapping noise.
The iliopsoas tendon, which connects to the inner part of the upper thigh, can also snap with hip movement.
Another site of snapping is where the ball at the top of the thigh bone fits into the socket in the pelvis to form the hip joint. The snapping occurs when the rectus femoris tendon, which runs from inside the thighbone up through the pelvis, moves back and forth across the ball when the hip is bent and straightened.
Less commonly, a cartilage tear or bits of broken cartilage or bone in the joint space can cause snapping, or a loose piece of cartilage can cause the hip to lock up. This can cause pain and disability.
Snapping Hip Syndrome Treatment
Unless snapping hip syndrome is painful or causes difficulty in sports or other activities, many people do not see a doctor or have it treated.
For minor snapping syndrome pain, try home treatments such as:
Reducing or modifying activity
Applying ice
Using over-the-counter pain relievers
For more severe pain or pain that does not improve with home treatment, see your doctor.
Physical therapy with emphasis on stretching, strengthening, and alignment can often help. Sometimes, treatment with a corticosteroid injection to the area can relieve inflammation. In rare cases, doctors may recommend surgery.
Snapping Hip Syndrome Stretches
Recommended exercises to treat snapping hip syndrome will vary depending on the type of snapping hip syndrome you have. Snapping hip syndrome stretches may include:
Quadriceps stretch. Standing arm's length from a wall, place the hand opposite the painful hip against the wall for support. With your other hand, take hold of the ankle of the painful leg and, keeping your knees together, pull your ankle up toward your buttocks. Hold for 30 to 60 seconds and release. Repeat three times.
Hamstring stretch. Lie flat on your back on the floor in a doorway so that your upper body is on one side of the doorway and your lower body is on the other and the painful hip is against the door frame. Raise the painful leg and rest it against the wall next to the door frame. Hold for 30 to 60 seconds and then lower. Repeat three times.
Piriformis stretch. Lying on your back with both knees bent, place the foot of your uninjured leg flat on the floor and rest the ankle of your painful leg over the knee of your uninjured leg. Take hold of the thigh of the uninjured leg and pull the knee toward your chest. Hold for 30 to 60 seconds and release. Repeat three times.
Iliotibial band stretch. Standing with your legs together, cross your uninjured leg in front of the painful leg, then bend down and touch your toes. Hold for 30 seconds, then return to starting position. Repeat three times.
Osteonecrosis is bone death caused by poor blood supply. It is most common in the hip and shoulder, but can affect other large joints such as the knee, elbow, wrist and ankle.
Osteonecrosis occurs when part of the bone does not get blood and dies. After a while, the bone can collapse. If osteonecrosis is not treated, the joint deteriorates, leading to severe arthritis.
Osteonecrosis can be caused by disease or by severe trauma, such as a fracture or dislocation, that affects the blood supply to the bone. Osteonecrosis can also occur without trauma or disease. This is called idiopathic -- meaning it occurs without any known cause.
Your health care provider will do a physical exam to find out if you have any diseases or conditions that may affect your bones. You will be asked about your symptoms and medical history.
Be sure to let your provider know about any medicines or vitamin supplements you are taking, even over-the-counter medicine.
After the exam, your provider will order one or more of the following tests:
If your provider knows the cause of osteonecrosis, part of the treatment will be aimed at the underlying condition. For example, if a blood clotting disorder is the cause, treatment will consist, in part, of clot-dissolving medicine.
If the condition is caught early, you will take pain relievers and limit use of the affected area. This may include using crutches if your hip, knee, or ankle is affected. You may need to do range-of-motion exercises. Nonsurgical treatment can often slow the progression of osteonecrosis, but most people will need surgery.
Many cases of osteonecrosis do not have a known cause, so prevention may not be possible. In some cases, you can reduce your risk by doing the following:
· Avoid drinking excessive amounts of alcohol.
· When possible, avoid high doses and long-term use of corticosteroids.
If more pressure is put on a bone than it can stand, it will split or break. A break of any size is called a fracture. If the broken bone punctures the skin, it is called an open fracture (compound fracture).
A stress fracture is a hairline crack in the bone that develops because of repeated or prolonged forces against the bone.
1. Check the person's airway and breathing. If necessary, call 911 and begin rescue breathing, CPR, or bleeding control.
2. Keep the person still and calm.
3. Examine the person closely for other injuries.
4. In most cases, if medical help responds quickly, allow the medical personnel to take further action.
5. If the skin is broken, it should be treated immediately to prevent infection. Call emergency help right away. DO NOT breathe on the wound or probe it. If possible, lightly rinse the wound to remove visible dirt or other contamination, but do not vigorously scrub or flush the wound. Cover with sterile dressings.
6. If needed, immobilize the broken bone with a splint or sling. Possible splints include a rolled up newspaper or strips of wood. Immobilize the area both above and below the injured bone.
7. Apply ice packs to reduce pain and swelling.
8. Take steps to prevent shock. Lay the person flat, elevate the feet about 12 inches (30 centimeters) above the head, and cover the person with a coat or blanket. However, DO NOT move the person if a head, neck, or back injury is suspected.
CHECK BLOOD CIRCULATION
Check the person's blood circulation. Press firmly over the skin beyond the fracture site. (For example, if the fracture is in the leg, press on the foot). It should first blanch white and then "pink up" in about two seconds. Signs that circulation is inadequate include pale or blue skin, numbness or tingling, and loss of pulse.
If circulation is poor and trained personnel are NOT quickly available, try to realign the limb into a normal resting position. This will reduce swelling, pain, and damage to the tissues from lack of blood.
TREAT BLEEDING
Place a dry, clean cloth over the wound to dress it.
If the bleeding continues, apply direct pressure to the site of bleeding. DO NOT apply a tourniquet to the extremity to stop the bleeding unless it is life-threatening.
· DO NOT move the person unless the broken bone is stable.
· DO NOT move a person with an injured hip, pelvis, or upper leg unless it is absolutely necessary. If you must move the person, pull the person to safety by his clothes (such as by the shoulders of a shirt, a belt, or pant-legs).
· DO NOT move a person who has a possible spine injury.
· DO NOT attempt to straighten a bone or change its position unless blood circulation appears hampered.
· DO NOT try to reposition a suspected spine injury.
· The person is not responding or is losing consciousness.
· There is a suspected broken bone in the head, neck, or back.
· There is a suspected broken bone in the hip, pelvis, or upper leg.
· You cannot completely immobilize the injury at the scene by yourself.
· There is severe bleeding.
· An area below the injured joint is pale, cold, clammy, or blue.
· There is a bone projecting through the skin.
Even though other broken bones may not be medical emergencies, they still deserve medical attention. Call your health care provider to find out where and when to be seen.
If a young child refuses to put weight on an arm or leg after an accident, won't move the arm or leg, or you can clearly see a deformity, assume the child has a broken bone and get medical help.
Take the following steps to reduce your risk of a broken bone:
· Wear protective gear while skiing, biking, roller blading, and participating in contact sports. This includes using a helmet, elbow pads, knee pads, and shin pads.
· Create a safe home for young children. Place a gate at stairways and keep windows closed.
· Teach children how to be safe and look out for themselves.
· Supervise children carefully. There is no substitute for supervision, no matter how safe the environment or situation appears to be.
· Prevent falls by not standing on chairs, counter tops, or other unstable objects. Remove throw rugs and electrical cords from floor surfaces. Use handrails on staircases and non-skid mats in bathtubs. These steps are especially important for the elderly.
The meniscus is a C-shaped piece of tough, rubbery cartilage that acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.
A torn meniscus is one of the most common knee injuries. Any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus.
Each of your knees has two menisci — C-shaped pieces of cartilage that act like a cushion between your shinbone and your thighbone. A torn meniscus causes pain, swelling and stiffness. You also might feel a block to knee motion and have trouble extending your knee fully.
Conservative treatment — such as rest, ice and medication — is sometimes enough to relieve the pain of a torn meniscus and give the injury time to heal on its own. In other cases, however, a torn meniscus requires surgical repair.
A torn meniscus can result from any activity that causes you to forcefully twist or rotate your knee, such as aggressive pivoting or sudden stops and turns. Even kneeling, deep squatting or lifting something heavy can sometimes lead to a torn meniscus. In older adults, degenerative changes of the knee can contribute to a torn meniscus with little or no trauma.
Performing activities that involve aggressive twisting and pivoting of the knee puts you at risk of a torn meniscus. The risk is particularly high for athletes — especially those who participate in contact sports, such as football, or activities that involve pivoting, such as tennis or basketball. The risk of a torn meniscus also increases as you get older, due to wear and tear on your knees.
A torn meniscus can lead to knee instability, inability to move your knee normally or persistent knee pain. You might be more likely to develop osteoarthritis in the injured knee.
A torn meniscus often can be identified during a physical exam. Your doctor might move your knee and leg into different positions, watch you walk and ask you to squat to help pinpoint the cause of your signs and symptoms.
Imaging tests
· X-rays. Because a torn meniscus is made of cartilage, it won't show up on X-rays. But X-rays can help rule out other problems with the knee that cause similar symptoms.
· MRI. This uses radio waves and a strong magnetic field to produce detailed images of both hard and soft tissues within your knee. It's the best imaging study to detect a torn meniscus.
Arthroscopy
In some cases, your doctor might use an instrument known as an arthroscope to examine the inside of your knee. The arthroscope is inserted through a tiny incision near your knee.
The device contains a light and a small camera, which transmits an enlarged image of the inside of your knee onto a monitor. If necessary, surgical instruments can be inserted through the arthroscope or through additional small incisions in your knee to trim or repair the tear.
Treatment for a torn meniscus often begins conservatively, depending on the type, size and location of your tear.
Tears associated with arthritis usually improve over time with treatment of the arthritis, so surgery usually isn't indicated. Many other tears that aren't associated with locking or a block to knee motion will become less painful over time, so they also don't require surgery.
Your doctor might recommend:
· Rest. Avoid activities that aggravate your knee pain, especially any activity that causes you to twist, rotate or pivot your knee. If your pain is severe, using crutches can take pressure off your knee and promote healing.
· Ice. Ice can reduce knee pain and swelling. Use a cold pack, a bag of frozen vegetables or a towel filled with ice cubes for about 15 minutes at a time, keeping your knee elevated. Do this every four to six hours the first day or two, and then as often as needed.
· Medication. Over-the-counter pain relievers also can help ease knee pain.
Therapy
Physical therapy can help you strengthen the muscles around your knee and in your legs to help stabilize and support the knee joint.
Surgery
If your knee remains painful despite rehabilitative therapy or if your knee locks, your doctor might recommend surgery. It's sometimes possible to repair a torn meniscus, especially in children and young adults.
If the tear can't be repaired, the meniscus might be surgically trimmed, possibly through tiny incisions using an arthroscope. After surgery, you will need to do exercises to optimize knee strength and stability.
