Q: Why do my shoulders hurt?

A: I ask this of myself way too often. Was it the 32 miles from Molokai to Oahu or the 32 miles from Catalina to Manhattan? Or was it the time I fell off my board on the Maliko run in Maui because I was laughing at Nathan, my training partner, as he buried the front half of an eighteen-foot board into the trough of a wave in front of him? Whatever it was, the darn thing hurts.

As paddlers, we all have sufficient reason for the problem. Don’t panic, the most common reasons are not limb-threatening and most shoulder injuries are treated successfully with conservative management. The following rundown on shoulder injuries should help you locate your problem.

Fatigue

Shoulder problems tend to develop slowly and are intensified through repetitive, intensive training routines. Fatigue from overtraining is certainly a possibility for your shoulder pain. Muscle fatigue will leave you with arms that feel heavy and tire easily. Rest is the only good remedy for severe fatigue and may take several weeks to recover.

What are the warning signs of a shoulder injury?

If you are experiencing pain in your shoulder ask yourself these questions:

Is the shoulder stiff?

Can you rotate your arm in all the normal positions?

Does it feel like your shoulder could pop out or slide out of the socket?

Do you lack the strength in your shoulder to carry out your daily activities?

If you answer "yes" to any one of these questions, pay close attention to the following discussion and consult your local Orthopedic Surgeon specializing in shoulder problems for an examination.

Shoulder Anatomy

What types of shoulder injuries are most prevalent?

Instability

Sometimes, one of the shoulder joints moves or is forced out of its normal position. This condition is called instability, and can result in a dislocation of the shoulder and tears in the labrum. Individuals suffering from an instability problem will experience pain in provocative shoulder positions. They also may feel as if their shoulder is slipping out of place. Labral tearing can also occur from subtle instability in which the shoulder is moving only slightly out of position on a repetitive basis, overloading the labrum.

Impingement

Impingement is caused by pinching the rotator cuff tendon between the acromion bone and humeral head. Impingement problems can be sustained when participating in sports with excessive overhead motion such as paddling and throwing.

Rotator Cuff Tendon

Why is the rotator cuff so important?

The rotator cuff is an important component of the shoulder. It is comprised of a group of muscles and tendons that help to lift the arm overhead. If injured or torn it can become difficult for people to recover the full shoulder function needed to properly participate in sports and simple overhead activity. Impingement can be in the form of Bursitis, Tendonitis or Tearing of the rotator cuff tendon. Rotator cuff pain generally hurts at the side of the arm. Bursitis is inflammation of the bursae, which is a lubricating sac between the acromion bone and the rotator cuff. Tendonitis occurs when the pinching affects the tendon causing inflammation within the tendon itself. Tearing of the rotator cuff tendon occurs through repetitive injury to the tendon and can be made worse by bone spurs that form on the undersurface of the acromion. The tearing is often felt as an acute event when the tendon detaches from the bone and retracts leaving the arm weak.

AC Joint Problems

Acromioclavicular joint problems are very common for surfers, paddlers and volleyball players. So if you participate in all three, you will eventually see me in my office. AC joint pain felt at the top of your shoulder and may radiate into your neck and give you a bit of a muscle spasm near the shoulder blade. Problems of the AC joint are either traumatic causing a separation of the joint, or from overuse causing arthrosis or arthritis of the joint.

What causes a shoulder injury to become worse?

Some people will have a tendency to ignore the pain, and "play through" shoulder injuries, which only aggravates the condition and can cause more problems. People also may underestimate the extent of the injury because steady pain, weakness in the arm, or limitation of joint motion will become almost second nature to them.

How are shoulder injuries treated?

Early detection is the key to preventing serious shoulder injuries. Many times, orthopedic surgeons will prescribe a series of exercises aimed at strengthening shoulder muscles. Anti-inflammatory medication also may be prescribed to reduce pain and swelling.

An early rehabilitation program will likely prevent the need for surgery, especially if the problem is treated early. Rehabilitation can also improve sports related activity through postural training, balanced muscular conditioning and technique evaluation.

What’s next?

In our next column we will focus on some treatment programs for specific problems. For now, enjoy a little rest and refocus for next year!

Brad Thomas, MD
Orthopedic Surgeon, Sports Medicine Specialist
Chief of Sports Medicine, Harbor UCLA Medical Center
Consulting Physician USA Water Polo