|
Structure
In dancers, injuries to the shoulder and arm are not as common as
lower extremity injuries. However, acute and overuse injuries from
repeated spins, lifting, and drops can lead to injury. Also, choreography
that involves weight bearing on the shoulder and/or arm can produce
atypical stresses to the shoulder joint and can also lead to injury.
The shoulder is comprised of three bones: the scapula
in the back (shoulder blade), the clavicle across the front (collar
bone), and the humerus (upper arm bone). These three structures
rely heavily on dynamic stability from the rotator cuff muscles
around the joint. There is also a joint capsule and labrum (cartilage)
which provide further stability to the joint.
Shoulder Dislocation
Shoulder Impingement
Rotator Cuff Tear
Acromioclavicular Joint Sprain
Shoulder Dislocation
“My shoulder popped out of joint.”
The shoulder joint is the body’s most mobile
joint. While this provides tremendous functional benefit, this also
makes the shoulder easy to dislocate. A partial dislocation (subluxation)
means the head of the upper arm bone (humerus) is partially out
of the socket (glenoid). A complete dislocation means it’s
popped all the way out.
Causes
Falling is the most common cause of a new shoulder dislocation.
However, a dislocation can also occur when the arm is forcibly moved
into an awkward position, usually while extended away from the body.
Both partial and complete dislocations cause pain and unsteadiness
in the shoulder. The muscles may have spasms from the disruption,
and this can make it hurt more. Repeated shoulder dislocations will
lead to instability of the joint. Dancers with this injury may notice
it becomes easier to sublux or dislocate the joint again and again.
Treatment
Shoulder subluxations will usually relocate without much assistance.
Dislocations, particularly first time dislocations, may need the
assistance of a physician to relocate the joint. The physician may
also wish to x-ray the joint to rule out any fractures. Following
relocation, a sling and activity restriction is advised for several
weeks. Ice and anti-inflammatory medication can be helpful to help
reduce acute inflammation in the joint. A supervised physical therapy
program is crucial to help prevent repeated dislocations. The therapy
is directed at strengthening the muscles around the shoulder and
upper back that help stabilize the shoulder in its socket.
Technical Tip:
Maintaining excellent strength and stability of the shoulder and
upper back muscles may help prevent shoulder dislocations. However,
as most dislocations occur accidentally, safety in the studio or
rehearsal space should be of top importance. Avoid repeating lifts
or difficult movements too many times, as when the muscles fatigue
accidents become more likely.
Back to top
Shoulder impingement
“My shoulder hurts when I reach overhead.”
Shoulder impingement syndrome is primarily due to
a narrowing of the space underneath a bony process (the acromion)
in the shoulder. The supraspinatus muscle (one of the rotator cuff
muscles) passes through this space and can become inflamed and painful
if compressed. In some cases, the supraspinatus bursa also becomes
compressed and inflamed; or calcium deposits may form within the
tendon of the supraspinatus.
Causes
Shoulder impingement syndrome can be due to a number of factors,
including:
• Repetitive arm movements, especially with overhead activities.
• Frequent extension of the arm at high speed under high load,
such as with baseball pitching.
• An increase in upper extremity training by a dancer whose
rotator cuff muscles are not in good condition.
Symptoms
It is common for individuals with shoulder impingement syndrome
to ignore the first signs of symptoms. There is usually no single
episode of the shoulder giving way and, at first a person may notice
only minor pain and a slight loss of strength. The injury will generally
progress over time. Dancers typically seek medical attention once
they notice regular pain with overhead motions or lifting objects.
Treatment
Initial treatment for shoulder impingement involves ice, rest, and
the use of anti-inflammatory medications to reduce acute swelling
in the joint. For chronic cases, a physician may recommend a corticosteroid
injection to assist with decreasing the inflammation in the joint.
Physical therapy or athletic training consultation is advised to
evaluate the shoulder function and improve rotator cuff strength.
Dancers with chronic, unresolved impingement conditions may be candidates
for a surgical technique to decompress the acromioclavicular joint.
Back to top
Rotator cuff tears
“I can’t raise my arm overhead.”
The rotator cuff muscles are attached to the upper
arm bone (humerus) by tendons. Rotator cuff tears occur when one
or more of these rotator cuff tendons are torn partly or completely.
Causes
Rotator cuff tears are most often the result of a forceful injury,
such as falling with an extended arm. Tears can also result from
repeated, abnormal stresses placed on the arm, such as with a throwing
mechanism. A tear or complete rupture of the rotator cuff tendons
is usually quite painful and disabling. The dancer will notice significant
difficulty or inability to raise the arm overhead. There is usually
no pain with passive movement of the shoulder. Along with X-rays,
the physician will often request an MRI to confirm the diagnosis
of a rotator cuff tear.
Treatment
As with most soft tissue injuries, the initial treatment for a rotator
cuff tear is a combination of rest and ice. Anti-inflammatory medications
can be helpful in reducing acute pain. Dancers with a partial rotator
cuff tear may be able to strengthen the shoulder with a rehabilitation
program to regain full function. Complete tears will most likely
require surgery to repair the injured tendon. Surgery is followed
by 2-3 months of additional rehabilitation before full function
to the shoulder can be restored.
Technical Tip:
The key to preventing a rotator cuff tear is to maintain a healthy
rotator cuff. Dancers should address any discomfort or weakness
in the rotator cuff immediately. If the shoulder is painful with
activity or with overhead motions, the dancer should avoid activities
such as lifting or throwing a partner until a proper diagnosis can
be obtained.
Back to top
Acromioclavicular Joint
sprain
“I fell on the top of my shoulder.”
Causes
The acromioclavicular joint (AC joint) joins the shoulder blade
(scapula) in the back to the collar bone (clavicle) in the front.
Injuries to this joint are usually the result of a direct force
to the tip of the shoulder, or by falling onto the shoulder. The
ligament between the acromion and the clavicle will be torn, either
partially or completely. With a complete tear, there is often a
“bump” that develops on top of the shoulder. This area
will be swollen and painful to touch, and the shoulder is usually
painful with all movements.
Treatment
Initial care of AC joint sprains will include ice and rest. Once
the diagnosis is confirmed, the physician may issue a sling or a
clavicle brace to help stabilize the joint. Tissue healing for partial
AC joint sprains will take about 6-8 weeks. During this time, athletic
training or physical therapy treatments can be helpful to strengthen
the shoulder and restore proper movement mechanics. Though not common,
complete AC joint tears may require surgery to repair the injured
ligament and restore joint integrity.
Shoulder injuries: Prevention / Tips
for dancers:
1. Overuse injuries require attention. Dancers should not try to
"work through the pain." When a shoulder injury is ignored,
it can become the source of chronic problems.
2. If your shoulder is sore after you use it actively, especially
at the limits of your reach, try giving it some rest. If the pain
persists or worsens, consult your physician.
3. When strengthening the shoulder girdle, dancers should focus
on developing the posterior shoulder muscles as well as the intrinsic
rotator cuff muscles. This will provide the greatest potential for
shoulder stabilization possible.
Back to top
|
THE
SHOULDER