Shoulder injuries are one of the most common problems in sports, whether
recreational or professional. An activity in which the arm
is used in repetitive or overhead movements can precipitate
shoulder bursitis or tendinitis. This includes sports such
as swimming, baseball, football and tennis. Sporting news
frequently describes professional athletes who cannot compete
because of shoulder bursitis and tendinitis. Windsurfers are
also at risk. The shoulder is constantly stressed during sailing,
whether it is waterstarting, jibing, or up hauling.
Shoulder bursitis/tendinitis is also referred to as “impingement
syndrome”. Impingement refers to the trapping of the
soft tissues of the shoulder, which leads to painful inflammation.
The shoulder joint is stabilized by a group of four muscles
called the rotator cuff. The muscles are the supraspinatus,
infraspinatus, teres minor, and subscapularis. The tendons
of these muscles (a tendon is a tissue which attaches muscle
to bone) pass through a very tight channel between the head
of the humerus (the upper arm bone) and the acromion process
of the scapula (the tip of the shoulder blade). A fluid filled
sac called a bursa, which acts to decrease friction, surrounds
these tendons. It is the rotator cuff tendons, with its bursa,
which become irritated and inflamed in this narrow space,
which further tightens when the arm is raised. This gives
rise to shoulder tendinitis and/or bursitis.
There are many factors, which predispose an individual to
develop impingement syndrome. The most common cause is overuse
by repetitive or overhead motions of the arm and shoulder.
Weak shoulder muscles cause the tendons and bursa to exert
more force, thus producing inflammation and pain. The combination
of these two factors is the ideal setup for shoulder tendinitis
and bursitis. The windsurfer that lacks regular exercise and
is practicing many waterstarts, or is up hauling often, is
particularly prone to developing this condition.
Further, improper or lazy technique only aggravates the problem.
Therefore windsurfers can prevent the impingement syndrome
by maintaining a consistent strengthening and exercise program,
and practicing correct form when sailing. The most
frequent symptom experiences in the impingement syndrome are
shoulder pain. The pain initially occurs only when the arm
is raised at the above shoulder level, whether during the
sporting activity itself, or with activities of daily living
such as brushing your hair or opening a door.
As the syndrome progresses, pain is present at rest, and may
wake the person up at night. The pain is usually in the upper,
front part of the shoulders, occasionally radiating to the
elbow or neck. Treatment of shoulder bursitis/tendinitis
has many modalities. The best initial therapy is rest. The
shoulder should not be used if it is hurts. Pain is the best
guide to resuming activity. Ice packs can be used over the
painful area in the early stages. Typically, ice is applied
after exercise for about 15 – 20 minutes, or 2 –3
times per day in the recovery period from a
mild attack. Physiotherapy offers many methods to decrease
the pain and swelling, such as ultrasound and deep heat.
The therapist or coach also teaches the individual how to
properly strengthen the shoulder to prevent the problem from
recurring. Moderate to severe cases often require anti-inflammatory
pills or cortisone injections in an attempt to reduce inflammation.
Electromagnetic pulse therapy is a newer modality, which is
showing excellent results. Rarely is surgery required for
treating the chronic condition. Overall, shoulder
bursitis/tendinitis is a minor ailment, which is easily treatable.
However, it can become serious if the body’s warning
signals are ignored, and proper care is not taken immediately.
ANTHONY MASCIA, MD. |
