"Snowboarder's Shoulder" or Impingement Syndrome
And again I am falling apart. The orthro actually called it "Snowboarder's Shoulder". One more pro toward skiing again.
Back to PT. Apparently this has been an ongoing project for years for me. :rolleyes: Too many OTB on the board and the MTB.
Now it is catching up and my shoulder is hurting someting fierce. Taking Viox and Tylenol 3 for a better comfort level. PT 1-3 times a week and I think a 30 minute massage per week would not hurt since insurance will pay 50% of the massage.
Here is what I found on the net: Anyone have more to add or experiences? No improvemtent in 3-4 weeks equals cortisteriod shot.
What Are the Structures of the Shoulder and How Does the Shoulder Function?
The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) (see diagram). Two joints facilitate shoulder movement. The acromioclavicular (AC) joint is located between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle. The glenohumeral joint, commonly called the shoulder joint, is a ball-and-socket type joint that helps move the shoulder forward and backward and allows the arm to rotate in a circular fashion or hinge out and up away from the body. (The "ball" is the top, rounded portion of the upper arm bone or humerus; the "socket," or glenoid, is a dish-shaped part of the outer edge of the scapula into which the ball fits.) The capsule is a soft tissue envelope that encircles the glenohumeral joint. It is lined by a thin, smooth synovial membrane.
The bones of the shoulder are held in place by muscles, tendons, and ligaments. Tendons are tough cords of tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder. Ligaments attach shoulder bones to each other, providing stability. For example, the front of the joint capsule is anchored by three glenohumeral ligaments.
The rotator cuff is a structure composed of tendons that, with associated muscles, holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength to the shoulder joint.
Two filmy sac-like structures called bursae permit smooth gliding between bone, muscle, and tendon. They cushion and protect the rotator cuff from the bony arch of the acromion.
What Are the Origin and Causes of Shoulder Problems?
The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. It is easily subject to injury because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons, and ligaments. Some shoulder problems arise from the disruption of these soft tissues as a result of injury or from overuse or underuse of the shoulder. Other problems arise from a degenerative process in which tissues break down and no longer function well.
Shoulder pain may be localized or may be referred to areas around the shoulder or down the arm. Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder.
Tendinitis, Bursitis, and Impingement Syndrome
What Are Tendinitis, Bursitis, and Impingement Syndrome of the Shoulder?
These conditions are closely related and may occur alone or in combination. If the rotator cuff and bursa are irritated, inflamed, and swollen, they may become squeezed between the head of the humerus and the acromion. Repeated motion involving the arms, or the aging process involving shoulder motion over many years, may also irritate and wear down the tendons, muscles, and surrounding structures.
Tendinitis is inflammation (redness, soreness, and swelling) of a tendon. In tendinitis of the shoulder, the rotator cuff and/or biceps tendon become inflamed, usually as a result of being pinched by surrounding structures. The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may get trapped under the acromion. Squeezing of the rotator cuff is called impingement syndrome.
Tendinitis and impingement syndrome are often accompanied by inflammation of the bursa sacs that protect the shoulder. An inflamed bursa is called bursitis. Inflammation caused by a disease such as rheumatoid arthritis may cause rotator cuff tendinitis and bursitis. Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement.
What Are the Signs of Tendinitis and Bursitis?
Signs of these conditions include the slow onset of discomfort and pain in the upper shoulder or upper third of the arm and/or difficulty sleeping on the shoulder. Tendinitis and bursitis also cause pain when the arm is lifted away from the body or overhead. If tendinitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm), pain will occur in the front or side of the shoulder and may travel down to the elbow and forearm. Pain may also occur when the arm is forcefully pushed upward overhead.
How Are These Conditions Diagnosed?
Diagnosis of tendinitis and bursitis begins with a medical history and physical examination. X rays do not show tendons or the bursae but may be helpful in ruling out bony abnormalities or arthritis. The doctor may remove and test fluid from the inflamed area to rule out infection. Impingement syndrome may be confirmed when injection of a small amount of anesthetic (lidocaine hydrochloride) into the space under the acromion relieves pain.
How Are Tendinitis, Bursitis, and Impingement Syndrome Treated?
The first step in treating these conditions is to reduce pain and inflammation with rest, ice, and anti-inflammatory medicines such as aspirin, naproxen (Naprosyn*), ibuprofen (Advil, Motrin, or Nuprin), or cox-2 inhibitors (Celebrex, Vioxx, or Nobic). In some cases the doctor or therapist will use ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow. Gentle stretching and strengthening exercises are added gradually. These may be preceded or followed by use of an ice pack. If there is no improvement, the doctor may inject a corticosteroid medicine into the space under the acromion. While steroid injections are a common treatment, they must be used with caution because they may lead to tendon rupture. If there is still no improvement after 6 to 12 months, the doctor may perform either arthroscopic or open surgery to repair damage and relieve pressure on the tendons and bursae.
