Shoulder Ligament Injuries Sioux City
The shoulder joint is one of the most mobile joints in the body and is capable of extreme motions in a flexion, extension and abduction. A general rule of thumb in the body is the more range of motion it has the less it is protected by bones and ligaments. The increased range of motion comes at a cost of sacrificing protection and stability, which leads to increased muscle, tendon, and ligament injuries in the shoulder.
The shoulder, or glenohumeral joint, is a junction of the humeral head that fits against the glenoid fossa. It forms a ball and cup joint that allows for the incredible mobility in all directions. The shoulder is stabilized by ligament attachments to the scapula and clavicle. The most well-known tissue is the shoulder capsule, which is a ligamentous structure connecting the scapula to the humerus. The capsule is joined with the rotator cuff muscles, which are four muscles from the scapula that insert on the humerus. Often when people refer to rotator cuff injuries they are talking about the supraspinatus tendon that runs on top of the capsule and underneath the acromion.
Ligaments are strong fibers made to resist stretch and prevent excessive movement. They do not have the elastic capability like a rubber band, which would snap back into position after being stretched. When ligaments are stretched beyond their structural limits, the fibers are breaking internally. During the healing process the fibers are repaired in the new stretched position. With repetitive trauma, stress, and strain the ligaments become “stretched out,” providing less protection and support to the shoulder joint.
Several major ligaments stabilize the upper extremity through attachments from the scapula to clavicle, which are very important in shoulder mobility. The shoulder ligaments help keep a structurally stable base for muscle contraction. In addition, the ligaments help anchor the bones together as a unit, allowing other muscles to raise, lower, or rotate the glenoid fossa to enhance shoulder movement. These ligaments include the acromioclavicular ligament, conoid ligament, coracoclavicular ligament, coracohumeral ligament, trapezoid ligament, and transverse ligament of humerus.
Shoulder Ligaments Role in Stability
The acromioclavicular ligament is part of the acromioclavicular joint. It makes up the highest portion of the shoulder running from the acromion to the clavicle. The acromioclavicular ligament can be divided into two sections, the superior and the inferior. Tho superior acromioclavicular ligament extends from the upper surface of the acromion to the outer edge of the clavicle. Its fibers combine with the trapezius and deltoid muscles. The ligament provides stability for the acromioclavicular joint in the horizontal direction. Meanwhile, the inferior acromioclavicular ligament is thinner than the superior ligament. It runs along the lower aspect of the joint and attaches directly to the the acromion and clavicular bones.
The conoid ligament is part of the coracoclavicular ligament, along with the trapezoid ligament. These two ligaments provide stabilization of the acromioclavicular joint. It attaches between the coracoid process of the scapula and the underside of the clavicle. It helps prevent separation of the clavicle and scapula. Think of raising your arm above your head; as the clavicle rises this ligament helps pull the scapula with it.
The coracoacromial ligament connect the acromion and the coracoid process of the scapula. It is a thicker ligament to help stabilize the shoulder joint and creates a ligamentous arch between the two bones.
The coracohumeral ligament provides a strong thickening of the capsule to help support the weight of the upper arm. Three smaller glenohumeral ligaments strengthen the front of the shoulder capsule but are rather weak and can be absent in some people.
The transverse humeral ligament spans across the humeral tubercles to help stabilize the long head of the biceps tendon inside the intertubercular groove.
Rotator Cuff Muscles
The four rotator cuff muscles and tendons are the infraspinatus, teres minor, subscapularis, and supraspinatus muscles. These muscles are the major stabilizer of the humeral head inside the glenoid fossa. They help guide the humeral heads movement and rotation along its axis within the glenoid cavity. Inability of the muscles to keep the humeral head in its proper position leads to soft tissue injuries in the capsule, muscles, tendons, or labrum.
Where the humeral head meets the glenoid cavity, it rotates along a rim of fibrocartilage called the glenoid labrum. The fibrocartilage helps absorb forces, stress, and strain applied to the shoulder joint. It helps allow the rotation and movement and keeps the two bones and cartilage from rubbing against one another. It provides little joint stability. Think of it as a rubber ring to aid movement and keep space, but does not hold the bones together.
Most of the joint stability comes from the muscle control stabilization of the humerus and its position against the glenoid cavity. The rotator cuff tendons blend with the articular capsule for added stability. The rotator cuff muscles are aided by the long head of the bicep tendon, which runs from the intertubercular groove over the top of the humorous to insert on the superior margin of the glenoid labrum.
Treatment for Shoulder Strains
When the shoulder fibers are stretched beyond their physical means, they will go through an inflammation, injury, and repair process. Mild or grade I sprains involve rest and ice. The ligaments will slowly remodel and rebuild over several weeks to months. Ligaments have a poor blood supply, which is why they take longer to heal than muscle or bone injuries. Repeatedly straining a ligament causes accumulated damage, which can result in chronic pain or more severe injuries. Additionally, the sprained ligament is unable to absorb its usual amount of force and is more likely to develop repeated or severe sprains during the healing process.
Mild to moderate ligament sprains can be treated with techniques such as Graston Technique to help accelerate the fibroblasts’ repair and cellular healing. The stainless steel tools slide along the ligament, creating inflammation and irritation to the scar tissue in the ligament. The treatment causes more repair cells to move into the area and speed up the healing process. Increase blood flow follows the repair cells and the overall recovery is improved and shortened.
With the shoulder not every ligament is accessible. The effectiveness of Graston treatments will depend on which ligament was injured and if the damage is near the surface, where the treatment can be applied. Damage to the bottom aspect of the ligaments decreases the effectiveness of Graston treatments. Corticosteroid injections can be helpful to decrease pain and inflammation for certain shoulder ligament injuries.
Severe sprains and complete ruptures may require surgical intervention to help stabilize the joint. Surgery involves fixing the two ends either with wires, metal plates, or screws. In some circumstances ligaments can be re-attached. Often severe injuries occur with acute traumatic events that fracture the clavicle, scapula, or humerus.
Shoulder Injuries to Muscles and Tendons
Chronic repetitive shoulder injuries often cause damage to the muscles and tendons that help support the structure of the glenohumeral joint. Treatment focuses on increasing the structural integrity of the muscles and tendons through massage therapy, Graston Technique, manual therapy, and Active Release Technique. Stretching the tight stabilizer muscles can make a beneficial impact on long-term recovery. Besides the rotator cuff muscles, long head of the bicep and deltoid muscles; additional muscles that affect shoulder and scapular movements include levator scapulae, trapezius, rhomboid muscles, latissimus dorsi, Pectoralis minor, pectoralis major, scalenes, coracobrachialis, brachialis, and triceps muscles.
Shoulder Stability Exercises
Shoulder stability exercises can be incorporated early into the treatment to enhance the flexibility and integrity of the muscle and tendons. The exercises help re-teach the shoulder muscles how to properly work together to stable stabilize the humerus inside the glenoid cavity. Often chronic repetitive use overwhelms several of the small rotator cuff muscles, leading to decreased humerus stability and increased injury. The humeral head begins to migrate superiorly towards the acromion, which leads to increased risk of supraspinatus tendinosis. The subscapularis, infraspinatus, and teres minor muscle are also commonly injured with repetitive activity and poor shoulder stabilization. Shoulder stability exercises include vibration therapy, wobble sticks, and stability exercise balls.
The stability exercises make the muscles work together to properly stabilize the shoulder. By utilizing unstable surfaces, the shoulder stabilizers are working harder and harder to perform activities. These exercises also prevent compensation with the big muscle groups that cross the shoulder and are often compensating for the weaker rotator cuff muscles.
Specific treatment and exercises depend on which muscle is not functioning, along with the shoulder ligaments and tissue that was injured. Treatment is different for an acromioclavicular ligament sprain, adhesive capsulitis, infraspinatus tendinopathy, or supraspinatus strain.
Overall muscle tendon strains can heal with conservative treatment. Muscle therapy techniques including massage therapy, Graston Technique, and Active Release Technique help remove soft tissue adhesions or scar tissue that has developed in the shoulder muscle over years of use. Returning the muscle to previous functional status and strengthening the neuromuscular control helps resolve the current shoulder injury and prevent future injuries to the muscles, tendons, and ligaments of the shoulder.
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