Exercise Your Shoulder Pain-free
Shoulder Injuries occur frequently in weightllfting and especially in bodybuilding where developing the entire deltoid group requires the athlete to perform a significant number of repetitions and variations in exercises, which multiplies the risk of injury. Not everyone responds the same way to the same shoulder injury. Some people may perform all sorts of arm raises that compress the tendon, sometimes even causing tendon degeneration, without initiating a painful inflammatory process. This is how a torn supraspinatus tendon can be discovered during assessment without that person ever having complained of pain. Another cause of shoulder pain may an imbalance In muscle tension around the articular capsule. Remember that the head of the humerus is solidly fixed against the glenoid fossa of the scapula by a group of muscle tendons adhering to or crossing over the articular capsule In front, this is the subscapularis a little more anterior is the long head of the biceps superiorly, is...
Periarticular Shoulder Problems Most shoulder problems involve the soft tissue periarticular shoulder structures rather than the glenohumeral joint. Because these supporting structures are vital to shoulder stability, a small injury to one component may cause significant problems in the motion and function of the shoulder. Classification is made difficult by the frequent overlap of these problems. At times one of the following specific periarticular shoulder problems is identified.
Duloxetine has been shown to be effective in reducing physical symptoms (back pain, shoulder pain, headache) in depressed patients as well as the core depressive symptoms (Detke et al., 2002), possibly due to its dual action on 5-HT and NE systems (Stahl, 2002). These findings have stimulated a renewed interest in reevaluating the diagnostic criteria for major depression given the relative underrepresentation of physical symptoms in the DSM-IV criteria (Fava, 1996).
As the pivotal connection between the upper extremity and the axial skeleton, the shoulder is a frequent source of musculoskeletal problems. Its great range of motion is available only at some compromise to bony stability. Most shoulder stability is provided by the periartic-ular soft tissues. A careful physical examination attempts to identify which components are contributing to a specific problem. Disorders extrinsic to the shoulder may also cause referred pain to this area. An evaluation of the cervical spine should be included for any problem presenting as shoulder pain.
Shoulder subluxation, a problem in 20-40 of stroke survivors (see Volume II, Chapter 36 on stroke rehabilitation). (Faghri et al., 1994 Chantraine et al., 1999 Linn et al., 1999 Wang et al., 2000). The impairments of subluxation and shoulder pain can be minimized in the majority of patients while improving passive joint range and volitional deltoid activation after 4-6 weeks of training. This training is insufficient to yield meaningful reduction if the NMES is delayed for 6-12 months post-subluxation (Wang et al., 2000). It should be noted that these studies used reduction of subluxation as an outcome and not upper limb functional activities.
The differential diagnosis of cervical nerve root pain includes cervical disc herniation, spinal canal tumor, trauma, degenerative changes, inflammatory disorders, congenital abnormalities, toxic and allergic conditions, hemorrhage, and musculoskeletal syndromes (e.g., thoracic outlet syndrome, shoulder pain).71,75 In cases of cervical radicu-lopathy unresponsive to conservative therapy, or in the presence of progressive motor deficit, investigation of other pathologic processes is indicated. Plain radiographs are usually not helpful because abnormal radiographic findings are equally common among symptomatic and asymptomatic patients. CT scan, myelography, and MRI each have a specific role to play in the diagnosis of cervical radiculopa-thy.73,74 CT scan is especially useful in delineating bony lesions, CT myelography can effectively demonstrate functional stenoses of the spinal canal, and MRI is an excellent noninvasive modality for demonstrating soft tissue abnormalities (e.g.,...
Stress fractures of the scapula in athletes are rare. There have been four reported cases in the literature a gymnast, a jogger using hand-held weights, a professional American football player with a stress fracture at the base of the acromial process, and a trap shooter with a fracture in the coracoid process 4,28-31 . The jogger had been jogging with weights for an 8-week period when he presented with a 2-week history of shoulder pain 29 . A bone scan revealed a linear band of increased uptake in the superomedial portion of the scapula, which was later present on plain radiographs. The authors theorized that the likely cause was overuse of the supraspinatus muscle in stabilizing the humeral head while the patient was jogging with weights.
The stress fractures seen in the weight lifters were transverse and involved the proximal humeral shaft 41,42 . Both patients complained of proximal arm and anterior shoulder pain, which occurred during bench press exercises for a period of time before presentation. One patient presented with a transversely oriented radiolucency in the proximal humerus, suggestive of cortical lysis with surrounding periosteal reaction, whereas the other patient presented with a transverse fracture of the proximal diaphysis with greater than 50 displacement. The former patient was treated with cessation of weight lifting for 8 weeks, followed by a gradually progressive supervised training program. The latter patient was treated with surgical fixation with an intramedullary nail. In terms of the mechanism of injury, these fractures were transverse in nature, suggesting a bending force rather than a rotational force, and occurred anatomically between the insertions of the pectoralis major and deltoid...
Most splenic cysts are asymptomatic and are discovered incidentally after radiologic procedures or at autopsy. Some patients present with idiopathic splenomegaly. A few patients have left upper quadrant abdominal pain or left shoulder pain. If a splenic abnormality is suspected, ultrasonography, CT, or both will define the cystic nature of the lesion. Calcifications are common in hydatid cysts, and they may also be seen in pseudocysts, but they are rare in true cysts. CT can define better the multiloculations seen in patients with splenic hemangioma or lymphangioma. Because splenic hemangiomas are the most common of true cystic lesions of the spleen and offer the greatest risk of spontaneous or post-traumatic rupture, radiographic determination of this likely diagnosis may influence the decision regarding operation.
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