Shoulder Injuries
Ross Hauser, M.D.

Shoulder injuries and pain are quite common in golfers, swimmers, and tennis players. Shoulder pain may be due to acute bursitis, also known as an inflammation of the gel-like cushion in the shoulder. This results in extreme pain in the upper arm and shoulder region. Pain may even extend down the arm and can be quite severe. These patients find it almost impossible to lie on the shoulder. This pain will generally begin to diminish after a few weeks. Rest and ice therapies are the usual treatments that are recommended by traditional orthopedists and are the treatments that the patients can tolerate. Massage usually irritates the area further. Acute bursitis is actually quite rare and many cases diagnosed as bursitis are actually due to rotator cuff tendonitis. Acute bursitis is characterized by severe unremitting pain, redness, and swelling in the shoulder. It is so painful that patients will not even let doctors go near the area to touch or inject it.

The rotator cuff tendons are the most common structures affected in shoulder sports injuries. Particularly common are injuries to the supraspinatus tendon. Onset of its symptoms is usually quite gradual. Pain and weakness occur during shoulder motion, particularly when the arm is moved from the body to the side, between 80 and 120 degrees. Treatment of supraspinatus rotator cuff injuries involves avoidance of repetitive over arm motion and the use of a conditioning program to stretch and strengthen the rotator cuff muscles.

If the symptoms persist, Prolotherapy on the attachment of the supraspinatus tendon to the humerus can be quite helpful in facilitating further shoulder rehabilitation. The rotator cuff is especially prone to degeneration as a person ages. Sports injuries to these tissues are thus much more likely in older adults. The aging process itself has been found to do the following to the rotator cuff: disruption of the integrity of the attachment of the tendon to the bone, loss of cellularity and fragmentation of the tendon, diminution of the vascularity of the tendon, and a decrease in the amount of fibrocartilage. (Brewer, B. Aging of the rotator cuff. American Journal of Sports Medicine. 1979;7:102-110.)

Rotator cuff tendon degeneration can be seen on autopsy in asymptomatic individuals even in their 20s.

It is evident that stimulating healing is going to be especially important for rotator cuff tendon injuries because of the normal degenerative process that is already occurring in this area with aging. Prolotherapy is extremely effective, even at older ages, to not only get rid of the shoulder pain from a weakened rotator cuff, but to increase its strength as well.

Another common shoulder condition that can be helped by Prolotherapy, and is frequently found in older athletes, is acromioclavicular ligament sprain. Partial tear of the ligament that holds the acromium to the clavicle can be extremely painful. The pain and tenderness is located over the outer tip of the collarbone. Pain worsens as the arm is moved across and in front of the body. Generally the shoulder is stable but painful. Instability in the acromioclavicular joint is one of the factors that causes rotator cuff injury. This gives the athlete another reason to treat the acromioclavicular sprain with Prolotherapy. X-rays are often ordered to determine the severity of the injury. Frequently the x-rays are taken with the patient holding a light weight, because this can help to more accurately reveal the extent of the injury. In addition to Prolotherapy, a rehabilitation program to strengthen the dynamic shoulder stabilizers (rotator cuff muscles) is also helpful. If the older athlete does not address the acromioclavicular sprain and rotator cuff injury immediately, a frozen shoulder may develop. This occurs because an athlete stops moving his/her shoulder through the full range of motion because of pain. The shoulder joint capsule then becomes scarred. Prolotherapy is helpful to strengthen the weakened tissues in such an instance, but massive amounts of physiotherapy will be needed to regain the motion. It is important that older athletes do not ignore pain. Pain always occurs for a reason. Prolotherapy is typically the treatment that gets rid of the pain and any subsequent problems that might have arisen.