Conditions of the shoulder

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The shoulder is a complex and fragile joint (fig 1) that is susceptible to injury when moved into positions where its anatomical elements hit against each other.

The raising of the arm is physically possible, but the anatomical elements can hit each other at some positions.

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Jocelyn-William LOUBRIAT

Francis HELIAS

Definition

The shoulder is a complex and fragile joint (fig 1) that is susceptible to injury when moved into positions where its anatomical elements hit against each other.

The raising of the arm is physically possible, but the anatomical elements can hit each other at some positions.

Protective elements called serous bursas play the role of shock absorbers. They can be damaged and inflamed.
The pain radiates to the shoulder when the arm is raised or during positions whereby the serous bursas is squeezed.

Over time this causes these protective elements to degenerate, and if no appropriate treatment is given, tendons will deteriorate or even tear.

The instability of the shoulder joint (past medical history of dislocation or sub-dislocation) favours these conditions.


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Fig 1: Shoulder joint and serous bursas

Mechanism of the lesion

The crushing of the serous bursas can occur when in rotation + adduction + raising of the arm, a position you adopt when doing a cross-over step (fig 2);
in abduction + inner rotation that you adopt when you try to grab a side hold (fig 3).
Extreme positions, such as “relax” hanging, push the bone structures to their limits.

Repetitive strain on these structures, which occurs every time you raise your arm, in addition to a bad position of the scapula due to the rolling up of the shoulders will definitely lead to their injury


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Fig 2: Shoulder joint in inner rotation Fig 3: Movement of abduction and inner rotation

Prevention

Technique correction:
It is necessary to learn how to place your shoulder the best, in particular during low effort positions, when you try to relax in order to recuperate.

Correction of the exercise schedule:
Taking rests is absolutely necessary to enable the structures to recover between each training session.

Correction of the physical preparation:
Making systematic specific stretching exercises to fight against the rolling up of the shoulders will help reduce conditions.
Adjusting the control of the muscles of the cuff (relaxing of certain muscles, reinforcement of others) to stabilise the shoulder joint will be essential.

This work will be optimized by involving a reeducation professional; it is just for prevention.

As always, warm-up is essential.
Treatment

Ice cube massages 3 times per day, combined with the use of an anti-inflammatory gel, can help to reduce the pain quickly.
However, you must remember that reducing the pain does not resolve the problem: an overall postural rebalancing is necessary.
The rolling up of the shoulders typically found among climbers increases shoulder strain tremendously.
A physiotherapist trained in the techniques using muscular chains (Busquet, Mézière…) may be of help.
The usual physiotherapeutic work to rebalance the shoulder will be necessary.

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