A shoulder’s movement is dependent upon a dynamic relationship of many muscle forces, ligament constraints, and bony joints. The shoulder has the greatest range of motion of any joint in the body which allows the athlete the ability to engage in a myriad of sports. However, this range of motion is not without risk. If any of the stabilizing ligaments or muscles in the shoulder are injured by trauma or overuse, the shoulder is at increased risk for injury. Shoulder injuries account for 8% to 20% of athletic injuries.
Dr. Nicholson’s practice includes a number of baseball players, ranging from the professional White Sox players to collegiate, scholastic, little leaguers, and weekend warriors. The angular velocity of the throwing shoulder can reach 7,000 degrees per second, one of the fastest actions in nature. Not surprisingly, this can lead to injury. The pain players experience during the throwing motion results in an inability to throw with accuracy and velocity.
Fellowship-trained shoulder surgeons, like Dr. Nicholson, understand that diagnosing the cause of pain in the throwing shoulder is challenging. It relies on input from the patient’s examination and history, from imaging scans and in some cases from arthroscopic surgery. Dr. Nicholson’s approach is to treat the patient, not the scan. It is a strategy that combines knowledge of the shoulder’s anatomy, an understanding of the pitching motion, and experience treating shoulder pain and injuries, and then individualizing treatment plans for each patient.
The shoulder moves in three dimensions allowing for a tennis swing that creates both spin and pace on the ball. Many competitive tennis players rotate their shoulder between 120-180 degrees. The high ball speeds seen in today’s tennis matches are achieved by generating tremendous torque in the shoulder. It is the repetitive forces during these movements that can potentially lead to injury. Overuse can be the result of too much play in a short period of time, too long of a season, or poor stroke mechanics.
Rotator cuff injuries, and specifically injury to the tendon attachment of the rotator cuff, are the single most common injury in tennis. Dr. Nicholson frequently treats shoulder injuries in tennis players ranging from a simple tendonitis or strain to a tearing of the tendon insertion from bone. Typically, less severe injuries are seen in younger age groups while more complicated injuries are associated with a higher level of competitive play.
Swimmers are another category of athletes frequently seen in Dr. Nicholson’s practice. Some research speculates that up to two-thirds of competitive swimmers are afflicted with shoulder pain. The reasons for this are two-fold: First, many swimming strokes require that you use the same repetitive overhand motions hundreds of times in a single workout. Competitive swimmers perform 10 times the number of movements of other overhand athletes. The second reason is the natural instability of our shoulders. The shoulder has the most range of motion than any joint in our body, and due to its anatomy, is at risk for injury when subjected to extreme and repetitive overhead movements.
Optimal shoulder function in swimmers, like other overhead athletes, depends on muscles in the rotator cuff around the shoulder, muscles that control the shoulder blade (the scapula), lower back and abdominal muscles, and ligaments in the shoulder. Imbalances from improper training, poor technique, or overuse of the muscles around the shoulder are a major source of injury. These imbalances can lead to impingement, rotator cuff tendonitis, and ligament tears.
Dr. Nicholson appreciates an athlete’s desire to return to play quickly. His treatment philosophy balances that goal with keeping players safe and having them return to play with a restored ability to perform with speed and accuracy.
Dr. Nicholson may initially recommend resting the arm. If the injury is thought to be related to muscles or ligaments, a physical therapy program that focuses on stretching and strengthening the shoulder is undertaken. Many of Dr. Nicholson’s patients find relief this way.
When conservative treatments fail to relieve the pain or provide sufficient range of motion, Dr. Nicholson may recommend surgery. Dr. Nicholson specializes in the arthroscopic repair of shoulder injuries, and he performs most of his procedures using this highly sophisticated technology. Arthroscopic repair of shoulder injuries has shown to reduce blood loss, pain, and hospitalization time as well as accelerate return to work, play, and activities of everyday life.