Shoulder Injury

The Shoulder

The shoulder is a ball and socket joint. It is the most mobile joint in our body. It is surrounded by ligaments and a joint capsule which provide stability when we move our shoulder. There are several muscles that surround the shoulder joint which give us the ability to move our arm to perform activities of daily living and the strength/power to perform functional, work and recreational activities.


Types of Shoulder Injuries

  1. Bone/Joint

    • Traumatic injury resulting in a fracture (broken bone)
    • Degeneration of joint surfaces (arthritis)

  2. Ligaments/Labrum/Capsule

    • Injuring these structures can result in shoulder instability, commonly referred to as a subluxation or dislocation (traumatic).
    • Some people have instability not from an injury, but because they have generalized ligament laxity (atraumatic).

  3. Muscles (Rotator Cuff)

    The rotator cuff is a group of four muscles that have 3 functions:

    • They compress and centre the ball of the shoulder in the socket during arm movement, providing stability to the shoulder joint.
    • They give you the ability to lift your arm above shoulder height and rotate the shoulder to reach behind your back (to tuck in your shirt or do up your bra) or up behind your head (to comb or wash your hair or pull a shirt off overhead).
    • They provide strength/power (along with other muscles) to use your arm at and above shoulder height. e.g. throwing a ball, lifting something heavy overhead

    Injuries to the rotator cuff commonly seen include impingement, tendonitis, muscle tear from an injury, degenerative age-related tearing, bursitis or fatigue associated with repetitive work or sustained load in a prolonged position.

The majority of injuries in the workplace are muscular in origin (rotator cuff related pain syndrome) and may be due to a traumatic injury (e.g. fall), overuse or secondary to a pre-existing weakness or degeneration of the muscle tissue.

A physical therapist can assist you with injury prevention:

  1. Patient Education
    • Identify risk factors in your job or recreational activities.
    • Modify work behaviours.
    • Provide suggestions to adapt your work environment or behaviours to reduce or eliminate your risk factors.
  1. Provide an active home-based exercise program to correct your posture and improve your muscle strength and endurance specific to your work or sport demands.

Injury Prevention

These are some things you can do in an active, manual
labour-type setting to reduce your risk of shoulder injury:

  • Use proper biomechanics with lifting, pushing or pulling. Keep the load close to you and less than 50 lbs or a suitable weight for your strength and body size. Use mechanical devices or ask for help if the load is too heavy.
  • Arrange work when able so it can be done within 15 inches from the front of your body. Avoid holding load in your hands with your arms outstretched (long lever load).
  • Front burners on the stove rule: Try to work within a distance similar to the front burners on a stove. If this is not possible, alternate the tasks that involve prolonged positions or holds with tasks that are light and require movement in order to prevent fatigue.
  • Adapt work area layout to prevent reaching across your body or reaching behind you. E.g. reaching into the back seat in a vehicle or reaching arm over the seat while backing up your vehicle.
    Instead, use mirrors and turn your head. Evaluate the environment for safety issues before commencing your task.
  • If you must do repetitive work, especially overhead, or repetitive heavy lifting try to limit how long. Take frequent breaks and alternate with lighter activities lower down to prevent fatigue.
  • Avoid overhead work if possible by positioning yourself closer to the work location (bring work down or raise self up). Use tool or control extenders to bring the work down where you can use stronger arm muscles.
  • Adapt your work environment. Keep frequently used items accessible. Keep lighter items higher up and heavier ones lower to the ground.
  • Focus on posture. Avoid shrugging your shoulders or hunched rounded posture when lifting or reaching overhead.
  • If you drive for work, adjust your seat to support a good postural position and use your arm rests to support your arms.
  • Maintain your personal fitness and muscle strength. Inadequate muscle strength or endurance for your work tasks puts you at increased risk for injury.

For students or people who work in a job that
involves sitting at a desk or computer:

  • Adjust your chair to support your body in good posture with arms supported on arm rests. Ensure your computer screen is at an appropriate height and distance for your vision and that your mouse is in front of your hand with your arm supported by your arm rest.
  • Adapt your work environment to keep frequently used items close and accessible (within 15 inches). See the ‘front burners on the stove’ rule.
  • Adapt your work station to avoid reaching across your body or behind you.
  • Avoid carrying a heavy back pack.