The following information is intended as a resource and should not be used to self-diagnose or treat. Use of non-steroidal anti-inflammatory drugs (NSAID’s) may be used to reduce inflammation and pain associated with that inflammation. Dancers should be aware that dancing while taking NSAID’s can mask pain, which can lead to further tissue injury.
In dancers, injuries to the shoulder and arm are not as common as lower extremity injuries. However, acute and overuse injuries from repeated spins, lifting, and drops can lead to injury. Also, choreography that involves weight bearing on the shoulder and/or arm can produce atypical stresses to the shoulder joint and can also lead to injury.
The shoulder is comprised of three bones: the scapula in the back (shoulder blade), the clavicle across the front (collar bone), and the humerus (upper arm bone). These three structures rely heavily on dynamic stability from the rotator cuff muscles around the joint. There is also a joint capsule and labrum (cartilage) which provide further stability to the joint.
"My shoulder popped out of joint."
The shoulder joint is the body’s most mobile joint. While this provides tremendous functional benefit, this also makes the shoulder easy to dislocate. A partial dislocation (subluxation) means the head of the upper arm bone (humerus) is partially out of the socket (glenoid). A complete dislocation means it’s popped all the way out.
Falling is the most common cause of a new shoulder dislocation. However, a dislocation can also occur when the arm is forcibly moved into an awkward position, usually while extended away from the body. Both partial and complete dislocations cause pain and unsteadiness in the shoulder. The muscles may have spasms from the disruption, and this can make it hurt more. Repeated shoulder dislocations will lead to instability of the joint. Dancers with this injury may notice it becomes easier to sublux or dislocate the joint again and again.
Shoulder subluxations will usually relocate without much assistance. Dislocations, particularly first time dislocations, may need the assistance of a physician to relocate the joint. The physician may also wish to x-ray the joint to rule out any fractures. Following relocation, a sling and activity restriction is advised for several weeks. Ice and anti-inflammatory medication can be helpful to help reduce acute inflammation in the joint. A supervised physical therapy program is crucial to help prevent repeated dislocations. The therapy is directed at strengthening the muscles around the shoulder and upper back that help stabilize the shoulder in its socket.
Maintaining excellent strength and stability of the shoulder and upper back muscles may help prevent shoulder dislocations. However, as most dislocations occur accidentally, safety in the studio or rehearsal space should be of top importance. Avoid repeating lifts or difficult movements too many times, as when the muscles fatigue accidents become more likely.
"My shoulder hurts when I reach overhead."
Shoulder impingement syndrome is primarily due to a narrowing of the space underneath a bony process (the acromion) in the shoulder. The supraspinatus muscle (one of the rotator cuff muscles) passes through this space and can become inflamed and painful if compressed. In some cases, the supraspinatus bursa also becomes compressed and inflamed; or calcium deposits may form within the tendon of the supraspinatus.
Shoulder impingement syndrome can be due to a number of factors, including:
- Repetitive arm movements, especially with overhead activities.Frequent extension of the arm at high speed under high load, such as with baseball pitching.
- An increase in upper extremity training by a dancer whose rotator cuff muscles are not in good condition.
It is common for individuals with shoulder impingement syndrome to ignore the first signs of symptoms. There is usually no single episode of the shoulder giving way and, at first a person may notice only minor pain and a slight loss of strength. The injury will generally progress over time. Dancers typically seek medical attention once they notice regular pain with overhead motions or lifting objects.
Initial treatment for shoulder impingement involves ice, rest, and the use of anti-inflammatory medications to reduce acute swelling in the joint. For chronic cases, a physician may recommend a corticosteroid injection to assist with decreasing the inflammation in the joint. Physical therapy or athletic training consultation is advised to evaluate the shoulder function and improve rotator cuff strength. Dancers with chronic, unresolved impingement conditions may be candidates for a surgical technique to decompress the acromioclavicular joint.
"I can’t raise my arm overhead."
The rotator cuff muscles are attached to the upper arm bone (humerus) by tendons. Rotator cuff tears occur when one or more of these rotator cuff tendons are torn partly or completely.
Rotator cuff tears are most often the result of a forceful injury, such as falling with an extended arm. Tears can also result from repeated, abnormal stresses placed on the arm, such as with a throwing mechanism. A tear or complete rupture of the rotator cuff tendons is usually quite painful and disabling. The dancer will notice significant difficulty or inability to raise the arm overhead. There is usually no pain with passive movement of the shoulder. Along with X-rays, the physician will often request an MRI to confirm the diagnosis of a rotator cuff tear.
As with most soft tissue injuries, the initial treatment for a rotator cuff tear is a combination of rest and ice. Anti-inflammatory medications can be helpful in reducing acute pain. Dancers with a partial rotator cuff tear may be able to strengthen the shoulder with a rehabilitation program to regain full function. Complete tears will most likely require surgery to repair the injured tendon. Surgery is followed by 2-3 months of additional rehabilitation before full function to the shoulder can be restored.
The key to preventing a rotator cuff tear is to maintain a healthy rotator cuff. Dancers should address any discomfort or weakness in the rotator cuff immediately. If the shoulder is painful with activity or with overhead motions, the dancer should avoid activities such as lifting or throwing a partner until a proper diagnosis can be obtained.
"I fell on the top of my shoulder."
The acromioclavicular joint (AC joint) joins the shoulder blade (scapula) in the back to the collar bone (clavicle) in the front. Injuries to this joint are usually the result of a direct force to the tip of the shoulder, or by falling onto the shoulder. The ligament between the acromion and the clavicle will be torn, either partially or completely. With a complete tear, there is often a “bump" that develops on top of the shoulder. This area will be swollen and painful to touch, and the shoulder is usually painful with all movements.
Initial care of AC joint sprains will include ice and rest. Once the diagnosis is confirmed, the physician may issue a sling or a clavicle brace to help stabilize the joint. Tissue healing for partial AC joint sprains will take about 6-8 weeks. During this time, athletic training or physical therapy treatments can be helpful to strengthen the shoulder and restore proper movement mechanics. Though not common, complete AC joint tears may require surgery to repair the injured ligament and restore joint integrity.
- Overuse injuries require attention. Dancers should not try to "work through the pain." When a shoulder injury is ignored, it can become the source of chronic problems.
- If your shoulder is sore after you use it actively, especially at the limits of your reach, try giving it some rest. If the pain persists or worsens, consult your physician.
- When strengthening the shoulder girdle, dancers should focus on developing the posterior shoulder muscles as well as the intrinsic rotator cuff muscles. This will provide the greatest potential for shoulder stabilization possible.