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Shoulder to Shoulder: Caring for this Essential Joint

  • 18 Jan 2023
  • 3 mins

Orthopedic surgeon Dr. Bryan Tan delves into how our shoulders function and respond, injury prevention, and pointers for enjoying sports which involve striking motions while maintaining good shoulder health.


Understanding the Shoulder

Our movements around the shoulder joint involve 3 separate joints for the shoulder region: the glenohumeral joint, the acromioclavicular joint, and the articulation between the shoulder blade and the rib cage.

The glenohumeral joint is a ball and socket joint formed between the arm bone (humerus) and the shoulder blade (scapula). The acromioclavicular joint is a smaller joint located above the glenohumeral joint formed between the collarbone (clavicle) and part of the scapula called the acromion.

As the glenohumeral joint is designed to allow a large range of movement, it is also the most unstable joint in the body.

However, stability of the joint is enhanced by the presence of a cartilaginous ring attached to the rim of the socket, known as the labrum.

A sleeve of tendons surrounds the upper part of the humerus. This sleeve of tendons is known as the rotator cuff. Its functions are to power the movements of the arm and to further enhance stability of the shoulder joint.

According to Dr. Tan, the commonly seen injuries to the shoulder include glenohumeral joint dislocation.


Enduring Mild Injuries: Do or Avoid?

In Dr. Tan’s opinion, whether an injury is mild or serious bears a degree of subjectivity.

Certainly, injuries which can be termed as mild such as joint sprains and tendon strains can and often resolve and recover on their own.

However, in a few cases, even seemingly mild injuries can result in persistent pain and affect shoulder function.

“As such, if the pain does not resolve over the course of 3-4 weeks, it is often a good idea to see a doctor to get the injury thoroughly checked,” he advises.

For injuries in general, many are caused by the participation in sports.

“Such shoulder injuries can occur as a result of a single episode that causes an acute injury or can result from repetitive movements that cause minute injuries that eventually accumulate to something more serious,” Dr. Tan explains.


A Matter of Definition

When we embark on change to meet our resolutions, we need to define our goals well. Simply stating that you wish to achieve a healthier lifestyle is insufficient.

Resolutions need to be set with realistic expectations, be detailed, and come with a plan. In the case of achieving a healthier lifestyle, a few questions need to be answered: How often will one exercise? What are the days and times one will exercise? What kinds of food should be prioritized? What is the quantity of sugar or salt to be cut down?

In addition, how realistic and sustainable will these behaviors be? If working out five times a week takes far too much commitment, then we will need to set our routines realistically based along with the other priorities in our lives.

Perhaps it is better to start with twice a week and focus energy on adjusting our diet at the same time to begin with. We must consider the other aspects of our lives that take up our time such as family, friends, career, personal needs and wants etc.

These are all important. Resolutions require time and effort to achieve. Practically, we should consider how our new behaviors can lead to meeting resolution goals, as part of fitting into our lives.


Shoulder Health Basics

There are several facets to maintaining and improving shoulder health.

For optimal joint function, one must have a combination of flexibility while maintaining stability, good neuromuscular control of the joint movements, and good strength of the muscles.

For a joint, the importance of flexibility is for allowing the joint to move through a large range of movement without sustaining an injury.

Such flexibility also allows one to carry out certain activities optimally instead of having to employ compensatory movements and risking injury from bad form.

Dr. Tan elaborates, “Good neuromuscular control of the shoulder allows one to move the joint efficiently and allows the body to subconsciously understand the joint position so that if the joint inadvertently gets to a position where an injury might be imminent, subconscious and immediate action will be taken to remedy the situation, hence averting an injury.”

Finally, strength would involve strength of not just muscles and tendons that power the shoulder, but also those that stabilize the scapula.

By stabilizing the scapula, the glenohumeral joint then has a stable strong base upon which to move.


Boxing, MMA, Muay Thai Anyone?

For people who participate in combat sports, they are naturally at a higher risk of suffering shoulder injuries.

In the case of those who take part in striking sports such as boxing or Muay Thai, they would risk experiencing injuries to the rotator cuff tendons.

Fortunately, Dr. Tan says, most of these injuries are not severe and will often resolve with rest and a course of physiotherapy. However, these participants certainly run the risk of injury to the other bones in their upper limbs, especially their hands.

As for mixed martial arts (MMA), this sport comprises a number of disciplines of martial arts: striking disciplines such as Taekwondo, karate, and Muay Thai; throwing disciplines such as judo and wrestling; and ground work such as sambo and Brazilian jujitsu.

Based on the range of movements, those who practise MMA are certainly at high risk of developing shoulder injuries.

On enjoying the benefits of combat sports and keeping injuries at bay, Dr. Tan offers, “Whilst certain injuries sustained during such activities may not be avoidable, there are certainly many things one can do to reduce the chances of sustaining injuries.

“If you are new to one of these sports and are not suitably conditioned to the demands of the sport, it is vital to ease into the sport rather than rush into it at a high intensity.

“This will allow your body, joints, and muscles to slowly adapt to the sport.”

It is also very important to devote time and effort to utilize strengthening and stretching exercises specific to a particular sport.

For example, if you are planning on taking up Muay Thai, you must ensure adequate flexibility in your hips and hamstrings in order to perform what are called head kicks.

Unfortunately, stretches and exercises that improve flexibility and strength could appear run of the mill and one might be tempted to skip these.

Dr. Tan cautions, “If you do not have the flexibility to perform those kicks, it is important to understand your limits and not try to emulate your favorite martial artist. Otherwise, there would be a very real risk of pulling or injuring a muscle or tendon.”

Even if you have been practising a particular combat sport for a while and have a good understanding of the demands placed on your body, it might be easy to become complacent and underestimate the importance of good conditioning.

This is especially true if you have had to take some time off from the sport due to work, family life, or an injury.

The rate of deconditioning of the body can be surprisingly rapid; knowledge and understanding of this fact, coupled with the discipline of working to rebuild often neglected aspects of fitness such as core strength and flexibility, will go a long way in preventing injuries.

Contributed by

Dr. Bryan Tan
Orthosports Orthopaedic Surgery & Sports Medicine
Farrer Park Hospital