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Part I

As a medical provider who sees a lot of CrossFit patients (and is a CrossFitter as well) I’m frequently asked about shoulder and knee injuries.   “What do you think it is?  How did it happen?  What should I avoid?” are common phrases during my workday. 

We all try to do what we can to stay safe during any sport or physical activity, but the reality is that injuries happen. I’ll use Aaron’s CrossFit Corner to hit on the big injuries that I frequently see in my CrossFit patients and why they happen.

To make them easier to understand, I’ll break these topics in to several small segments.  This column will focus on the shoulder of the CrossFitter under 35 years old (yes, age makes a difference).  While there are a multitude of injuries that can occur to the shoulder joint, I’ll discuss the most common ones that I see in my practice.

Rotator Cuff Tendonitis (or, Impingement Syndrome)

The rotator cuff’s main job is to initiate movement of the shoulder and add secondary stability.  It’s not as big as you’d think…from front to back its attachment site , approximately 25mm.

The most common causes and movements that can contribute to rotator cuff tendonitis are repetitive overhead activities (such as any form of press), sumo deadlift high pulls or excessive dips and ring dips.

One clinical feature (this means symptom) is soreness over the lateral shoulder.  Sometimes a “grinding” sensation within the shoulder (from inflammation of the bursa sac) is noted.  One may also experience difficulty sleeping on affected side.  The pain often gets better with rest and nonsteroidal anti-inflammatory drugs (NSAIDs). 

Treatments for rotator cuff tendonitis include activity modification for several weeks, anti-inflammatories and physical therapy.  Stubborn cases may receive an injection of a corticosteroid.

Glenoid Labral Tearing

The glenoid labrum is a fibrocartilaginous structure that runs around the shoulder “socket”.

While occasionally repetitive in nature, the most common causes of glenoid labral tearing are often more traumatic comparative to impingement syndrome.  Patients can often recall a specific incident that caused their discomfort.  Heavy Olympic-style lifts (snatch) or movements that create traction on the arm (think muscle-ups or butterfly pullups) are the most common culprit.

Symptoms of glenoid labral tears are usually an acute onset of pain unrelieved by a period of rest.  Patients oven have a “click” with shoulder circumduction and have difficulties repeating the movement.  In the weight lifting population, the majorities of the symptoms are in the back of the shoulder but sometimes can be vague complaints of “deep” shoulder pain.

Treatments for this problem include activity modification and anti-inflammatories.  Physical therapy will sometimes help.  The glenoid labrum has a poor healing potential so failure to improve after a prolonged period of rest will often necessitate a MRI to confirm the diagnosis.  Often, surgery is necessary.

AC Joint Pain

The Acromio Clavicular Joint is a very small joint just superior to the ball and socket portion of the shoulder where the main movement is bringing your arm across your body.

Most common cause for this type of pain is repetitive use in what we call “horizontal adduction” (think hugging someone).  Usual offenders are pushups, burpees, and bench press.

Clinically patients will have pain with activities on the top portion of the shoulder that may get better with oral NSAIDs . Other movements likely won’t bother it and instead of a “sharp, stabbing pain” patients will more likely describe “dull achiness”.  Weakness of the shoulder isn’t a sign of AC Joint pain, and sometimes people will feel a “bump” on the top of their shoulder.  Previous history of AC Joint separation would put someone at risk.

Treatments for AC Joint pain include cessation of the movements for several weeks and regular anti-inflammatories. Moderate cases will get a corticosteroid injection, and failure to improve will often result in surgery.

As you can see, a lot of these injuries will improve with a period of rest.  The shoulder joint is a delicate joint that doesn’t require the same sort of intensity of a movement such as the squat.  Make sure you’re going to a gym that has your body’s health as a main priority.  If a lot of your friends are getting injured make sure you take a serious look at your programming.  If, after a period of rest, activity modification, and regular anti-inflammatories you’re not where you need to be…I’m here to help.

Aaron Hewitt PA-C is a Physician Assistant with OrthoCarolina’s Sports Medicine Center. He is a former Assistant Athletic Trainer with the Minnesota Vikings (NFL), and is an orthopedic provider for UNC-Charlotte and Myers Park High School. He also is a Physician Assistant Team Lead for Sports Medicine, Spine, Hand & Pediatrics and a Clinical and Surgical Preceptor for Physician Students. In addition to CrossFit, Aaron is dedicated to running, yoga and clean eating.

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