Shoulder problems in climbers are invariably of an overuse nature. The risk of injury can be significantly reduced with a bit of prevention and care. If the worst does occur, then the watchwords are early diagnosis and treatment.

Shoulder pain caused by inflammation of the tendons of the rotator cuff as they attach onto the humerus (long bone of upper arm) is known as tendinitis. The tendons of the cuff are supraspinatus, infraspinatus, teres minor and subscapularis. Supraspinatus is the most commonly problematic.
 

Symptoms  

• Sharp or aching pain on the outside of the upper arm (lateral) at the top.
• Pain on abduction (movement away from the body laterally)
• Painful arc. This when the pain is only in the middle of the movement.
• Pain on resistance of abduction.
• May disturb sleep if you lie on the affected arm.

Causes

Overuse or trauma of the tendon. It is thought that the blood supply of the tendon becomes 'wrung out' with movement and this, over time or overloading, produces changes in the cells of the tendon which results in breakdown and pain (tendinitis) in overuse. In acute cases the causes are invariably sudden loading on the shoulder. In the chronic cases this is usually due to repeated overstrain on the tendon.

Shoulder pain can have many causes other than rotator cuff tendinitis:

• Pain from the joints, discs or nerves of the neck and upper back (thoracic spine).
• Inflammation of the subacromial bursa (a fluid filled membrane), which lies under the acromion process (the flat bone at the outer part of the top of the shoulder). This is called subacromial bursitis.
• Rupture or partial rupture of the rotator cuff or any of the tendons which make up the cuff
• Calcification of the tendon (when bone deposits get laid down in the tendon). This is more common in older athletes.
• Pain from the long head of biceps at its upper end.
• Instability of the shoulder joint
• Inflammation of the capsule of the shoulder joint (capsulitis)

Injury management

• Avoid sustained holds and prolonged or difficult routes
• Massage and warm up the area prior to climbing and as soon as possible after a session use ice or other coolant
• Ask your G.P. about the use of anti-inflammatory drugs
• Stretch the appropriate areas regularly, with particular attention to neck shoulder, and elbow.

Expected outcome

This will be dependant on the nature of the injury and also the underlying cause. In acute cases, with careful management and good underlying movement patterns, a good recovery may be expected over six to eight weeks. However if there are underlying problems and the injury is of a more chronic nature, it could take you many months of hard work and frustration to reach your targets.

Injury prevention

• Regularly stretch the shoulder girdle and shoulder joint muscles
• Avoid overtraining; ensure you have adequate rest and recovery between sessions
• Warm up and stretch the appropriate muscles, progressively load the shoulder while climbing, avoid going straight into sustained or loaded moves
• Good postural alignment in everyday activities
• Muscle balance and stability of the upper quadrant (back, shoulder girdle and arm)