Shoulders

If you think women just can''''t throw a ball, take a look at Birmingham, Alabama, native Lee Anne Ketcham.

Ketcham was the starting pitcher for the Colorado Silver Bullets, the first postwar all-female pro baseball team to be recognized by the National Association of Professional Baseball Leagues. She was also the first female pitcher to play for the Maui Sting Rays, an all-men''''s professional team in Hawaii.

Her fastball has been clocked at 80 miles per hour, which would qualify it for a speeding ticket in almost every state in the union.

When anyone''''s shoulder is pushed to the limits like that, it needs tender loving care. To perform the way she does, Ketcham spends one-third of her weight-lifting time strengthening a series of muscles that surround the shoulder joint. That''''s important for keeping her shoulder not only strong but stable as well.

Inside Your Shoulder

The shoulder and arm that can help catapult a ball at 80 miles per hour obviously has excellent working parts designed for efficiency and power. The central pivot of this mechanism is a ball-and-socket joint in which the ball-shaped head of the upper arm bone, or humerus, fits into a cuplike socket called the glenoid cavity. The shoulder joint is like a golf ball sitting on a golf tee. The socket part of the joint is very shallow, which means that the ball-shaped head of the humerus can rotate freely in the cavity, and the shoulder can move through a large range of motion.

Building Your Cuff With some therapeutic shoulder range-of-motion exercises, you can help relieve the pain of rotator cuff injury. These exercises both increase flexibility and strengthen the muscles around the shoulder, which can help prevent future injury, according to James Kramer, M.D., assistant clinical instructor in the family practice residency program at the Moses H. Cone Memorial Hospital in Greensboro, North Carolina. Figures 1 through 4 show some exercises that can be done with a two- to three-foot strip of surgical tubing or exercise elastic that''''s wrapped around a doorknob. Just be sure to consult with your doctor before doing these exercises--and stop if you begin to feel shoulder pain. After completing these exercises, do the stretches shown below
1. Hold one end of the elastic in your fist, with the other end around a door handle as shown.	/td>	2. Rotate your hand so the thumb points down and inward.
3. Change position so you can hold the elastic as shown above, stretched across the front of your body.	/td>	4. Rotate your hand outward, so the thumb points up.
To stretch after exercising, hold a towel as shown and pull on each end slowly two or three times.	/td>	A second stretch: Reach to the top of the doorjamb and hold, then relax. Repeat two or three times.

Because the cavity of the socket is shallow and the "ball" part of the shoulder joint has plenty of mobility, that ball would slip right out if it weren''''t strapped in by ligaments and tendons. If your shoulder starts to hurt, maybe it''''s because these structures are getting a heavy-duty workout. Even if you''''re not hurling a hardball at the speed of a Porsche in the passing lane, you can still mess up the muscle tendons around that joint--especially the group of four muscles that doctors call the rotator cuff.

The Cuff Link

The most common shoulder problem among women ages 30 to 45 is rotator cuff tendinitis, also called impingement syndrome, according to James Kramer, M.D., assistant clinical instructor in the family practice residency program at the Moses H. Cone Memorial Hospital in Greensboro, North Carolina. This injury occurs when one of the tendons of the rotator cuff gets pinched between two bony parts of the shoulder. "As the arm bone swings out to the side and up above, the head of the humerus rides up and, essentially, pinches the tendon on the bony covering above it," says Dr. Kramer. Activities that can bring on rotator cuff tendinitis involve a lot of overhead motion--such as pitching, swimming, playing tennis or reaching overhead when you''''re on the job. You''''re especially vulnerable if you repeat the same motion over and over again for six weeks or more.

How do you know you have it? This type of tendinitis usually begins with a deep aching in the shoulder, and there may also be pain on the upper outside portion of the shoulder, says Dr. Kramer. You might not feel the pain while your arms are down, but as soon as you reach overhead, you get a sharp complaint from your shoulder. You may also feel pain while you''''re sleeping at night.

If you can''''t get the upper hand on your overhead activities, here are some actions doctors recommend to end the pain or guard against it.

Get within reach. If you can identify what activities you do that require repetitive overhead motions and cut them out of your daily routine, that''''s the first thing to do, says Dr. Kramer. If you have to pull files from a high shelf, for example, use a step stool so the shelf is within easy reach.

Heed your body''''s hints. When you''''re doing an unfamiliar activity like apple picking or painting a ceiling, you may find that your shoulders start to ache. "Don''''t push through that," says Dr. Kramer. "If you really notice your shoulders starting to ache, slow down or stop what you are doing at that particular time."

Apply for relief. If you feel shoulder pain from doing overhead activities, applying ice should help. Use a bag of ice cubes, a bag of frozen dried beans or an ice pack wrapped in a towel to protect your skin from direct contact. Hold it to your shoulder for 10 to 20 minutes, suggests Dr. Kramer. You can repeat as often as you like, but allow some time for your skin to warm up between each application.

Put out the fire. Take an anti-inflammatory such as ibuprofen to reduce inflammation and alleviate the pain, says Dr. Kramer.

When Pain Leaves You Frozen Stiff

When it''''s uncomfortable to move, naturally, you try to do the opposite. "The more it hurts to move your shoulder, the more you tend to keep it still," says Dr. Kramer. But that could lead to other problems. One possible consequence is something doctors call adhesive capsulitis, also known as frozen shoulder.

You have frozen shoulder when the capsule around the joint starts to stiffen. Some people also develop adhesions in the frozen shoulder, which is what happens when pieces of body tissue form in the wrong places and cling like duct tape to the moving parts.

Even if you''''re feeling some pain in the shoulder area because of adhesions, experts recommend that you perform range-of-motion exercises to keep the joint limber and supple.

If you try a number of shoulder exercises and find that you can''''t reach or stretch as far as you used to, it''''s a sign that

In a no-strain work position, your chair should be adjusted so you can sit upright with your shoulders back, feet flat on the floor and elbows bent at a 90-degree angle.

Where Pain and Posture Mix

Some women feel shoulder and neck pain combined with a feeling of weakness in their upper arms and backs. They may also have numbness and tingling all the way down their arms into their hands. If you have some of these symptoms, you should probably see your doctor to find out whether you have thoracic outlet syndrome.

This syndrome is more common in women than men--and you''''re more likely to get it if you have a long, swanlike neck and droopy shoulders or postural problems, says Dr. Pascarelli. Also, if some of your neck muscles are tight with tension, that could be a trigger for the condition, according to Dr. Pascarelli. And it often goes unrecognized. The symptoms are caused by traction or compression of nerves around the neck or compression of blood vessels.

Here are some ways to decompress if you have the syndrome.

Be straight with yourself. Avoid slumping at your chair, says Dr. Pascarelli. Thoracic outlet syndrome often develops in secretaries who are sitting at their computer keyboards with their shoulders hunched and necks jutting forward. Maintain good posture, and you''''re less likely to have the problem.

Ride erect. When you''''re in the car, sit up straight and keep your hands in a light grip at the 10 o''''clock and 2 o''''clock positions on the steering wheel. If you have a height-adjustable steering wheel, put it in the lowest position when you''''re driving. Elevate the driver''''s seat if you can--or get a seat pad to raise yourself so your hands can rest comfortably on the wheel while you''''re driving. "If the steering wheel is too high, that''''s going to throw a tremendous amount of tension on your neck and shoulders," says Dr. Pascarelli.

Compute at ease. If the desk holding the computer is too high, that means you''''ll be looking up at the screen--which could put unwanted compression on the nerves that aggravate thoracic outlet syndrome. Check to make sure your desk and chair are the right height for you, suggests Dr. Pascarelli. Then adjust the height of your chair so that you can sit comfortably with your neck and back in alignment when you''''re working. The center of the screen should be about six inches below eye level.

See also Joints, Muscular System, Skeletal System