Shoulder functions depend on multiple components working together to perform desired tasks, including muscles (rotator cuff, etc.), tendons, ligaments, cartilage and bone. Certain injuries or problems can arise involving any of these components of the shoulder that can contribute to shoulder dysfunction.
Dysfunction can result in pain, weakness, a decreased range of motion, instability or a combination of these issues. Many issues in the shoulder can be managed with non-operative measures such as rest, ice, medications (anti-inflammatory i.e. Aleve/Ibuprofen) and physical therapy. For other conditions further intervention such as steroid/cortisone injections or surgical intervention may be required.
If you are having persisting pain, weakness, loss of motion or feelings of instability compromising your function or quality of life, you should consider seeking medical evaluation by your primary care doctor or orthopedic surgeon. Along with a clinical examination, evaluation will likely include x-rays and possibly an MRI.
Common Shoulder Injuries
Separation actually refers to injury to the acromioclavicular (AC) joint as opposed to the actual shoulder. This is a small joint consisting of the junction of the collarbone (clavicle) and acromion (part of the scapula, aka, shoulder blade). Injury typically involves a forceful fall onto the shoulder that stretches or disrupts the joint capsule or the associated ligaments, which stabilize the collarbone.
You may notice swelling, a bump or prominence at the end of the collarbone at the top of the shoulder. This injury does not usually require surgery, but instead medical management and therapy. Severe cases may require ligament reconstruction and stabilization of the collarbone.
Dislocation occurs with forceful injury on the shoulder that causes the ball to dislocate or no longer remain centered on the socket. Dislocation can be very painful and, if it does not fall back into place on its own, will require manipulation by a health care provider to put the ball back into place on the socket.
With a first time dislocation, management involves a period of immobilization in a sling and physical therapy to rehab and strengthen the shoulder’s dynamic stabilizers (rotator cuff and surrounding muscles).
If the patient has recurring episodes of dislocation or partial dislocations, known as subluxation events, surgical stabilization of the shoulder may be needed in addition to therapy. With advancements in surgical techniques and instrumentation, shoulder stability can often be restored through arthroscopic (scope) surgery. This is accomplished by repairing the torn or stretched soft tissue static stabilizers of the shoulder. Repairing these soft tissues acts to restore anatomy and provide a “bumper” in the front of the shoulder helping to prevent the shoulder from dislocating again.
Younger patients are at a higher risk of recurrent dislocation than older patients. When an older patient sustains a dislocation there is an increased chance of a full thickness rotator cuff tear that may require surgery to repair.
Rotator Cuff Injury
This can vary across a spectrum from contusion and strain to full thickness tear. The rotator cuff is a group of four muscles that originate from the shoulder blade and insert on the humerus (upper arm bone that includes the ball of the shoulder joint) to produce rotation and elevation, as well as stability and compression of the shoulder joint. Contusion is essentially a deep muscle bruise that can occur after a fall or other trauma to the shoulder. Rest, ice and medical management can help with this injury.
A strain occurs when the rotator cuff muscle or tendon is stretched as a result of injury. It produces pain but does not result in a significant tear. The rotator cuff can be susceptible to partial or full thickness tears with certain repetitive overhead activities, lifting or trauma. Partial thickness rotator cuff injury typically responds to medical management and a course of physical therapy and home exercises to strengthen the rotator cuff muscles and stabilize the scapula. Full thickness tears typically require surgical intervention, repairing and anchoring the tendon back to the bone. Many times this can be repaired arthroscopically (scope) or through a small open incision.
Common shoulder problems
Arthritis (degenerative joint disease)
Arthritis can result in pain and decreased range of motion of the shoulder due to deterioration, loss, and damage to the smooth cartilage that normally covers the end of both the ball (humeral head) and socket (glenoid).
Injury, wear and tear and genetics can all contribute to arthritis. It can be managed with medications, injections and joint replacement surgery.
Frozen Shoulder (Adhesive Capsulitis)
This describes a condition in which there is a loss in shoulder range of motion and pain. This can occur after injury, inflammation and surgery. However, many times there is no instigating factor.
Frozen shoulder is slightly more common in women than men and in people who are diabetic. This condition does not usually require surgery but takes time to resolve. Management with medication, therapy, time and possible injections often leads to resolution.
Subacromial Impingement and Bursitis
This happens when swelling and inflammation occur in the space underneath the shoulder blade and over the top of the rotator cuff muscles and tendons. This can be caused by overuse, muscle imbalances around the shoulder, injury or variations in bone anatomy. People can have bone structure to their shoulder blade that results in a prominent ridge or spur decreasing the available space that can cause irritation of the bursa and rotator cuff leading to this painful condition.
Symptoms usually improve with rest, medication, physical therapy and injections. However if symptoms persist or continue to recur, arthroscopic surgery to clean up the inflamed bursa and smooth down the spur is a good option to manage this condition.
If you’re experiencing shoulder instability, immobility or pain, attend our Nov. 9th talk: Shoulder Pain – Causes, Treatment and You. Click here to register.