Shoulder

Chronic Shoulder Instability :: Clavicle Fracture (Broken Collarbone)s :: Dislocated Shoulder
Rotator Cuff Tears :: Scapula (Shoulder Blade) Fractures :: Shoulder Impingement/Rotator Cuff Tendinitis :: Shoulder Injuries in the Throwing Athlete :: Arthritis of the Shoulder

shoulder

Warning Signs of a Shoulder Injury

If you are experiencing pain in your shoulder, ask yourself these questions:

  • Is your shoulder stiff? Can you rotate your arm in all the normal positions?
  • Does it feel like your shoulder could pop out or slide out of the socket?
  • Do you lack the strength in your shoulder to carry out your daily activities?

 

Common Shoulder Injuries

Most problems in the shoulder involve the muscles, ligaments, and tendons, rather than the bones. Athletes are especially susceptible to shoulder problems. In athletes, shoulder problems can develop slowly through repetitive, intensive training routines.

Some people will have a tendency to ignore the pain and "play through" a shoulder injury, which only aggravates the condition, and may possibly cause more problems. People also may underestimate the extent of their injury because steady pain, weakness in the arm, or limitation of joint motion will become almost second nature to them.

Orthopedic surgeons group shoulder problems into the following categories.

Instability

Sometimes, one of the shoulder joints moves or is forced out of its normal position. This condition is called instability, and can result in a dislocation of one of the joints in the shoulder. Individuals suffering from an instability problem will experience pain when raising their arm. They also may feel as if their shoulder is slipping out of place.

Impingement

Impingement is caused by excessive rubbing of the shoulder muscles against the top part of the shoulder blade, called the acromion.

Impingement problems can occur during activities that require excessive overhead arm motion. Medical care should be sought immediately for inflammation in the shoulder because it could eventually lead to a more serious injury.

Rotator Cuff Injuries

The rotator cuff is one of the most important components of the shoulder. It is comprised of a group of muscles and tendons that hold the bones of the shoulder joint together. The rotator cuff muscles provide individuals with the ability to lift their arm and reach overhead. When the rotator cuff is injured, people sometimes do not recover the full shoulder function needed to properly participate in an athletic activity.

Treatment of Shoulder Injuries

Early detection is the key to preventing serious shoulder injuries. Often, an orthopedic surgeon will prescribe a series of exercises aimed at strengthening the shoulder muscles.

Here are some easy shoulder exercises that you can do to strengthen your shoulder muscles and prevent injuries.

Basic shoulder strengthening

Attach elastic tubing to a doorknob at home. Gently pull the elastic tubing toward your body. Hold for a count of five. Repeat five times with each arm. Perform twice a day.

Wall push-ups

Stand facing a wall with your hands on the wall and your feet shoulder-width apart. Slowly perform a push-up. Repeat five times. Hold for a count of five. Perform twice a day.

Shoulder press-ups

Sit upright in a chair with armrest, with your feet touching the floor. Use your arms to slowly rise off the chair. Hold for a count of five. Repeat five times. Perform twice a day.

Other Treatment

Anti-inflammatory medication also may be prescribed to reduce pain and swelling.

Fractures, Injuries, and Conditions

Chronic Shoulder Instability

Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of an injury or from overuse. After the shoulder becomes loose and slips out of place repeatedly, it is vulnerable to repeat episodes, which is called chronic shoulder instability.

Chronic Shoulder Instability-OrthoInfo – AAOS

Clavicle Fracture (Broken Collarbone)

A broken collarbone, also known as a clavicle fracture, is often caused by a direct blow to the shoulder. The collarbone (clavicle) is located between the ribcage (sternum) and the shoulder blade (scapula), and it connects the arm to the body. Most often, breaks occur in the middle of the long bone (clavicle), but occasionally will break where it attaches at the ribcage or shoulder blade.

Clavicle Fracture (Broken Collarbone) -OrthoInfo – AAOS

Dislocated Shoulder

A partial dislocation means the head of the upper arm bone (humerus) is partially of the socket. A complete dislocation means it is all the way out of the socket. Both partial and complete dislocations cause pain and unsteadiness in the shoulder and need to be treated by an orthopedic physician. Symptoms can include swelling, numbness, weakness, and/or bruising.

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Rotator Cuff Tears

The rotator cuff is a network of four muscles that come together as tendons to form a covering around the head of the humerus (your upper arm bone). The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. When your rotator cuff is torn, it will weaken your shoulder. This means that many simple activities of daily living may become painful and difficult to do. Nonsurgical treatment options relieve pain and improve function but shoulder strength does not usually improve without surgery.

Rotator Cuff Tears-OrthoInfo – AAOS

Scapula (Shoulder Blade) Fractures

The shoulder blade (scapula) is a triangular-shaped bone that is protected by a complex system of surrounding muscles. One of more parts of the scapula may be fractured with high-energy, blunt trauma injuries, such as those experienced in a motor vehicle collision. Symptoms often include extreme pain when moving the arm, swelling around the back of the shoulder, and scrapes around the affected area. Both nonsurgical and surgical options are available depending on the severity of your fracture.

Scapula (Shoulder Blade) Fractures-OrthoInfo – AAOS

Shoulder Impingement/Rotator Cuff Tendinitis

The rotator cuff is a common source of pain in the shoulder. Pain can be the result of:

  • Tendinitis. The rotator cuff tendons can be irritated or damaged.
  • Bursitis. The bursa can become inflamed and swell with more fluid causing pain.
  • Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.

Shoulder Impingement/Rotator Cuff Tendinitis-OrthoInfo – AAOS

Shoulder Injuries in the Throwing Athlete

Overhand throwing places extreme stress on the shoulder, specifically to the anatomy that keeps the shoulder stable. Dr. Voytik, team physician for all the surrounding schools, is skillfully trained in monitoring and treating athletic injuries and conditions, such as tears and tendinitis.

Shoulder Injuries in the Throwing Athlete-OrthoInfo – AAOS

Arthritis of the Shoulder

Osteoarthritis

Also known as "wear-and-tear" arthritis, osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing pain.

Osteoarthritis usually affects people over 50 years of age and is more common in the acromioclavicular joint than in the glenohumeral shoulder joint.

damaged-cartilage
(Left) An illustration of damaged cartilage in the glenohumeral joint. (Right) This x-ray of the shoulder shows osteoarthritis and decreased joint space (arrow).
Illustration on left reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic disease that attacks multiple joints throughout the body. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.

The joints of your body are covered with a lining — called synovium — that lubricates the joint and makes it easier to move. Rheumatoid arthritis causes the lining to swell, which causes pain and stiffness in the joint.

Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. In RA, the defenses that protect the body from infection instead damage normal tissue (such as cartilage and ligaments) and soften bone.

Rheumatoid arthritis is equally common in both joints of the shoulder.

Posttraumatic Arthritis

Posttraumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder.

Rotator Cuff Tear Arthropathy

Arthritis can also develop after a large, long-standing rotator cuff tendon tear. The torn rotator cuff can no longer hold the head of the humerus in the glenoid socket, and the humerus can move upward and rub against the acromion. This can damage the surfaces of the bones, causing arthritis to develop.
The combination of a large rotator cuff tear and advanced arthritis can lead to severe pain and weakness, and the patient may not be able to lift the arm away from the side.

rotator-cuff-arthropathy

Avascular Necrosis

Avascular necrosis (AVN) of the shoulder is a painful condition that occurs when the blood supply to the head of the humerus is disrupted. Because bone cells die without a blood supply, AVN can ultimately lead to destruction of the shoulder joint and arthritis.

Avascular necrosis develops in stages. As it progresses, the dead bone gradually collapses, which damages the articular cartilage covering the bone and leads to arthritis. At first, AVN affects only the head of the humerus, but as AVN progresses, the collapsed head of the humerus can damage the glenoid socket.

Causes of AVN include high dose steroid use, heavy alcohol consumption, sickle cell disease, and traumatic injury, such as fractures of the shoulder. In some cases, no cause can be identified; this is referred to as idiopathic AVN.

Arthritis of the Shoulder-OrthoInfo – AAOS