Overview

Overview of Shoulder Problems

Most shoulder problems happen when soft tissues in the joint and shoulder region break down. The shoulder is a ball-and-socket-type joint that helps the shoulder:

  • Move forward and backward.
  • Allow the arm to rotate in a circular motion.
  • Hinge out and up away from the body.

To better understand shoulder problems and how they occur, the image below describes the bones, ligaments, and tendons that make up the shoulder.

The bones of the shoulder are held in place by:

  • Muscles, which help the shoulder move.
  • Tendons, which are tough cords of tissue that attach the shoulder muscles to bone.
  • Ligaments, which attach the shoulder bones An anatomical illustration depicting a shoulder joint. The labeled structures are: acromion, acromioclavicular joint, clavicle, bursa, rotator cuff tendons including supraspinatus, subscapularis, teres minor, infraspinatus, humerus, biceps muscle, glenohumeral joint, and scapula.to each and provide stability.
  • Rotator cuff, which is made up of tendons and muscles and holds the ball at the top of the arm bone in the socket. It also provides mobility and strength to the shoulder joint.

Who Gets them?

Who Gets Shoulder Problems?

Men, women, and children can have shoulder problems. They occur in people of all races and ethnic backgrounds.

Types

Types of Shoulder Problems

Shoulder problems vary widely. Doctors usually describe the problem by the type, for example:

  • Dislocation, happens when the ball of your top arm bone pops out of the socket.
  • Separation, happens when the ligaments between the collarbone and the shoulder blade area tear.
  • Rotator cuff disease, such as tendinitis and bursitis, happens when tendons in the shoulder inflame or become red, sore or swollen.
  • Torn rotator cuff, a tear in the tendon in the rotator cuff.
  • Frozen shoulder or adhesive capsulitis, happens when movement of the shoulder is restricted.
  • Fracture, is a crack or break in a bone, usually in the collarbone or upper arm bone.
  • Arthritis, can be one of two types:
    • Osteoarthritis, happens when over time the cartilage in the joint wears down and the bones rub together.
    • Rheumatoid arthritis is a disease that happens when your immune system causes inflammation in a joint.

Symptoms

Symptoms of Shoulder Problems

The symptoms of your shoulder problem depends on the specific type of condition or injury you have.

Dislocation

The signs and symptoms of dislocation of the shoulder joint can include:

  • Pain.
  • Muscle spasms.
  • Swelling.
  • Numbness.
  • Weakness.
  • Bruising.

Separation

The signs and symptoms of a shoulder separation include:

  • Pain or tenderness.
  • A bump in the middle of the top of your shoulder.

Rotator Cuff Disease: Tendinitis and Bursitis

The signs and symptoms of rotator cuff disease, including tendinitis and bursitis can include:

  • Slow onset of pain in upper part of your arm.
  • Difficulty sleeping on your shoulder.
  • Pain when lifting your arm away from your body or over your head.
  • Pain may travel down the front of your shoulder into the arm.

Rotator Cuff Tear

The signs and symptoms of a rotator cuff tear can include:

  • Pain over the deltoid muscle at the top of your arm.
  • Pain on the outer side of your shoulder when you raise or lower your arm from the side of your body.
  • Weakness.
  • Clicking or popping noise when moving your arm.

Frozen Shoulder

The signs and symptoms of a frozen shoulder include:

  • Tightness or stiffness in your shoulder joint.
  • Inability to carry out simple movements of your arm.
  • More discomfort at night.

Fracture

The signs and symptoms of a fracture in your shoulder can include:

  • Severe pain.
  • Redness or bruising.
  • Bones appear out of position.

Arthritis

The signs and symptoms of arthritis can include:

  • Pain.
  • Decrease in your shoulder motion.

Causes

Causes of Shoulder Problems

The cause of shoulder problems can include:

  • Repeating the same motion with your shoulder.
  • Aging.
  • Using the shoulder too much, especially if you are older.
  • Performing manual labor.
  • Injuring the shoulder, sometimes from playing sports or falling.

Diagnosis

Diagnosis of Shoulder Problems

Doctors diagnose knee problems using findings from your:

  • Medical history.
  • Physical exam.
  • Diagnostic tests.

Medical History

Your doctor will ask about your injury or other condition that may be causing the pain.

Physical Examination

Your doctor will examine your shoulder checking for:

  • Limits of movement in joint.
  • Location of your pain.
  • Extent of your joint instability.

Diagnostic Tests

Depending on the findings of the medical history and physical exam, the doctor may use one or more tests to determine the nature of your shoulder problem. Common tests your doctor may order include:

  • Standard x-ray (radiography). A procedure in which low-level radiation passes through the body to produce a picture called a radiograph. An x-ray is helpful for diagnosing fractures or other problems of the bones. Soft tissues, such as muscle and tendons, do not show up on an x-ray.
  • Arthrogram. A diagnostic record that can be seen on an x ray after injection of a contrast fluid into the shoulder joint to outline structures such as the rotator cuff. In disease or injury, this contrast fluid may either leak into an area where it does not belong, indicating a tear or opening, or be blocked from entering an area where there normally is an opening.
  • Ultrasound. A noninvasive, patient-friendly procedure in which a small, hand-held scanner is placed on the skin of the shoulder. Just as ultrasound waves can be used to visualize the fetus during pregnancy, they can also be reflected off the rotator cuff and other structures to form a high-quality image of them. The accuracy of ultrasound for the rotator cuff is particularly high.
  • Magnetic resonance imaging (MRI). A noninvasive procedure in which a machine with a strong magnet passes a force through the body to produce a series of cross-sectional images of the shoulder.

Treatment

Treatment of Shoulder Problems

Dislocation

Treatment for a shoulder dislocation may also include:

  • Your doctor placing the ball of your upper arm back into the socket, called a closed reduction.
  • Wearing a sling or device to keep your shoulder in place.
  • Exercises or rehabilitation to improve:
    • Improve range of motion.
    • Increase muscle strength.
    • Prevent additional injuries.
  • Surgery if you injure the tissues or nerves around your shoulder or dislocate the same shoulder again. Your doctor may recommend:
    • Traditional open surgery to repair the dislocation.
    • Arthroscopic surgery, which a doctor performs through a tiny incision and insert a small scope or arthroscope inside your shoulder joint.

Separation

Treatment for a shoulder separation may also include:

  • A sling to keep your shoulder in place.
  • Exercise or rehabilitation, after a period of rest.
  • Surgery to repair the joint if the tear is severe.

Rotator Cuff Disease: Tendinitis and Bursitis

Treatment for tendinitis and bursitis may also include:

  • Medicines to help reduce swelling and pain. Usually your doctor will recommend anti-inflammatory medicines such as aspirin or ibuprofen.
  • Ultrasound to warm deep tissues and improve blood flow to the area of your injury.
  • Injection of a corticosteroid into your shoulder joint.
  • Surgery if after 6 to 12 months your shoulder is not better, either open surgery or an arthroscopic surgery.

Rotator Cuff Tear

Treatment for a rotator cuff tear may also include:

  • Heat or cold to the area of your injury.
  • Medicines to help reduce swelling and pain, usually an anti-inflammatory such as aspirin or ibuprofen.
  • Electrical stimulation of your muscles and nerves using transcutaneous electrical nerve stimulation (TENS).
  • Injection of a corticosteroid into your shoulder joint.
  • Physical therapy or rehabilitation.
  • Surgery, either an open or arthroscopic procedure.

Frozen Shoulder

Treatment for a frozen shoulder may also include:

  • Gentle stretching exercises.
  • Hear to the area of your injury.
  • Medicines to help reduce swelling and pain, usually an anti-inflammatory such as aspirin or ibuprofen.
  • Using a TENS to provide electric stimulation of your muscles and nerves.
  • Injection of a corticosteroid drug into your shoulder.
  • Arthroscopic surgery to allow the doctor to manipulate the shoulder and remove adhesions in the joint.

Fracture

Treatment of a shoulder fracture may also include:

  • A doctor putting the bones into a position to promote healing.
  • A sling or other device to keep the bones in place.
  • After the bone heals, exercise or rehabilitation to strengthen the muscles and restore movement in the shoulder joint.
  • Surgery if the bones are out of position and the doctor cannot place them in the correct position.

Arthritis

Treatment of arthritis in the shoulder may also include:

  • Medicines to help reduce swelling and pain, usually an anti-inflammatory such as aspirin or ibuprofen.
  • Physical therapy.
  • Medications that are specific for the treatment of rheumatoid arthritis.

If you injure a shoulder, try the following:

  • Rest. Don’t use your shoulder for 48 hours
  • Ice. Put an ice pack on your injured shoulder for 20 minutes, four to eight times per day. You can use a:
    • Cold pack.
    • Ice bag.
    • Plastic bag filled with crushed ice wrapped in a towel.
  • Compression. Put even pressure or compression on the painful area to help reduce the swelling to your shoulder. A wrap or bandage will help hold your shoulder in place.
  • Elevation. If you are able, keep the injured area above the level of your heart. Using a pillow under your shoulder will help.

Research Progress

Research Progress Related to Shoulder Problems

Numerous studies are supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and other institutes of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH) to better understand shoulder problems and improve their treatment. The specific goals of those studies include:

  • Improving the results of surgery to repair shoulder injuries.
  • Exploring the role of possible biopsychosocial and genetic risk factors in which the development of chronic shoulder pain is likely to occur.
  • Developing and testing the effectiveness of biomechanically based rehabilitation strategies to improve upper extremity function and reduce pain in people with shoulder problems.
  • Identifying or developing agents (such as growth factors) that help the muscle and tendon repair process.
  • Better understanding the factors that lead to the progression of rotator cuff tears and using new materials and techniques to diagnose and manage rotator cuff tears clinically.
  • Using animal models for better understanding of the healing response after surgery to repair shoulder injuries, and for helping to determine the most effective postoperative activity protocol.

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