Shoulder Pain and Problems
What is the shoulder?
The shoulder is made up of several layers, including:
- bones - the collarbone (clavicle), the shoulder blade (scapula), and
the upper arm bone (humerus)
- the joints that facilitate movement include:
- the acromioclavicular (AC) joint where the clavicle meets the acromion
- the shoulder joint (glenohumeral joint) - a ball-and-socket joint that facilitates
forward, circular, and backward movement of the shoulder
- ligaments - the soft tissue structures that connect bones to bones,
including:
- joint capsule - a group of ligaments that connect the humerus to the socket of the
shoulder joint on the scapula to stabilize the shoulder and keep it from dislocating
- ligaments that attach the clavicle to the acromion
- ligaments that connect the clavicle to the scapula by attaching to the corocoid process
- acromion - the roof (highest point) of the shoulder that is formed by a
part of the scapula
- tendons - soft tissue structures that attach muscles to bone. The
rotator cuff tendons are a group of tendons that connect the deepest layer of muscles to
the humerus.
- muscles - to help support and rotate the shoulder in many directions
- bursa - a closed space between two moving surfaces that has a small
amount of lubricating fluid inside; located between the rotator cuff muscle layer and the
outer layer of large bulky muscles
- rotator cuff - composed of tendons, the rotator cuff and associated
muscles holds the ball of the glenohumeral joint at the top of the upper arm bone
(humerus)
Shoulder pain may be localized in a specific area or may spread to areas
around the shoulder or down the arm.
What are some of the different types of shoulder problems?
Common shoulder problems include:
Dislocation - The shoulder
joint is the most frequently dislocated major joint of the body -- often caused by a
significant force that separates the shoulder joint's ball (the top rounded portion of the
upper arm bone, or humerus) away from the joint's socket (glenoid).
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Separation - The shoulder
becomes separated when the ligaments attached to the collarbone (clavicle) are torn or
partially torn away from the shoulder blade (scapula). Shoulder separation may be caused
by a sudden, forceful blow to the shoulder or as a result of a fall.
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Bursitis often occurs when
tendonitis and impingement syndrome cause inflammation of the bursa sacs that protect the
shoulder.
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Impingement syndrome
is caused by the squeezing of the rotator cuff.
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Tendonitis of the shoulder is
caused when the rotator cuff and/or biceps tendon become inflamed, usually as a result of
being pinched by surrounding structures. The injury may vary from mild inflammation to
involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and
thickened, it may get trapped under the acromion.
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Rotator cuff tear - one
or more rotator cuff tendons becomes inflamed from overuse, aging, a fall on an
outstretched hand, or a collision.
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Adhesive
capsulitis (frozen shoulder) - a severely restrictive condition frequently
caused by injury that, in turn, leads to lack of use due to pain. Intermittent periods of
use may cause inflammation and adhesions to grow between the joint surfaces, thus,
restricting motion. There is also a lack of synovial fluid to lubricate the gap between
the arm bone and socket that normally helps the shoulder joint to move. This restricted
space between the capsule and ball of the humerus distinguishes adhesive capsulitis from
the less complicated condition known as stiff shoulder.
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Fracture - a partial or total
crack or break through a bone that usually occurs due to a impact injury.
What causes shoulder problems?
Although the shoulder is the most movable joint in the body, it is also an
unstable joint because of its range of motion. Because the ball of the upper arm is larger
than the socket of the shoulder, it is susceptible to injury. The shoulder joint must
also be supported by soft tissues -- muscles, tendons, and ligaments, which are also
subject to injury, overuse, and under use.
Degenerative conditions and other diseases in the body may also contribute to shoulder
problems, or generate pain that travels along nerves to the shoulder.
How are shoulder problems diagnosed?
In addition to a complete medical history, diagnostic procedures may
include:
- physical examination - to determine range of motion, location of pain,
and level of joint instability/stability
- imaging procedures, such as:
- arthrogram - a test in which dye is injected into the shoulder joint
and x-rays are taken to outline structures of the shoulder. When the fluid leaks into an
area that it does not belong, disease or injury may be considered, as a leak would provide
evidence of a tear, opening, or blockage.
- MRI (magnetic resonance imaging) scan - a non-invasive procedure that
produces cross-sectional images of the shoulder
- CT scan (computerized tomography) - cross-sectional
images of the body (shoulder) that show great detail
- electromyogram (EMG) - an electric test that may show the presence of
nerve damage
- ultrasound - provides images of the soft tissues that support the
shoulder without the use of radiation
- laboratory tests - to determine if other problems may be the cause
- arthroscopy - to look into the shoulder joint with an arthroscope, a
small camera inserted into the shoulder joint to make a diagnosis, and possibly to treat
the problem. The procedure usually requires general anesthesia and is performed in the
operating room.
Treatment of shoulder problems:
Specific treatment will be determined by your physician(s) based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Treatment may include:
- activity modification
- rest
- physical therapy
- medications
- surgery
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