Overview of Shoulder Problems

What is the shoulder?

• bones - the collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus).

• joints - facilitate movement, including the following:
  • clavicle
    
    
  • acromioclavicular (AC) joint (where the clavicle meets the acromion)
    
    
  • shoulder joint (glenohumeral joint) - a ball-and-socket joint that facilitates forward, circular, and backward movement of the shoulder.

• ligaments - a white, shiny, flexible band of fibrous tissue that binds joints together and connects various bones and cartilage, including the following:
  • 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 coracoid process

• acromion - the roof (highest point) of the shoulder that is formed by a part of the scapula.

• tendons - the tough cords of tissue that connect muscles to bones. 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.

Different types of shoulder problems

Common shoulder problems include the following:

• 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).
  
  
• 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.
  
  
• bursitis
  Bursitis often occurs when tendonitis and impingement syndrome cause inflammation of the bursa sacs that protect the shoulder.
  
  
• impingement syndrome
  Impingement syndrome is caused by the excessive squeezing or rubbing of the rotator cuff and shoulder blade. The pain associated with the syndrome is a result of an inflamed bursa (lubricating sac) over the rotator cuff, and/or inflammation of the rotator cuff tendons, and/or calcium deposits in tendons due to wear and tear. Shoulder impingement syndrome can lead to a torn rotator cuff.
  
  
• tendonitis
  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 become trapped under the acromion.
  
  
• rotator cuff tear
  A rotator cuff tear involves one or more rotator cuff tendons becoming inflamed from overuse, aging, a fall on an outstretched hand, or a collision.
  
  
• adhesive capsulitis (frozen shoulder)
  Frozen shoulder is 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.
  
  
• fracture
  A fracture is a partial or total crack or break through a bone that usually occurs due to a impact injury.

What causes shoulder problems?

Degenerative conditions and other diseases in the body may also contribute to shoulder problems, or generate pain that travels along nerves to the shoulder.

Rotator Cuff Injury

What is rotator cuff injury?

The rotator cuff consists of muscles and tendons that hold the shoulder in place. It is one of the most important parts of the shoulder. The rotator cuff allows a person to lift his/her arms and reach up. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities. Rotator cuff tears are also due to aging.

What are the symptoms of a rotator cuff tear?

The following are the most common symptoms of a rotator cuff tear. However, each individual may experience symptoms differently. Symptoms may include:

• recurrent pain, especially with certain activities
• pain that prevents sleeping on the injured side
• grating or cracking sounds when moving the arm
• limited ability to move arm
• muscle weakness

The symptoms of a rotator cuff tear may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

What is painful arc syndrome?

Painful arc syndrome is a condition characterized by pain when a person lifts his/her arm between 45 and 160 degrees from the side of the body. The condition is caused by tendonitis or bursitis of the shoulder.

Shoulder Tendonitis

What is shoulder tendonitis?

Tendonitis of the shoulder is an inflammation of the rotator cuff and/or biceps tendon. Shoulder tendonitis is usually the result of a tendon being pinched by surrounding structures. Shoulder tendonitis often occurs in certain sports that require the arm to move over the head repeatedly, such as in baseball, weight lifting, racket sports, and certain swimming strokes. The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, also known as rotator cuff tendonitis, it may get trapped under the acromion (the roof, or highest point, of the shoulder that is formed by a part of the scapula, or shoulder blade).

What are the symptoms of shoulder tendonitis?

The following are the most common symptoms of shoulder tendonitis. However, each individual may experience symptoms differently. Symptoms may include:

• inability to hold arm in certain positions
• pain or tenderness in the shoulder

The symptoms of shoulder tendonitis may resemble other conditions or medical problems. Always consult a physician for a diagnosis.

How is shoulder tendonitis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for shoulder tendonitis may include an x-ray (a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film).

Shoulder Dislocation

What is dislocation of the shoulder?

Dislocation of the shoulder means the displacement of the upper arm bone (humerus) out of the shoulder joint. 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). The shoulder can dislocate in several ways, including the following:

• forward and downward dislocation - these are the most common types of dislocations, which are usually the result of falling on an outstretched hand or on the shoulder itself.
  
  
• backward dislocation - this type of dislocation may be caused by a direct blow to the front of the shoulder, or the violent twisting of the upper arm.

In addition, a shoulder can be partially dislocated (the head of the upper arm is partially out of the shoulder socket) or completely dislocated (the head of the upper arm is completely out of the shoulder socket).

A dislocation can result in a fracture of the upper arm bone. Other complications may include the following:

• nerve damage
• damage to an artery
• muscle damage

What are the symptoms of a shoulder dislocation?

The following are the most common symptoms of a dislocated shoulder. However, each individual may experience symptoms differently. Symptoms may include:

• pain in the upper arm and shoulder, which is usually worse during movement
• swelling
• numbness and weakness
• bruising
• deformity of the shoulder (in a forward dislocation)

The symptoms of a dislocated shoulder may resemble other conditions or medical problems. Always consult a physician for a diagnosis.

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