The shoulder is the most flexible joint in the body that enables a wide range of movements. Ageing, trauma or sports activities can cause injuries and disorders that can range from minor sprains or strains to severe shoulder trauma.
The shoulder joint is a ball and socket joint made up of three bones, namely the humerus, scapula, and clavicle. The head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade), which is called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones, enabling smooth movement. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.
Common Shoulder Disorders
Strains and Sprains
A sprain is the stretching or tearing of ligaments (tissues that connect adjacent bones in a joint). It is a common injury and usually occurs when you fall or suddenly twist your arm. A strain is the stretching or tearing of muscle or tendon (tissues that connect muscle to bone). It is common in those participating in sports.
Shoulder instability is a chronic condition that causes frequent dislocation of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (socket portion) of the shoulder. A partial dislocation is referred to as a subluxation.
Rotator Cuff Tear
A rotator cuff is a group of tendons in the shoulder joint that provides support and enables a wide range of motion. A major injury to these tendons may result in rotator cuff tears. It is one of the most common causes of shoulder pain in middle-aged and older individuals.
A bursa is a sac present between the acromion process and the rotator cuff. It contains a lubricating fluid that prevents friction between the moving rotator cuff and the acromion. Inflammation of the bursa that surrounds these tendons is called rotator cuff bursitis or shoulder bursitis.
Shoulder impingement is the inflammation of the tendons of the shoulder joint. Impingement results in the young and middle-aged who engage in physical activities that require repeated overhead arm movements. The pain may be due to bursitis (inflammation of the bursa) overlying the rotator cuff or inflammation of the cuff itself. In some circumstances, a partial tear of the rotator cuff may cause impingement pain.
Acromioclavicular (AC) Joint Osteoarthritis
Osteoarthritis also called degenerative joint disease, is the most common form of arthritis. It occurs most often in older people. AC joint osteoarthritis affects the tissue covering the ends of bones (cartilage) in the AC joint of the shoulder. The cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the AC joint.
A break in a bone that makes up the shoulder joint is called a shoulder fracture. The clavicle and end of the humerus closest to the shoulder are the bones that usually fracture. Clavicle and humerus fractures can occur by a direct hit from a motor vehicle accident, collision or fall. A fracture of the scapula can occur by high-energy trauma during an accident from a high-speed motor vehicle.
Frozen shoulder, also called adhesive capsulitis, is a condition in which you experience pain and stiffness in your shoulder. The shoulder joint is covered by a connective tissue capsule that is lined on the inside by a thin membrane called synovium. This lining produces a fluid that keeps the joint lubricated. Gradual thickening and tightening of this capsule restrict shoulder movement causing a frozen shoulder.
Bicep Tendon Rupture
The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones in your shoulder on one side and the elbow on the other side. Injury and overuse can cause fraying of the biceps tendon and eventual rupture. A biceps tendon rupture can either be partial, where it does not completely tear the tendon or complete, where the tendon completely splits in two and is torn away from the bone.
Symptoms of Shoulder Disorders
Symptoms vary depending on the type of shoulder disorder. Common symptoms include:
- Muscle cramping
- Catching or locking sensation
- Difficulty in lifting your arm
- Tenderness at the shoulder
- Hearing popping sound at the time of fracture
- Weakness with shoulder and elbow movements
Treatment of Shoulder Disorders
Treatment varies depending on the type of shoulder injury or disorder. Initially, nonsurgical treatment options may be recommended before considering surgery.
- Ice: Application of ice packs on the shoulder to decrease swelling and pain
- Activity Modification: Avoiding activities that trigger symptoms and changing lifestyles
- Physiotherapy: Regular exercise regimen to improve range of motion and strengthen shoulder muscles
- Anti-inflammatory Medication: Prescribed pain medications to relieve inflammation and pain
- Cortisone Injection: Cortisol is a hormone that is naturally produced in the human body and functions to reduce stress and inflammation. Steroids are synthetic drugs that resemble cortisol and are used in treating shoulder pain.
- Other techniques such as acupuncture, TENS, and ultrasound therapy may additionally be recommended.
Surgery may be required if you do not respond to non-surgical treatment options.
- Arthroscopy: Several shoulder conditions can be treated by arthroscopy. An arthroscope is a small, fibre-optic instrument consisting of a lens, light source, and video camera. The camera projects images of the inside of the joint onto a large monitor, allowing your surgeon to look for any damage, assess the type of injury and simultaneously repair it.
- Open Surgery: A traditional open surgery approach would require a large surgical incision to be made to repair the affected region if the injury is large and complex.