Shoulder injuries occur from athletic activities that involve repetitive, excessive, overhead motion, such as pitching baseball, tennis, swimming, and weightlifting. Injuries to the shoulder also happen from doing everyday activities, such as hanging curtains, washing walls, or lifting the laundry basket. The shoulder is a complex joint that connects with muscles and tendons to allow full range of motion of the arm.
The shoulder consists of the head of your upper arm bone (the humerus), your shoulder blade (the scapula), and your collarbone (the clavicle). The humerus fits into a round socket called the glenoid. The rotator cuff is a combination of tendons and muscles that keep your humerus in alignment.
The shoulder’s unique mobility leads to problems of impingement of the bony structures or the soft tissues as well as instability. With some shoulder injuries, you may only feel pain with movement of the joint. Others, however, result in pain at rest.
What are the types of shoulder injuries?
Most shoulder injuries fall into one of the four major categories: (1) tendon inflammation or tear; (2) instability; (3) arthritis; and (4) fracture.
Rotator Cuff Tears – The rotator cuff is one of the most significant structures of the shoulder. This component allows you to lift your arm and reach overhead. When your rotator cuff is injured, you will have loss of function of the shoulder.
Bursitis – A bursae is a small, fluid-filled sac that is located in the shoulder joint and other joints of the body. When the bursae is inflamed and swollen, there is loss of cushion between the bones and the overlying soft tissues that reduce the friction of the gliding motion. This condition is called bursitis, and it can cause the shoulder to have pain and loss of function.
Tendinitis – A tendon is a cordlike structure that connects muscle to bone. Tendinitis of the shoulder is the result of wearing down of the tendon from overuse. The acute form of tendinitis results from excessive throwing or other overhead activities during sporting activities or work. Chronic tendinitis is due to age, and there is degeneration of the tendon with this condition.
Tendon Tears – The tendon can split and tear from an acute injury or degenerative changes related to the aging process, long-term overuse and wear and tear, or from sudden trauma. Tendon tears can be partial or complete.
Impingement – Shoulder impingement is the result of the top of the shoulder blade putting pressure on the underlying soft tissues during arm lifting. The blade rubs on the bursa and rotator cuff causing limited movement and pain. If left untreated, severe impingement can result in rotator cuff tearing.
Instability – The shoulder is considered unstable when the head of the humerus is forced out of the socket. Instability occurs from sudden trauma or due to overuse of the joint. Dislocations can be partial (called subluxation), where the ball of the upper arm just partially comes out of socket. A complete dislocation is where the ball comes all of the way out of position. If the surrounding support structures are torn or loose, dislocations can occur repeatedly. Shoulder instability leads to increased risk of arthritis.
Arthritis – When there is wear and tear on a joint with inflammation, the joint is considered to have arthritis. Shoulder joint arthritis causes stiffness, decreased range of motion, crepitus, and pain. This type of injury is more common among older people.
Fracture – A fracture is a broken bone. Shoulder trauma can result in a fracture of the humerus, the clavicle, or the scapula, and this causes severe pain, bruising, and swelling of the shoulder.
What can I expect at the doctor’s examination?
If you have a shoulder injury, you should seek medical attention immediately. I will conduct a thorough evaluation in order to determine the cause of your shoulder pain and offer prompt treatment. During the physical examination, I inspect your shoulder for physical abnormalities, deformity, muscle weakness, tender areas, and swelling.
It is also necessary for me to assess your joint range of motion and strength. To properly evaluate your injury, I will take X-rays and possibly order a MRI, CT scan, and/or ultrasound. An arthroscopy is a surgical procedure where I look inside the joint with a tiny camera to evaluate the extent of the injury. This may be necessary for repair and diagnosis of certain shoulder injuries that are complex.
What is the treatment for shoulder injury?
The treatment of your shoulder injury depends on the type of injury. Some of the various options that I utilize include:
Activity Changes – Treatment typically involves alteration of your activities and rest so your shoulder can regain strength and flexibility.
Physical Therapy – Certain types of shoulder injuries require physical therapy. This treatment involves exercises and range of motion techniques that help you regain strength and motion of the shoulder joint.
Medications – I often prescribe certain medications to reduce inflammation and pain. Also, specific shoulder injuries require injections of anesthetics or steroids.
Surgery – While some shoulder injuries respond to conventional treatment modalities, others require surgical correction and intervention. Rotator cuff tears and recurring dislocations often require surgery. I also perform arthroscopic procedures to remove scar tissue and repair torn tissues for some shoulder injuries.
