Shoulder Injuries & Conditions
Your shoulders are the joints where your upper-arm bones (humerus), shoulder blades (scapula), and collarbone (clavicle) meet. The humerus fits into the rounded socket of the scapula on each side of your body. Each shoulder is held in place by a group of four muscles and tendons, called a rotator cuff, which covers and protects the humerus and lets you raise and move your arm.
Pain in your shoulder can have many causes. You might injure it in a fall or accident, or you could have overdone a chore like painting. Sometimes shoulder pain comes from a condition like arthritis. It can even stem from problems in other parts of your body, which is called referred pain.
At Aptiva Health, we offer same-day and walk-in appointments for shoulder injuries and conditions to evaluate, diagnose, and make the appropriate referral for additional treatment based upon your specific shoulder injury or condition. We treat these conditions in our General Medicine, Orthopedics, Sports Medicine, Pain Management, and Physical Therapy departments.
Symptoms
Ask yourself some questions to help you decide if you have a shoulder injury:
Can you move your arm normally, or is your shoulder too stiff or painful?
Do you feel like your shoulder could pop out of the socket?
Is your shoulder strong enough for things you normally do?
You can treat some shoulder injuries at home for a few days with rest and ice. You can bandage it to hold it in place if necessary, and elevate it above the heart. But some injuries need professional help. Here are signs that you need to see a doctor right away:
Your shoulder joint looks deformed.
You can’t use your shoulder at all.
The pain is intense.
The shoulder is swelling suddenly.
Your arm or hand is weak or numb.
Common Injuries & Conditions
Rotator cuff tear. Your rotator cuff is the group of muscles and tendons in your shoulder that hold your arm in place and let you lift your arm up overhead. You can damage it through overuse or in a fall. It also begins to show wear and tear as you age. Your shoulder may hurt at night and when you try to lift things. You might hear a crackling sound when you move it.
Shoulder Labrum (SLAP) Tear. The shoulder labrum is a ring of cartilage around the shoulder socket that stabilizes the head of the upper arm bone. A SLAP tear or lesion occurs when there is damage to the top of the labrum, or where the biceps tendon connects to the labrum. SLAP is an acronym that stands for Superior (topmost) Labral tear from Anterior (front) to Posterior (back). A SLAP tear is a torn piece of cartilage in the inner portion of the shoulder joint. It can be painful and/or limit movement in the shoulder, especially overhead motions.
Impingement. This happens when the tendons of the rotator cuff get pinched in the bones of the shoulder. It can cause swelling and pain. If you lift your arms over your head a lot, it can set this off.
Bursitis. The bursa (a fluid-filled sac that cushions in your joint) can get swollen and irritated if you repeat the same motions over and over again. But it can also be caused by a fall or another injury. If you have bursitis, you may notice the pain most when you move your shoulder.
Tendinitis. This is when the tendons that make up your rotator cuff get inflamed. It can happen slowly over time or as the result of a fall or a direct hit to your shoulder.
Bone spurs. Also known as “osteophytes,” these small, smooth pieces of bone rub up against and wear on your rotator cuff and keep your shoulder from moving the way it should. They can lead to tendinitis or a rotator cuff tear.
Dislocation. If your shoulder is pulled back too hard or rotated too far, the top of your arm might pop out of its socket. You will feel pain and weakness in your shoulder. You may also have swelling, numbness and bruising.
Separation. This injury affects the joint where your collarbone and shoulder blade come together. It’s called the acromioclavicular (AC) joint. A fall or hard blow tears the ligaments holding it together. If your collarbone gets pushed out of place, you’ll have a bump on top of your shoulder.
Fracture. A bone can break or crack if you fall or take a hard hit. The most common breaks are to the clavicle (collarbone) and the humerus (arm bone closest to your shoulder). You’ll have a lot of pain and it may bruise. If your collarbone is broken, your shoulder can sag and you might not be able to lift your arm.
Frozen shoulder. This condition limits how much your joint will move. Abnormal bands of tissue (adhesions) build up in the joint and keep your shoulder from moving freely. Your shoulder might “freeze” because pain or surgery have made you use it less, allowing the adhesions to build up.
Biceps tendon tear. Biceps tendon tears can be either partial or complete.
Partial tears. Many tears do not completely sever the tendon.
Complete tears. A complete tear will split the tendon into two pieces.
In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes when lifting a heavy object. The long head of the biceps tendon is more likely to be injured. This is because it is vulnerable as it travels through the shoulder joint to its attachment point in the socket. Fortunately, the biceps has two attachments at the shoulder. The short head of the biceps rarely tears. Because of this second attachment, many people can still use their biceps even after a complete tear of the long head. When you tear your biceps tendon, you can also damage other parts of your shoulder, such as the rotator cuff tendons.
Shoulder Arthritis. There are five major types of arthritis typically affect the shoulder.
Osteoarthritis
Also known as "wear-and-tear" arthritis, osteoarthritis is a condition that destroys the smooth outer covering (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing pain.
Osteoarthritis usually affects people over 50 years of age and is more common in the acromioclavicular joint than in the glenohumeral shoulder joint.
Posttraumatic Arthritis
Posttraumatic arthritis is a form of osteoarthritis that develops after an injury, such as a fracture or dislocation of the shoulder.
Rotator Cuff Tear Arthropathy
Arthritis can also develop after a large, long-standing rotator cuff tendon tear. The torn rotator cuff can no longer hold the head of the humerus in the glenoid socket, and the humerus can move upward and rub against the acromion. This can damage the surfaces of the bones, causing arthritis to develop.
The combination of a large rotator cuff tear and advanced arthritis can lead to severe pain and weakness, and the patient may not be able to lift the arm away from the side.
Avascular Necrosis
Avascular necrosis (AVN) of the shoulder is a painful condition that occurs when the blood supply to the head of the humerus is disrupted. Because bone cells die without a blood supply, AVN can ultimately lead to destruction of the shoulder joint and arthritis.
Avascular necrosis develops in stages. As it progresses, the dead bone gradually collapses, which damages the articular cartilage covering the bone and leads to arthritis. At first, AVN affects only the head of the humerus, but as AVN progresses, the collapsed head of the humerus can damage the glenoid socket.
Causes of AVN include high dose steroid use, heavy alcohol consumption, sickle cell disease, and traumatic injury, such as fractures of the shoulder. In some cases, no cause can be identified; this is referred to as idiopathic AVN.
Diagnosis
Your orthopedic specialist at Aptiva Health will start with a physical exam to check for any structural problems and rule out anything that might involve your spine or neck.
Next, they will test your range of motion to measure the strength and flexibility of your shoulder. This process will involve moving your arms in various ways (like above your head, across your body, or behind you, and rotating it 90 or 180 degrees).
Your doctor also might recommend one or more imaging tests to get a closer look:
X-rays. These can help your doctor find bone spurs, arthritis, and other bone-related causes of your shoulder pain. Your doctor may also recommend an arthrogram, which involves a shot of dye to make the details show up more clearly.
Magnetic resonance imaging (MRI) scan. This uses radio waves and a powerful magnet to make detailed images of your shoulder.
Computerized tomography (CT) scan. This is a series of X-rays taken from different angles. When they’re put together, they can give your doctor a better look at what’s happening with your shoulder.
Electromyography (EMG). This measures the electrical activity in your muscles to see if there are any problems with your nerves.
Arthroscopy. This is a surgical procedure that lets a tiny fiber-optic camera show your doctor high-definition images of your shoulder. In some cases, your doctor may also be able to treat the problem during the procedure.
Treatment
For dislocations, separations and fractures, your orthopedic specialist will determine whether setting the shoulder is the best treatment pathway following a thorough examination or whether surgical intervention is necessitated based on the severity of the dislocation, separation or fracture.
For many other issues that cause shoulder pain, your orthopedist may suggest rest, heat or ice and a medicine like ibuprofen or aspirin to reduce the pain and swelling. Additionally, your orthopedist may start you out on a physical therapy regimen to see if symptoms approve.
If your shoulder doesn’t improve after these first steps, your orthopedist may try injecting a corticosteroid (an anti-inflammatory medicine) into the joint to relieve swelling and pain. Your orthopedist may also discuss other types of injections as well to relieve swelling and pain in the shoulder.
Sometimes cartilage tears, rotator cuff tears, impingement, bursitis, frozen shoulder, and end-state shoulder arthritis do not improve with rest and medicine. In these instances, your orthopedic surgeon may recommend surgical intervention after exhausting conservative treatment measures.
With any problem in your shoulder, your treatment plan will include exercises to help you stretch and strengthen the joint, and to improve your range of motion.