Shoulder Pain

The Shoulder

The shoulder is a complex joint formed from a variety of bones, muscles, ligaments, tendons, and nerves. Offering a wide range of motion and significant flexibility, we use our shoulders for a myriad of day-to-day activities. For active individuals, like baseball, tennis, or volleyball players, shoulders are utilized even more, making the intricate structures within the joint susceptible to injury. Some prominent structures within the joint include:

  • Humerus: upper arm bone
  • Scapula: shoulder blade
  • Clavicle: collarbone
  • Rotator cuff: collection of muscles and tendons that surround the joint
  • Bursa: small sac of fluid that protects the rotator cuff’s tendons
  • Labrum: cup of cartilage that encircles the humerus to help keep the “ball” in place

The shoulder is a ball-and-socket joint, with the top the humerus or “ball” fitting into the scapula or “socket.”

Common Shoulder Conditions

The labrum is a cup-shaped ring of cartilage that keeps the ball of the shoulder in place. This structure contributes to shoulder stability, so when torn, it can lead to a partial or complete shoulder dislocation and a considerable amount of pain. Along with dislocation, a torn shoulder labrum may result in a catching or locking sensation when moving. There are two different kinds of labral tears:

  • SLAP tear: also known as superior labrum from anterior to posterior tear, and is a type of tear that starts at the upper arm and extends to the back
  • Bankart tear: usually occurs during a shoulder dislocation when the ball slips out of the socket and tears the lower portion of the labrum

Labral tears often occur due to repetitive overhead motions during sports such as volleyball or tennis, but they may also develop as a result of the natural aging process. Oftentimes, surgical intervention is required to restore previous function and mobility.

The rotator cuff is a group of muscles and tendons that cover the head of the humerus, forming a cuff to keep the arm in its socket. Enabling a wide range of mobility, the rotator cuff allows you to rotate your shoulder and lift your arm. In a rotator cuff tear, the muscles and tendons can be torn in two ways:

  • Partial-thickness tear: when one or more of the tendons is damaged
  • Full-thickness tear: when one or more of the tendons is entirely severed from the bone

These tears may result from a sudden movement, such as lifting something too heavy, or they may occur gradually over time, either due to old age, repetitive stress, or lack of blood supply. Although partial-thickness tears may be healed with physical therapy, more severe tears may require surgery. Your orthopedic specialist at Comprehensive Medical Care may recommend surgery if your symptoms have persisted for over six months, if the tear is larger than three centimeters, if you are a competitive athlete, or if there is a significant loss of shoulder function.

Tendonitis occurs when the tendons in the shoulder become inflamed or irritated. This condition may arise from repetitive use, a sports injury, or sudden trauma. Sometimes, tendonitis may occur from being pinched by nearby structures. The primary symptom of tendonitis is pain at the site of the injured tendon, either chronic or bouts of acute pain. Other symptoms may include:

  • Soreness
  • Limited range of motion
  • Swelling
  • Redness

Typically, shoulder tendonitis can be treated with physical therapy and RICE: rest, ice, elevation, and compression. In severe cases, surgery is able to realign tendons or remove bone spurs that may be rubbing against the tendons.

A frozen shoulder, also known as adhesive capsulitis, occurs when the connective tissues in your shoulder thicken around the joint. As a result of the swelling, scar tissue often forms, which causes pain and restricts movement in the shoulder. This condition usually develops due to the joint’s immobilization for an extended period of time, and it has three stages:

  1. Freezing: for one to nine months, pain gradually worsens as mobility decreases
  2. Frozen: for four to six months, pain may improve, yet stiffness persists
  3. Thawing: for six months to two years, shoulder mobility progressively increases

Frozen shoulders are typically treated with physical therapy and NSAID pain medications to relieve inflammation and restore joint flexibility. If nonsurgical intervention is unsuccessful, your orthopedic specialist may suggest surgical treatment.

A shoulder dislocation occurs when the head of the humerus slips out of its normal position in the shoulder blade; essentially, the ball falls out of its socket. A dislocation can occur in two different ways:

  • Anterior dislocation: forward and downward dislocation, often results from falling on an outstretched hand
  • Posterior dislocation: backward dislocation, often from a direct blow or twisting of the upper arm

This type of condition can cause considerable pain, swelling, weakness, bruising, and a shoulder deformity. To treat a shoulder dislocation, your team at Comprehensive Medical Care will move the joint back into its place. Following this procedure, also known as a reduction, you will need to immobilize your shoulder with a sling and complete rehabilitation exercises to restrengthen the joint.

There are two main types of arthritis that affect the shoulder:

  • Osteoarthritis: degenerative joint disease, most often experienced in adults over 50
  • Rheumatoid arthritis: joint inflammation caused by an autoimmune disease

Shoulder pain due to arthritis sometimes may call for a shoulder replacement to restore strength, mobility, and function. In a shoulder replacement procedure, the arthritic parts of the shoulder are replaced with artificial implants.

Treatments for Shoulder Conditions

There are numerous nonsurgical treatment options to alleviate the above shoulder conditions. Among the most common treatments are:

  • Rehabilitation
  • Heat therapy
  • Regenerative medicines
  • RICE: Rest, Ice, Compression, and Elevation
  • Corticosteroid injections
  • Over-the-counter pain relievers
  • Anti-inflammatory medications

Only when these conservative options have not been successful at relieving your pain will your team at Comprehensive Medical Care then recommend surgical intervention. What type of surgery you receive will greatly depend on the severity of your condition, the presence of other injuries, and the location of your pain. Some shoulder surgeries that you may undergo for your shoulder condition are:

  • Rotator cuff repair: open repair, mini-open repair, or arthroscopic repair
  • Frozen shoulder arthroscopy
  • Shoulder replacement
  • Biceps tendon surgery
  • AC joint reconstruction
  • Labral repairs: SLAP repair or bankart repair
  • Shoulder dislocation arthroscopy