Shoulder Injuries

Shoulder Injuries and Conditions

Most shoulder pain involves muscles, ligaments, cartilage and tendons. Athletes and workers are especially susceptible to problems involving both shoulder blade pain and shoulder joint pain.

Let’s look at some of the causes of shoulder pain.

Rotator Cuff Tears

The rotator cuff is a group of muscles and tendons that surround the shoulder joint that keeps the ball of the upper arm bone firmly within the socket of the shoulder and tendons that surround the shoulder joint. People who repeatedly perform overhead motions in their jobs or sports are more likely to sustain rotator cuff injuries.

Diagnosis And Symptoms Of A Rotator Cuff Tear

The pain associated with a rotator cuff tear is often described as a dull ached deep inside the shoulder. It may also cause weakness in the arm and create problems trying to reach behind your back or overhead. The pain can disturb sleep when lying on the shoulder.

Shoulder Impingement / Rotator Cuff Tendinitis

Young athletes and middle-aged people are more likely to experience rotator cuff pain. Athletes that are especially vulnerable are those who use their arms overhead for sports such as baseball, tennis and swimming. Workers who do repetitive lifting or overhead activities using the arm such as painting, electricians, ceiling fixers etc are also at risk.

Diagnosing Rotator Cuff / Impingement

There is usually tenderness in the front of the shoulder or the midpoint of the arm. Lifting the arm could also cause shoulder pain and stiffness. Pain at night and difficulty sleeping are also problems associated with rotator cuff pain.

Onset symptoms may be mild, and patients usually do not seek treatment at an early stage. These symptoms may include pain radiating to the side of the arm from the front of the shoulder, sudden pain when reaching, minor pain both while resting and with activity for athletes, shoulder pain can be more common when throwing a ball.

Dislocated Shoulder / Shoulder Instability

The body’s most mobile joint is the shoulder, making it vulnerable to dislocation. An injury in which your upper arm pops out of its socket defines a dislocated shoulder. Common complications associated with a dislocated shoulder are labral tears or Bankart lesions.

Diagnosis And Symptoms Of A Dislocated Shoulder

Shoulder dislocations can cause weakness, numbness or tingling near the injury, for example down your arm or in your neck. The intensity of pain might increase if the muscles in your shoulder spasm from the disruption. Symptoms of a dislocated shoulder may include the obvious visibly out of place shoulder, intense pain and inability to move the joint.

Dislocated Shoulder Treatment Option

Treatment options for a dislocated shoulder may involve closed reduction, immobilizations, medication, rehabilitation or surgery.

SLAP Tear

SLAP is an acronym for Superior labrum Anterior and Posterior. The top part of the labrum is injured in a SLAP injury. The biceps tendon attaches to the labrum in this top area (superior). Both in the front (anterior) and back (posterior) of this attachment point is where a SLAP tear occurs. Sometimes the biceps tendon is involved in the injury as well. SLAP tears are common in athletes who throw overhead such as baseball and tennis players.

Diagnosis And Symptoms For A SLAP Tear

Commonly, the symptoms of a SLAP tear are similar to many other shoulder problems. They include a decreased range of motion, a sensation of grinding, popping or locking and pain with lifting or movement, especially lifting overhead or holding the shoulder in specific positions.

SLAP Tear Treatment Options

The initial treatment for a SLAP injury in nonsurgical in many cases. Treatment options may include medication or manual therapy. If your pain does not improve with these methods your chiropractor may recommend shoulder arthroscopy.

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder is characterised by stiffness and pain in your shoulder joint. It is also known as adhesive capsulitis. Symptoms typically begin slowly and worsen over time. In time (possibly 2 years) it can resolve by itself.

Diagnosis And Symptoms Of Frozen Shoulder

There are 3 stages of frozen shoulder that can last many months and typically its development is slow.

1. Freezing/inflammatory stage: Shoulder’s range of motion starts to become limited during this stage, and pain occurs with any movement of the shoulder.
2. Adhesive/Frozen stage: Although pain may begin to decrease during this stage, the shoulder becomes stiffer, and range of motion diminishes greatly.
3. Thawing stage: Shoulder’s range of motion begins to improve during this stage.

Frozen Shoulder (Adhesive Capsulitis) Treatment Options

The goal of frozen shoulder treatments is to regain as much range of motion in the shoulder as possible as well as to control pain.

Shoulder Arthritis (Shoulder Osteoarthritis)

Osteoarthritis is a condition in which the smooth outer covering (articular cartilage) of bone wears down over time. It is also known as “wear-and-tear” arthritis. The cartilage becomes frayed and rough as it wears away, and the protective space between the bones decreases, eventually the bones of the joint rub against each other during any movement causing pain.

Diagnosis And Symptoms of shoulder arthritis (shoulder osteoarthritis)

Aggravated by activity, the most common symptom of arthritis of the shoulder is pain. There is usually a limited range of motion and painful grinding or clicking can be felt or heard upon shoulder movement. Pain at night is also common, particularly when lying on the affected side.

Treatments for Common Shoulder Injuries & Conditions

The best remedy for preventing serious shoulder injuries is early detection. An orthopaedic surgeon will often prescribe a series of exercises aimed at strengthening the shoulder muscles. Other treatment may include the prescription of anti-inflammatory medication to reduce pain and swelling. When these treatments are not sufficient, surgery may be an option.

Shoulder Arthroscopy

Orthopaedic surgeons perform arthroscopy to inspect, diagnose, and repair problems inside a joint. It can be used to perform a rotator cuff repair, SLAP repair, subacromial decompression, etc. A small camera, called an arthroscope, is inserted into your shoulder joint. The images are used by your surgeon to guide miniature surgical instruments. The benefit is that your surgeon can use very small incisions, rather than the larger incision needed for standard, open surgery, due to the thinness of the arthroscope and surgical instruments. This shortens the time it takes to recover, results in less pain for patients, and is more cosmetically pleasing.

Rotator Cuff Tear Nonsurgical Treatments and Arthroscopic Rotator Cuff Repair

Often nonsurgical treatments that include rest, ice and physical therapy are all that is needed for a rotator cuff tear. Sometimes your doctor might suggest a steroid injection as well. However, if the injury is severe and involves a complete tear of the muscle or tendon, a surgical repair may be required.

Surgical options may include a bone spur removal using arthroscopy, where a fiber-optic camera and tools are inserted through very small incisions; a tendon repair or replacement; or in severe cases, a shoulder replacement, known as reverse shoulder arthroplasty.

Shoulder Impingement/Rotator Cuff Tendinitis Nonsurgical Treatments and Arthroscopic Subacromial Decompression

Initial treatment is nonsurgical in most cases. Your doctor may suggest rest, medicine, physical therapy, or a steroid injection. Many patients experience a gradual improvement and return to normal activity, although this option may take several weeks to months.

When nonsurgical treatment does not relieve pain, surgery may be an option. Your doctor may remove part of the acromion. This is known as a subacromial decompression. This procedure can be performed by shoulder arthroscopy, where minimally invasive surgical instruments are inserted into one-centimeter incisions around your shoulder. Your doctor examines your shoulder through a fiber-optic camera.

Dislocated Shoulder/Shoulder Instability Nonsurgical Treatments and Arthroscopic Capsulorrhaphy

Through a process called “closed reduction,” the doctor will place the ball of the upper arm bone (humerus) back into the joint socket. Once the shoulder joint is back in place, severe shoulder pain stops almost immediately.

Surgical options for shoulder instability include arthroscopic capsulorrhaphy, which utilizes sutures or suture anchors to repair the torn tissue, alleviating instability symptoms.

SLAP Tear Nonsurgical Treatments and Arthroscopic SLAP Repair

Usually, the initial treatment for a SLAP injury is nonsurgical. Treatment options may include non-steroidal anti-inflammatory medication to reduce pain and swelling and physical therapy to strengthen the shoulder.

Your doctor may recommend surgery if your pain does not improve. Shoulder arthroscopy is the surgical technique most used for repairing a SLAP injury. Your surgeon inserts into your shoulder joint a small camera, and then uses the images to guide miniature surgical instruments. Because the surgical instruments are thin, your surgeon can use very small incisions, rather than the larger incision needed for standard, open surgery.

Frozen Shoulder (Adhesive Capsulitis) Nonsurgical Treatments and Arthroscopic Capsular Release

Treatments can include medications, therapy, steroid injections, shoulder manipulation and surgery.

Over-the-counter pain relievers can help reduce frozen shoulder pain. In some cases, your doctor may prescribe stronger medication or administer a steroid injection. A physical therapist can also assist with frozen shoulder exercises to help regain mobility in the shoulder.

If physical therapy does not resolve the problem, your surgeon may recommend a manipulation under anesthesia and/or shoulder arthroscopy (arthroscopic capsular release). During a manipulation under anesthesia, you are briefly put to sleep. Your surgeon will gently manipulate your shoulder, causing the capsule and scar tissue to stretch, thereby increasing your range of motion. In the shoulder arthroscopy method, the surgeon releases the joint capsule with minimally invasive instruments, allowing the capsule to expand and regain motion.

Shoulder Arthritis (Shoulder Osteoarthritis) Nonsurgical Treatments and Shoulder Replacement

Initial treatment of arthritis of the shoulder is nonsurgical. Your doctor may recommend treatment options that include rest, physical therapy, medication, or corticosteroid injections.

If these treatments do not work, surgery may be an option. Shoulder arthroscopy is a procedure where your surgeon inserts a small camera into the shoulder joint to release adhesions and repair tissue that has been torn or is causing arthritis symptoms.

Advanced arthritis is treated with shoulder joint replacement known as arthroplasty. In this procedure, the arthritic parts of the shoulder are removed, and the ball-and-socket joint is replaced with a prosthesis.

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