Dr. Bassem Elhassan, Co-Chief of the Shoulder Service, has created many surgical techniques throughout his career. When a patient came to him after a serious 4-wheeler accident, Dr. Elhassan used a muscle transfer technique to reduce the patient's pain and help him regain mobility in his shoulder.
Shoulder Pain and Problems
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Shoulder Pain and Problems
What are shoulder problems?
Shoulder pain and problems are common. There are many types of shoulder problems that are caused by injuries and sudden (acute) or long-lasting (chronic) inflammation of the shoulder joint. The shoulder is a complex joint that has great mobility. This ability to move also increases the chances that it can be injured.
The shoulder is made up of several layers, including the following:
Bones. The collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus).
Joints. These help with movement, including the following:
Sternoclavicular joint (where the clavicle meets the sternum)
Acromioclavicular (AC) joint (where the clavicle meets the acromion)
Shoulder joint (glenohumeral joint). A ball-and-socket joint that aids forward, circular, and backward movement of the shoulder.
Ligaments. A white, shiny, flexible band of fibrous tissue that binds joints together and connects bones and cartilage, including the following:
Joint capsule. A group of ligaments that connect the humerus to the socket of the shoulder joint on the scapula to stabilize the shoulder and keep it from dislocating.
Ligaments that attach the clavicle to the acromion
Ligaments that connect the clavicle to the scapula by attaching to the coracoid process
Acromion. The highest point (roof) of the shoulder that is formed by a part of the scapula.
Tendons. The tough cords of tissue that connect muscles to bones. The rotator cuff tendons are a group of tendons that connect the deepest layer of muscles to the humerus.
Muscles. These help support and rotate the shoulder in many directions.
Bursa. A closed space between 2 moving surfaces that has a small amount of lubricating fluid inside. It is located between the rotator cuff muscle layer and the outer layer of large, bulky muscles.
Rotator cuff. Made up of tendons, the rotator cuff (and related muscles) holds the ball of the glenohumeral joint at the top of the upper arm bone (humerus).
What causes shoulder problems?
The shoulder is the most movable joint in the body. But it is also an unstable joint because of its range of motion. Because the ball of the upper arm is larger than the socket of the shoulder, it is at risk of injury. The shoulder joint is supported by soft tissues. These are the muscles, tendons, and ligaments. They are also subject to injury, overuse, and degeneration.
Progressive diseases that break down tissues in the body over time may also play a role in shoulder problems. Or they may cause pain that travels along nerves to the shoulder.
Common causes of shoulder problems include the following:
Dislocation. The shoulder joint is the most often dislocated major joint of the body. This is often caused by a strong force that separates the shoulder joint's ball away from the joint's socket. The ball is the top rounded part of the upper arm bone (humerus). The socket is called the glenoid.
Separation. The AC joint becomes separated when the ligaments attached to the collarbone (clavicle) are torn, or partly torn, away from the shoulder blade (scapula). Shoulder separation may be caused by a strong blow to the shoulder or a fall.
Bursitis. Bursitis often occurs when tendonitis and impingement syndrome cause inflammation of the bursa sac that protects the shoulder.
Impingement syndrome. This is caused by the excessive squeezing or rubbing of the rotator cuff and shoulder blade. The pain is from an inflamed bursa (lubricating sac) over the rotator cuff. Or it may be due to inflammation of the rotator cuff tendons. And it may be due to calcium deposits in tendons due to wear and tear. Impingement syndrome can lead to a torn rotator cuff.
Tendinosis. Tendinosis of the shoulder is caused when the rotator cuff or biceps tendon become worn out and inflamed. This is often a result of being pinched by nearby tissues. The injury may vary from mild inflammation to most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may become trapped under the acromion.
Rotator cuff tear. A rotator cuff tear involves 1 or more rotator cuff tendons becoming inflamed and torn from overuse, aging, a fall on an outstretched hand, or a collision.
Adhesive capsulitis (frozen shoulder). This condition is often caused by injury that leads to lack of use due to pain. Not enough use may cause inflammation and scar tissue to grow between the joint surfaces. This further limits motion. There is also a lack of synovial fluid to lubricate the gap between the arm bone and socket. This fluid normally helps the shoulder joint to move.
Fracture. A fracture is a partial or total crack or break through a bone. It often occurs due to an impact injury.
What are the symptoms of shoulder problems?
Shoulder pain may be only in 1 area. Or it may spread to areas around the shoulder or down the arm. The location and type of symptoms depend on the injury or the location of the inflammation. Below are symptoms of some common shoulder problems.
A rotator cuff injury will often cause pain in the front or outside of the shoulder. The pain gets worse when you raise your arm or try to lift an object over your head. Rotator cuff pain can be severe. It can make even simple tasks impossible and wake you up at night.
If you have shoulder instability, pain can start suddenly, for example, just as you throw a ball. You may have numbness all the way down your arm. If the instability happens slowly, you may have mild pain only at certain times. Your shoulder might feel weak, sore when you move it, or “loose” in your joint. Shoulder instability is different than a shoulder dislocation.
The symptoms of a dislocated shoulder include intense pain, inability to move the joint, a visibly out of place shoulder, and swelling or bruising. The dislocation can cause numbness, tingling, or weakness near the injury or down your arm. A dislocated shoulder requires immediate medical care.
If shoulder pain is caused by inflammation, such as bursitis, it may feel stiff, achy, and hurt more when you move it. Sometimes it can look swollen or red.
How are shoulder problems diagnosed?
A healthcare provider will ask about health history. They will give you a physical exam. The exam is to look at the range of motion, area of pain, and level of joint stability. You may have tests such as:
X-ray. This imaging test uses a small amount of radiation to make images of tissues, bones, and organs onto film.
MRI. This imaging test uses large magnets, radio waves, and a computer to make detailed images of tissues in the body. It can often find damage or disease in and around ligament, tendon, or muscle.
CT scan. This imaging test uses a series of X-rays and a computer to make horizontal images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Electromyogram (EMG). This is a test to evaluate nerve and muscle function.
Ultrasound. This imaging test uses high-frequency sound waves to create an image of the internal organs.
Laboratory tests. These can help to figure out if other problems may be the cause.
Arthroscopy. This is a minimally invasive procedure used for joint conditions. This procedure uses a small, lighted, optic tube (arthroscope) that is put into the joint through a small cut (incision). Images of the inside of the joint are projected onto a screen. It is used to look at any changes in the joint, to find bone diseases and tumors, and to figure out the cause of bone pain and inflammation.
How are shoulder problems treated?
The goals of treatment are to ease pain and restore your shoulder to normal function. To do this, a variety of treatments may be used, including:
Changing how you do some daily activities (activity modification)
Medicines such as ibuprofen, naproxen, and other nonsteroidal anti-inflammatory medicines (NSAIDs)
An injection of anti-inflammatory steroids
Surgery (when other options fail or are not advised for the injury or condition)
Key points about shoulder problems
Shoulder pain and problems are common.
The shoulder is the most movable joint in the body. But its ability to move increases the chances that it can be injured or damaged.
Common causes of shoulder problems include dislocation, separation, and fracture.
Shoulder pain may be localized in a specific area. Or it may spread to areas around the shoulder or down the arm.
Treatment may include medicines, rest, physical therapy, surgery, and changing how you do some daily activities.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.
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