Shoulder Pain & Injury Information

What is the basic anatomy of the shoulder?
The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), collar bone (clavicle), and shoulder blade (scapula). These bones are held together by muscles, tendons, and ligaments.
What are some common causes of shoulder pain?
The most common causes of shoulder pain include overuse tendonitis, degenerative tendinosis, or a strain or tear of the rotator cuff. Other common causes of shoulder pain include labral tears, frozen shoulder, dislocation or instability, arthritis, calcific tendonitis and biceps tendonitis.
What is the rotator cuff and its function?
The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm (humerus) to the shoulder blade (scapula). The rotator cuff tendons provide stability to the shoulder and the muscles allow the shoulder to rotate.
What are some common rotator cuff problems?
Common rotator cuff injuries include:
  • Tearing of the rotator cuff, especially for tendons that have been weakened through age or excessive wear and tear.
  • Tendinitis may develop through repetitive overhead movements of the arms such as painting or throwing a ball.
  • Rotator cuff impingement may develop if the tendons of the rotator cuff are squeezed between the upper arm (humerus) and a nearby bone called the acromion.
  • Subacromial bursitis is the inflammation of the small sac of fluid (bursa) that cushions the rotator cuff tendons from a nearby bone (the acromion).
  • Frozen shoulder (adhesive capsulitis) may be experienced in cases where the upper arm (humerus) adheres to the shoulder blade and causes shoulder pain and stiffness.
How is a rotator cuff injury diagnosed?
An injury to the rotator cuff can be diagnosed using one or a combination of the following tests, in order of significance:
  • Physical examination, performed by a doctor to examine the limitations of the shoulder in different movements.
  • Painful Arc tests may be performed by a physician to determine pain resulting when raising the arm beyond 90 degrees. ┬áPain that is elicited when raising the arm beyond 90 degrees.
  • X-rays may be taken, but plain films don’t detect rotator cuff problems. They may show fractures, bone spurs, or other bone abnormalities.
  • Magnetic resonance imaging (MRI) testing uses magnetic waves to create highly detailed images of the muscles, bones, and tendons in the shoulder.
  • Ultrasonography, where an ultrasound probe directs painless high-frequency sound waves at the shoulder, to create images of the muscles and tendons.
  • Computed tomography (CT) scans utilize a machine to take multiple X-rays of the shoulder, which are then reconstructed by a computer to create detailed images. CT is not as effective as MRI at detecting rotator cuff problems.
  • Arthrogram, where dye is injected into the shoulder joint and X-ray films are taken. If the X-rays show evidence of dye leaking out of the shoulder joint it may indicate a rotator cuff tear.
What is a labral tear?
The labrum is made of a thick tissue that is susceptible to injury with trauma to the shoulder joint. When a patient sustains a shoulder injury a labral tear may result. The labrum also becomes more brittle with age, and can fray and tear as part of the normal aging process.
What are the symptoms of a labral tear?
Symptoms of a labral tear depend on where the tear is located. They may include an aching sensation in the shoulder joint and “catching” of the shoulder when it moves.
What is the treatment for a labrum tear?
The treatment of a torn labrum depends on the type of tear that has occurred and age of the patient. Most labral tears do not require surgery; however, in patients with persistent symptoms, surgery may become necessary if more conservative treatment fails to produce desired results.
Why does my shoulder feel loose or instable?
Shoulder instability is a problem that occurs when the structures that surround the shoulder (glenohumeral) joint do not work to maintain the ball within its socket. If the joint is too loose, it may slide partially out of place, a condition called shoulder subluxation. If the joint comes completely out of place, this is called a shoulder dislocation.
Who suffers from shoulder instability?
Shoulder instability tends to effect four groups of people:
  • Trauma victims.
  • Young patients that have sustained a prior shoulder dislocation are more likely to have another.
  • Young athletes who compete in sports that involve overhead activities such as volleyball, swimming and baseball may have a loose shoulder or multidirectional instability (MDI).
  • Double-jointed patients may suffer from shoulder instability or even dislocations.
What is the treatment of shoulder instability?
Treatment of shoulder instability depends on several factors, and almost always begins with physical therapy and rehabilitation. Some conditions require strengthening exercises and sometimes cortisone injections and anti-inflammatory medications.
Will I need surgery for shoulder instability?
If therapy fails, there are surgical options that can be considered depending on the cause of the instability. This is especially true in young athletic patients.
What is “frozen shoulder?”
Frozen shoulder (adhesive capsulitis) is a condition that produces stiffness, pain, and limited range of movement. It may follow an accident or an injury that causes the tissues around the joint to stiffen and scar tissue to form. It results in difficult, painful shoulder movements.
What causes frozen shoulder?
Frozen shoulder can develop when you stop using the joint normally because of pain, injury, or a chronic health condition, such as diabetes or arthritis.
Frozen shoulder may occur:
  • After surgery or injury.
  • Most often in people 40 to 70 years old.
  • More often in women (especially in postmenopausal women) than in men.
  • Most often in people with chronic diseases such as diabetes.
Any shoulder problem can lead to frozen shoulder if you do not work to maintain a full range of motion.
How is frozen shoulder diagnosed?
Frozen shoulder can be diagnosed through a physical exam but may require additional tests. An arthrogram, which is an X-ray image of your joint taken after a contrast material (such as a dye or air) is injected into it, can help confirm the diagnosis.
How is frozen shoulder treated?
Treatment for frozen shoulder usually starts with nonsteroidal anti-inflammatory drugs (NSAIDs) and application of heat to the affected area, followed by gentle stretching. Ice and medicines (including corticosteroid injections) may also be used to reduce pain and swelling. Physical therapy can help increase your range of motion. Surgery may be needed for more serious cases.