Shoulder Injuries

What Are Shoulder Injuries?

Shoulder pain is a common reason to visit a physician’s office. The shoulder joint is comprised of three bones, including the humerus, the scapula, and the clavicle. The shoulder is a ball and socket type of joint that allows for significant movement, and must therefore be anchored by the muscles, tendons, and ligaments found in the region.

The shoulder joint can be unstable and is therefore a common site of injury. The majority of shoulder injuries involve the muscles, tendons, and ligaments of the shoulder as opposed to the bones. Common injuries of the shoulder include separations, dislocations, sprains, strains, impingement, tears, fractures, arthritis, and frozen shoulder.

Instability occurs when the shoulder joint is forced out of its normal position and can result in a dislocation of the shoulder. Patients suffering from instability type injuries will often report pain when lifting their arm, as well as a weakness of the affected arm. They may also feel like the shoulder is slipping out of the socket. A shoulder dislocation occurs when the ball is pushed out of the socket. Once a shoulder is dislocated, it may occur again. A shoulder separation occurs when the ligaments holding the clavicle tear and it displaces up.

Impingement occurs when there is excessive rubbing of the muscles of the shoulder against the acromion process of the shoulder blade. This results in irritation or inflammation of the tendons (tendinitis), or bursa sac (bursitis). These injuries usually occur when engaging in overhead activities. Patients may complain of minor pain and decreased strength, which may progressively get worse.

Rotator cuff tears are another type of shoulder injury. The rotator cuff includes the infraspinatus, supraspinatus, teres minor, and subscapularis muscles. The role of the rotator cuff is to provide stability and aid while lifting the arm and reaching overhead. The supraspinatus is the most commonly injured component of the rotator cuff. Symptoms of rotator cuff injuries include pain, decreased range of motion, and weakness of the affected arm. Rotator cuff tears can occur from repetitive use or through the aging process. Sometimes they can be caused by a fall on an outstretched hand.

Other types of shoulder injuries include shoulder strains, arthritis, fractures, and frozen shoulder. Shoulder strains can result after an individual places excessive stress on the shoulder joint. Shoulder strains can cause pain as well as a decrease in shoulder range of motion. Arthritis of the shoulder occurs in some individuals with aging. Arthritis causes painful movement of the shoulder because the cartilage that lines the bones is worn away.

Shoulder fractures occur when there is a crack through part or all of one of the shoulder bones, usually the humerus or clavicle. Frozen shoulder refers to extreme stiffness of the shoulder. The main symptom of frozen shoulder is the inability to move the shoulder in any direction without pain.

Causes of Shoulder Injuries

Shoulder injuries are usually diagnosed through a patient history, physical examination, and possibly special imaging tests including X-rays, ultrasound, or magnetic resonance imaging (MRI). Many shoulder injuries are caused by the breakdown of soft tissues in the shoulder. This can occur as the result of aging or with repetitive use. Individuals who participate in sports or those who do heavy manual labor are more at risk of suffering a shoulder injury. There are a number of factors that increase the risk of suffering a shoulder injury, including:

• Heavy physical work
• Awkward working positions
• Stress
• Obesity

Treatments for Shoulder Injuries

Initial treatment of minor shoulder injuries typically involves rest, ice, compression, and elevation. Physical therapy including specific stretching and strengthening exercises may be recommended to reduce pain and improve shoulder range of motion and strength. If pain persists, further treatment options may be recommended, depending on the type of injury.

Shoulder arthroscopy is performed through small incisions, using a camera to visualize the inside of the joint. There are various types of arthroscopic shoulder surgery including rotator cuff repairs and repair of labral tears, including Bankart tears and SLAP tears. For patients suffering from biceps tendonitis, biceps tendinosis, rupture of the long head of the biceps, or SLAP tears, a procedure called a biceps tenodesis can be performed. During this procedure, the biceps tendon’s normal attachment within the shoulder is detached and is then reinserted to a new position on the bone of the humerus. Complications following shoulder arthroscopy are rare. The most common complication is shoulder stiffness, which can result in prolonged rehabilitation.

Conclusion

The shoulder is a complex ball and socket joint that is commonly injured. Shoulder injuries commonly include separations, dislocations, sprains, strains, impingement, rotator cuff or labral tears, fractures, arthritis, and frozen shoulder. Most shoulder injuries result due to the breakdown of soft tissues that make up the joint; however, some are caused by an acute injury. Individuals who participate in overhead sports or those who have a job that requires excessive manual labor are at an increased risk of suffering a shoulder injury. Treatment will vary depending on the type and severity of an individuals’ injury. Patients are encouraged to speak to their physician about their symptoms to determine what treatment option is best for their case.

References

1. Ginn KA, Herbert RD, Khouw W, Lee R. A randomized, controlled clinical trial of a treatment for shoulder pain. Physical Therapy. 1997;77(8):802-809.
2. Miranda H, Vilkari-Juntura E, Martikainen R, Takala E-P, Riihimaki H. A prospective study of work related factors and physical exercise as predictors of shoulder pain. Occup Environ Med. 2001;58:528-534.
3. Nahit ES, Hunt IM, Lunt M, Dunn G, et al. Effects of psychosocial and individual psychological factors on the onset of musculoskeletal pain: common and site-specific effects. Ann Rheum Dis. 2003;62:755-760.
4. Naredo E, Aguado P, De Miguel E, Uson J, et al. Painful shoulder: comparison of physical examination and ultrasonographic findings. Ann Rheum Dis. 2002;61:132-136.
5. van der Windt DAWM, Thomas E, Pope DP, de Winter AF, Macfarlane GJ, et al. Occupational risk factors for shoulder pain: a systematic review. Occup Environ Med. 2000;57:433-442.