COMMON SHOULDER INJURIES & CONDITIONS
Common Shoulder Injuries and Conditions
Shoulder pain is an extremely common orthopaedic condition and can stem from many causes. Most shoulder problems involve the muscles, ligaments and tendons of the joint, rather than the bones. Early detection and treatment is key to preventing the development of more serious shoulder conditions.
Rotator cuff tears
The normal aging process causes the ends of the muscles near their attachment site (tendons) to thin and ultimately weaken, leading to partial or complete tears, also known as rotator cuff tears. Rotator cuff tears are typically located at or near the tendinous connection to the bone.
- Degenerative rotator cuff tear typically occurs from age-related wear and tear.
- Traumatic rotator cuff tear is caused by an acute injury.
- Partial thickness rotator cuff tear occurs when the rotator cuff tendons inside the shoulder wear down with age and the tear goes part of the way into the tendon. Some partial rotator cuff tears may go unnoticed because they don’t always cause pain.
- Massive rotator cuff tear is when the tendon completely tears or separates from the bone. With a massive rotator cuff tear, there is basically a hole in the tendon.
Acromio-clavicular joint sprain (separated shoulder)
A separated shoulder joint is one of the most commonly diagnosed shoulder injuries. It is frequently seen in sporting activities such as football, cycling, skiing, snowboarding and soccer. The injury is often caused by a fall directly onto the point of the shoulder or a jamming upward of the arm from a fall onto the point of the elbow.
Long-term and continuous shoulder pain and usually a progressive loss of range of motion are the classic symptoms of shoulder arthritis. This condition and related symptoms are most commonly age related. Tearing of the surrounding muscle/tendon tissues (rotator cuff complex) is often seen simultaneously with the aging process.
- Osteoarthritis is a progressive degenerative condition involving the lining (articular cartilage) of the joint surfaces. Degeneration or thinning and pitting of these surfaces creates a roughened and worn joint surface.
- Rotator cuff tear arthropathy is defined by shoulder arthritis with a large rotator cuff tear. It is a severe and complex form of shoulder arthritis in which the shoulder has lost both the cartilage that normally covers the joint surface and also the tendons of the rotator cuff tear that help position and power the joint.
- Rheumatoid arthritis is a chronic inflammatory condition that can affect more than just the joints. It is an autoimmune disorder, occurring when the immune system mistakenly attacks the body’s own tissues.
Shoulder adhesive capsulitis (frozen shoulder)
Frozen shoulder is a common condition most prevalent in women over the age of 40 and is thought to occur in the diabetic population as well as people with known thyroid disease. This shoulder condition has been noted to occur in both shoulders in approximately 10% of the population.
Calcific tendonitis occurs when calcium deposits build up in the muscles or tendons. While it can happen anywhere in the body, it typically occurs in the rotator cuff. Shoulder pain and shoulder swelling will occur in the event elevation motions are repetitive or occur under excessive loads or velocities.
Shoulder instability is the result of a condition or injury in which the ball of the joint physically moves out of the socket. Shoulder instability is generally classified as mild to severe. In cases of severe instability, the ball dislocates completely out of the socket and may require shoulder surgery. In less severe cases, the ball may only partially slip or “sublux.”
- Traumatic instability arises from an acute injury from a force. Typically, traumatic instability is caused by a fall on an outstretched hand, for example, football, skiing or wrestling.
- Anterior instability is the most common type of dislocation, accounting for more than 90% of first-time or recurrent dislocations. It is caused by the arm being positioned with an excessive amount of external rotation moving away from the body.
- Posterior instability is a rare condition, most commonly due to trauma or seizures.
- Multidirectional instability, or atraumatic shoulder instability, is a general looseness of the shoulder’s joint not caused by trauma, causing the shoulder to become unstable.
Shoulder impingement occurs when tendons in the shoulder are impinged by the shoulder bones. It is a common source of shoulder pain and can be caused or exacerbated by repetitive overhead activity, such as swimming, tennis and painting.
- Bone spurs, or osteophytes, are bony growth that develops along the edge of the bone, often forming where bones meet.
- Proximal biceps disease is characterized by strains, tears or inflammation of the biceps tendon, which connects the biceps muscle to the shoulder joint. This condition can be difficult to diagnose, because of the tendon’s proximity to other possible pain generators.
Shoulder labral tears
The labrum is a piece of rubbery tissue, or fibrocartilage, attached to the edge of the shoulder socket that helps keep the ball of the joint in place. A labral tear occurs when this cartilage is torn. Labral tears can result from injury or the aging process.
- SLAP (superior labrum from anterior to posterior) tear is a common type of labral tear. SLAP tears occur at the front of the upper arm where the bicep tendon connects to the shoulder. Those prone to this injury include athletes who engage in quick-snap, high-energy motions over the top of the shoulder.
- Bankart lesion occurs when the labrum, or piece of cartilage on the edge of the shoulder, pulls off the front of the socket. This injury occurs most often when the shoulder dislocates and, if not healed properly, can cause further dislocations, instability, pain and weakness.
- HAGL (humeral avulsion of the glenohumeral ligament) lesion is associated with anterior shoulder instability. While uncommon, these lesions can cause significant shoulder pain and dysfunction.
Shoulder fractures are most often the result of trauma, causing a fracture of the glenoid (socket) of the shoulder joint. The majority of shoulder fractures are treated without surgery. Some fractures carry a high risk of arthritis, are unlikely to heal or may heal in the wrong position if left untreated, and therefore require surgery.
- Proximal humerus fracture is an injury to the top end of the humerus — the only bone in the upper arm — usually caused by trauma. The proximal end of the humerus, known as the head, forms the ball of the ball-and-socket shoulder joint.
- Scapular fracture is a fracture to the shoulder blade, or scapula. This type of fracture is rare and often can be treated without surgery.
Clavicle fractures are a break in the collarbone. They are fairly common and typically result from a fall onto the shoulder or when an outstretched arm places too much pressure on the bone causing it to break. This type of fracture can be very painful and make it difficult to move your arm.
Acromioclavicular (AC) joint separations
Acromioclavicular (AC) joint separations are a common injury among physically active people. With an AC joint separation, the collar bone separates from the shoulder blade. This injury commonly occurs from a fall or blow directly to the “point” of the shoulder.
Acromioclavicular (AC) joint arthritis
The acromioclavicular joint, or AC joint, is at the top of the shoulder where the collarbone and highest part of the shoulder blade meet. Arthritis in this region can create pain and tenderness at the top of the shoulder and make it difficult to reach the arm across the body.
Sternoclavicular (SC) joint disorders
The sternoclavicular joint, or SC joint, is located where the collarbone and sternum, or breastbone, meet at the base of the neck. Issues with the SC are not common and generally arise from an injury or other disorders.
Scapula, or shoulder blade, disorders occur when an injury or condition causes the system of muscles that surround and support the bone to become weak or imbalanced. This can alter the position of the shoulder blade at rest or in motion.