Common Shoulder Injuries
Rotator Cuff Tendinitis/Tear
Rotator cuff tendinitis is inflammation of shoulder’s rotator cuff muscle tendons. This can occur in overhead or throwing sports as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head. Chronic inflammation can cause the tendons of the rotator cuff to develop microscopic tears. Pain associated with arm movement or nighttime shoulder pain, especially when lying on the affected shoulder is characteristic. X-rays may show a bone spur, while MRI may show inflammation or a tear in the rotator cuff. Treatment involves resting the shoulder and avoiding activities that cause pain. Ice and nonsteroidal anti-inflammatory drugs will help reduce inflammation and pain. Physical therapy to strengthen the muscles of the rotator cuff should be started. Steroid injections can be used if the pain persists or if therapy is not possible because of severe pain. Arthroscopic surgery is the most invasive option to repair some tears and remove bone spurs.
A shoulder separation refers to the stretching or tearing of ligaments at the acromioclavicular joint, or where the clavicle meets the scapula (shoulder blade). A shoulder separation is usually caused by an impact to the front of the shoulder or by falling on an outstretched hand. The severity of the separation is determined by the magnitude of the force and direction of joint separation. Type I and II AC joint injuries are considered mild. These injuries are likely to respond to conservative treatment. In more severe type IV, V, and VI shoulder separation injuries, the supporting ligaments are actually be torn. These injuries are primarily treated with surgery.
Adhesive Capsulitis (aka Frozen Shoulder)
Adhesive capsulitis is an inflammatory condition that causes limited or reduced motion range of motion in the shoulder joint. It can be caused by injury or disease. Decreased motion of the joint leads to stiffness which can result in pain. Diabetes, stroke, accidents, lung disease, and heart disease are all considered risk factors for frozen shoulder. The shoulder joint becomes painful, then tight along with stiffness that is worse at night.
Initial treatment consists of anti-inflammatory and pain medication. Joint movement is then restored with gentle stretching exercises. Surgery is necessary in some cases in which shoulder manipulation under general anesthesia is performed.
The shoulder joint is the most commonly dislocated major joint of the body. Dislocations typically occur in abduction or rotational injuries which causes the humeral head to pop out of the joint. A subluxation is a partial dislocation.
The shoulder can dislocate in any direction. Anterior are more common than posterior dislocations. Pain is usually intense. Swelling, numbness, and weakness may also occur. Diagnosis is primarily made with physical exam and x-rays to rule out a fracture. Reduction is a procedure in which the doctor relocated the head of the humerus into the socket. Following reduction, the arm is put in a sling or a shoulder immobilizer for several weeks. After pain and swelling decrease, physical therapy can be started to restore the range of motion of the shoulder and strengthen the muscles.
- Egol, Koval, Zuckerman. Handbook of Fractures. 2009.
- Miller. Miller Review of Orthopedics. 2009.