Did you know that what you think of as the shoulder (the glenohumeral joint) is just one aspect of a larger joint structure? Or that it is the most mobile joint of the body, capable of motion in all three planes of movement: sagittal (front to back), transverse (side-to-side) and longitudinal (up and down)?
The point is, the shoulder is a complex joint. With that complexity and mobility comes the potential for problems…painful problems. The shoulder is subject to a number of orthopedic conditions that can cause pain and disability. Knowing what they are is the first step in protecting this vital joint.
Basic Shoulder Anatomy
The shoulder is a meeting of three bones:
- The clavicle (collarbone)
- The humerus (upper arm bone)
- The scapula (shoulder blade)
The shoulder is not just one joint, but two: where the scapula meets the humerus (the glenohumeral joint) and the clavicle (acromioclavicular joint). Holding these bones together is a multitude of tendons, muscles, ligaments and cartilage, such as the deltoid, the rotator cuff complex and the labrum.
Common Shoulder Pain Causes
With all that complexity, there’s an increased chance that something may go wrong with the shoulder structure. A number of potential sources cause shoulder pain. Some of the most common are below.
Rotator Cuff Injury and Impingement
Rotator cuff injuries are the most common cause of shoulder pain for people over the age of 30. Pain stemming from the rotator cuff is usually one of two varieties: inflammation and tears.
Rotator cuff inflammation—also known as rotator cuff tendinitis or rotator cuff tendinopathy—is when the muscles of the rotator cuff become irritated, inflamed or painful. Sometimes it’s caused by the rotator cuff being trapped between the humerus and a bony outcrop called the acromion process—that’s a shoulder impingement
A rotator cuff tear can be partial, or it can be fully torn in two or torn off the bone, and it can be caused by injury or overuse.
Tendinitis and impingements can usually be treated nonsurgically. Treatments include:
- Resting the injured shoulder
- Anti-inflammatory medications
- Corticosteroid injections
- Physical therapy
Partial rotator cuff tears can usually be treated conservatively as well, using the modalities listed above. Full tears may need to be surgically repaired. At Summit Medical Group Orthopedics, rotator cuff repair surgeries are performed arthroscopically whenever possible due to faster healing times and less trauma to the shoulder.
A strain is an injury to a muscle. In the shoulder, the deltoid, or one of the rotator cuff muscles may be strained. Biceps, triceps and pectoralis strains may sometimes be felt in the shoulder area as well.
Shoulder strains are usually temporary. They are typically managed with rest, nonsteroidal anti-inflammatory medications (NSAIDs) and physical therapy.
Osteoarthritis is the most common form of shoulder arthritis. Also known as wear-and-tear arthritis, it is the breakdown of the cartilage that wraps the ends of bones in a joint. This tissue, called articular cartilage, allows the bones of a joint to glide smoothly together.
Arthritis cannot be cured, only managed. An active lifestyle and regular physical therapy are two of the best ways to keep shoulder arthritis from interfering with your life. If you have end-stage osteoarthritis—there’s no cartilage left and your bones are grinding together—a shoulder replacement may be an option for you.
Labrum tears are injuries to the cartilage lining of the glenoid.
Conservative treatment, including rest, ice and physical therapy, is usually sufficient for most labrum tears. Surgery—called debridement—is a treatment of last resort. Debridement will likely be performed arthroscopically, with the torn piece of cartilage being removed. After surgery, the injured arm will be immobilized in a sling for a period of weeks, and physical therapy to return range of motion and strength will be necessary.
Frozen shoulder, or adhesive capsulitis, has three stages. The first stage is painful, when the tough connective tissue capsule begins to thicken and it starts to become difficult to move the shoulder. In the second stage, pain may improve but range of motion gets worse. In the third stage, range of motion begins to improve. It can take up to four years to cycle through the stages.
Frozen shoulder usually resolves on its own, but it can take a long time. Exercises and physical therapy are aimed at stretching the capsule and increasing the joint’s range of motion. NSAIDs and corticosteroid injections can help with pain and inflammation.
Diagnosing Shoulder Pain
With so many potential causes of shoulder pain, how do you know which condition you have? Your first step should be to see a shoulder and elbow or sports medicine orthopedic specialist.
The cause of shoulder pain may be hard to pinpoint because most common forms of shoulder pain cause similar symptoms, including:
- Limited range of motion
- Bruising at the shoulder
A dislocated shoulder is most likely to cause a visual deformity, i.e., the arm looks out of place.
Orthopedic specialists will usually start with a physical exam and a medical history. During a physical exam, the doctor will manipulate your arm in various ways to check for symptoms of pain. Positions in which pain occurs may give clues to the nature of the pain.
Likewise, a medical history will provide essential information to produce a diagnosis. If the pain began gradually rather than suddenly, that may be an indication of a chronic condition or overuse. If you’ve recently experienced a sports injury or fall, the problem is more likely to be acute.
Imaging studies can be very useful when the cause of shoulder pain is unclear. In most cases, X-rays are the first imaging test ordered. X-rays do not depict soft tissue such as tendons or cartilage, but can detect or rule out problems with bone, such as bone spurs from osteoarthritis or a clavicle fracture.
Computed tomography (CT) or magnetic resonance imaging (MRI) scans can paint a more complete picture of shoulder anatomy, including tendons, ligaments and cartilage. These tests may show tears to the rotator cuff or labrum, or abnormalities with bursae.
Summit Medical Group Orthopedics’ shoulder and elbow experts were trained at some of the top medical schools and residency and fellowship programs in the country. If you are experiencing shoulder pain, request an appointment with a shoulder and elbow specialist. Our experts will diagnose the cause of your pain and develop a customized treatment plan that’s right for you, your condition and your life circumstances.