SHOULDER PAIN

ADHESIVE CAPSULITIS

Adhesive Capsulitis, or a frozen shoulder, is a poorly understood.

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SHOULDER INSTABILITY

Shoulder instability occurs when the shoulder moves completely out of its socket (dislocation) and requires a medical professional to “relocate it”, or to a lesser degree, when it slips out of joint but spontaneously move back in place (subluxation).

Usually, the shoulder dislocates or subluxes forward (this is called an anterior dislocation). Much less often, it dislocates backward (posterior dislocation), and sometimes, it can slip out forward, backward, or downward (this is called multidirectional instability). Remember, you may have an “unstable” shoulder that has not completely dislocated.

The shoulder is most at risk for anterior dislocation when the arm is placed in an abducted and external rotated position (such as a fall on the outstretched hand or tackling a player).

An anterior dislocation is obvious because it is immediately noticed by the person right after the trauma. However, minor instability may result in a sensation that the shoulder is slipping out of place with or without pain.

One might also experience pain or a sense of “apprehension” when the arm is abducted and externally rotated (ask your physical therapist about this).

A sudden dislocation is an emergency. The patient should be taken to the emergency room immediately to make sure there is no damage to the blood vessels or nerve that goes to the shoulder, arm, and hand.

Usually, the emergency room physician can move the arm in such a way that the dislocated shoulder reduces back into its proper place. Rarely is surgery indicated.

Treatment: Pain and muscle relaxant medication is often prescribed. Ice can also help reduce the pain. Physical therapy is usually started 2-3 weeks after a dislocation to strengthen the muscles that support the shoulder joint.

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SHOULDER TENDONITIS AND IMPINGEMENT

Tendonitis is an inflammation of the shoulder tendons.

The signs of inflammation are pain, warmth, redness, tenderness to touch, and loss of function. Shoulder tendonitis (often called Rotator Cuff Tendonitis) can occur when the rotator cuff is overloaded, fatigued, traumatized, and with age-related degenerative changes.

Pinching or impingement of the rotator cuff tendons occurs in a region under a bony structure called the acromion (the projection of the shoulder blade that forms the tip of the shoulder).

Impingement happens when the arm is raised overhead repeatedly, or raised overhead with a heavy load in your hand, or may occur when you sleep on your shoulder.

Diagnosis: X-rays may show a hook or spur that increases the odds that you will pinch the rotator cuff tendons.

Treatment: For impingement or rotator cuff tendonitis usually involves rest, anti-inflammatory medications like ibuprofen, physical therapy to restore proper strength and movement, and less often, a cortisone injection.

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ROTATOR CUFF TEARS

Rotator cuff tears happen in younger people when they experience a trauma such as a fall. In middle-aged people and seniors, rotator cuff tears are usually the result of a gradual wearing out of the rotator cuff tendon(s).

 

Signs and symptoms: Of rotator cuff tears are pain in the shoulder often radiating down to the middle of the arm especially when the arm is raised overhead, weakness, and in severe cases, a complete loss of the ability to lift the arm.

Diagnosis: Diagnostic tests sometimes include an arthrogram (a radio-opaque dye is injected into the shoulder, and if it leaks out of the rotator cuff, it can be viewed on x-ray) or an ultrasound, but an M.R.I. of the rotator cuff is the most common test used for diagnosis.

Treatment: In young and middle-aged patients is usually arthroscopic or open repair of the torn tendons. In older patients, activity modification, anti-inflammatory medication, physical therapy and cortisone injections are typical.

Surgery is a last resort because it is so hard on the body and many seniors may not survive the affects of anesthesia.

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LABRAL TEARS

The labrum is a cartilage ring that surrounds the shoulder socket (called the glenoid) and makes it deeper. In the above picture, it is the thin blue ring around the glenoid. Since the socket is deepened by the labrum, the ball of the arm bone (called the head of the humerus) has a better fit into it.

Labrum or labral tears are usually associated with trauma, instability of the shoulder, or repetitive throwing as with a baseball player.

Signs and symptoms: Of a labral tear is painful clicking, locking, or popping. Instability may be present because the labrum is not doing its job of holding the ball in the socket.

Treatment: Medical intervention for a labral tear typically involves an MRI for diagnosis and arthroscopic repair but labral tears are often hard to diagnose.

               A special kind of labral tear, a superior labral anterior to posterior (SLAP) tear, often involves the biceps tendon as well.

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