Shoulder Injuries & Conditions

Common Injuries of the Shoulder

 

The biomechanics of the shoulder are complex, requiring a total of four joints that connect the arms and shoulders to the chest and allow for a full range of motion from lifting to putting the hands in precise positions.

 

Only when this range of motion is compromised, do most people appreciate the sophisticated design of the shoulder’s anatomy.

Dislocations of the shoulder are common in any sport such as skiing, snowboarding, and mountain biking, where there is risk of falling on the shoulder.

 

Shoulders can dislocate in several directions: posterior, anterior and inferior. Putting the shoulder back into proper position should not be attempted by anyone without the proper medical training; in some cases, surgery may be required.

Damage to the shoulder’s rotator cuff can be caused by traumatic injury, or by repetitive overhead activity (weightlifting, tennis).

 

The rotator cuff is formed by four tendons that attach to the muscles that keep the shoulder stabilized and in its socket. When the rotator cuff is damaged, the shoulder is weak and movement is painful; it may be difficult or impossible to raise the arm over-head. Should non-operative treatments fail, surgical interventions include debridement and artificial shoulder replacement.

Shoulder impingement can describe any number of symptoms, from generalized aches in the shoulder to pain and difficulty when raising the arm out to the side, or in front of the body.

 

The impingement can be coming from inflamed tendons (tendonitis) or inflamed bursae (bursitis). Bone spurs can also complicate the impingement. Careful diagnosis is needed to determine the cause of the impingement and the most effective treatment.

Common Shoulder Conditions

Acromioclavicular (AC) Joint Arthritis


Overview - (AC) Joint Arthritis This arthritis affects a joint at the top of your shoulder. It's where the shoulder blade's bony protrusion (called the "acromion") meets the clavicle. This joint acts as a pivot point when you raise your arm above your head. Causes - (AC) Joint Arthritis What causes AC joint arthritis? We don't always know. It's most common in people older than 50. Women are affected more often than men. You can develop it over time if you do activities that put a lot of stress on your shoulder. It's a problem for people who work construction, for example. It can affect athletes who do a lot of overhead arm motions. You can also develop this arthritis as a result of injury or infection. Symptoms - (AC) Joint Arthritis Symptoms may include pain and stiffness in your shoulder. Your range of motion may be limited. And you may feel or hear grinding or clicking sensations when you move your arm. Treatment - (AC) Joint Arthritis To treat this arthritis, your doctor may recommend things like medications, hot and cold compresses, and changing your activities. You may benefit from physical therapy. If these don't help, you may need surgery. Your healthcare provider will create a plan that's right for you.




Anatomy of the Shoulder


Overview The shoulder is a complex structure made of three separate joints. They work together to give the shoulder a tremendous range of motion. Let's take a closer look at the main parts of the shoulder's anatomy. Bones Three bones are found in the shoulder. The humerus is the large bone of the upper arm. The scapula, commonly called the "shoulder blade," is a flat, triangular bone at the rear of the shoulder. It has two large protrusions, the acromion and the coracoid process. And finally, the clavicle, often called the "collarbone," is a long, thin bone positioned between the scapula and the sternum. Glenohumeral Joint The glenohumeral joint is where the humerus meets the scapula. This is a ball-and-socket joint. The "ball" is the head of the humerus. The "socket" is the glenoid, a shallow cavity in the scapula. The surfaces of the ball and the socket are covered with a tough, smooth layer of articular cartilage. A ring of cartilage called the "labrum" surrounds the glenoid. The joint is surrounded by a sac called the "joint capsule" and the glenohumeral ligaments. The glenohumeral joint allows the arm to be raised and rotated. Acromioclavicular Joint The acromioclavicular joint, also called the "AC" joint, is where the clavicle meets the acromion of the scapula. The ends of these bones are covered with articular cartilage. They are connected by the acromioclavicular ligament and are stabilized by the coracoclavicular ligament. The AC joint plays a role in lifting the arm. Sternoclavicular Joint The sternoclavicular joint is where the other end of the clavicle meets the sternum. It allows the clavicle to move, and plays a role in thrusting the arm and shoulder forward.




Biceps Tendonitis


Overview - Biceps Tendonitis This is a problem with a tendon in your shoulder. Most often, it's the "long head of biceps" tendon. It travels from the front of your upper arm to the top of your shoulder socket. With this condition, the tendon becomes painfully inflamed or irritated. Causes - Biceps Tendonitis Biceps tendonitis is usually caused by normal wear and tear. It can be a problem for people who perform repetitive shoulder movements. It can be a problem for people who play tennis or baseball, and for swimmers. Over time, these activities can damage your shoulder's tendon. It can become red and swollen. The covering around it, called the "tendon sheath," can thicken. Symptoms - Biceps Tendonitis Biceps tendonitis causes pain in the front of your shoulder. You may feel this pain when you lift your arm, or when you do activities that involve your shoulder. Your upper arm may ache. And sometimes you may feel a snapping sensation in your shoulder. Treatment - Biceps Tendonitis Treatment options may include rest, ice, medications, and physical therapy. If those don't help, you may need surgery. Your healthcare provider can create a plan that's right for you.




Bursitis of the Shoulder (Subacromial Bursitis)


Overview This is a swelling of a fluid-filled sac called the "subacromial bursa." It's in the shoulder, between a bony protrusion called the "acromion" and the rotator cuff. You have similar sacs near other large joints throughout your body. They act as cushions between your bones and your soft tissue. Normally they have a small amount of fluid inside them. But sometimes they can swell. We call that "bursitis." Causes Shoulder bursitis is usually caused by constant stress or friction against your bursa. It can happen if you do a lot of repeated arm motions, especially with your arm raised. A lot of lifting and pulling can cause it. This type of bursitis is often a problem for painters and for construction workers. Symptoms Symptoms include pain and tenderness. It may be hard for you to move your shoulder. You may not have your full range of motion. You may feel pain during activity and when you are at rest. It can wake you up at night. Treatment Treatment options include rest, medications and physical therapy. If these aren't helpful, you may benefit from surgery. Your healthcare provider can create a plan that's right for you.




Calcific Tendinitis of the Shoulder (Reactive Calcification)


Overview This painful condition occurs when calcium deposits form in tendons of the rotator cuff. These tendons and surrounding tissues in the shoulder become inflamed. Reactive calcification often develops in young people, but it can affect people of all ages. Progression The exact cause of reactive calcification is not known, but the process is a progression. Once the process it triggered (for reasons that are unclear), calcium crystals begin to form and collect within the tissues of a tendon. This usually is not painful, and most people don't realize the deposits are forming. Eventually, the calcification process will stop, and the calcium deposits will begin to break down and be reabsorbed by the body. It is during the reabsorption phase that many people feel pain. Symptoms Symptoms of reactive calcification may include moderate to severe pain, especially when the arm is lifted. Other symptoms may include stiffness or restriction of shoulder movement, swelling in the joint, and pain at night that disrupts sleep. Treatment Treatment options may include anti-inflammatory medications, corticosteroid injections, and physical therapy. In many cases, treatment is not needed because symptoms improve on their own. In severe cases, surgery may be necessary to break up and remove the deposits.




Clavicle Fracture (Broken Collarbone)


Overview This is a common shoulder injury. It's a break of the bone that rests between the shoulder blade and the sternum. We call it the "collarbone." Your collarbones help connect your arms to your body. Causes You can break a collarbone by falling hard with your arm outstretched. You can also break a collarbone if you are hit hard on the shoulder. This injury can happen to athletes, during road accidents, and it can be caused by accidents in the home. Symptoms If you break a collarbone, you feel pain and tenderness in your shoulder. It may be hard for you to move or lift your arm. Your shoulder may sag, and you may see a bump in the skin because of the shifted bone. You shoulder may be bruised and swollen. Treatment Your broken collarbone may be treated with a sling and with medications to help your pain. Physical therapy may also help. If your collarbone has shifted out of position, you may need surgery. Your healthcare provider can create a plan that is right for you.




Biceps Tendon Tear (at the Shoulder)


Overview - Biceps Tendon Tear Tendons are strong bands of tissue that connect muscle to bone. With this injury, one of the tendons anchoring your biceps muscle is torn. It may be torn partially or completely. Because the biceps is attached with two separate tendons, you may find that you can still use your biceps muscle even if one tendon is completely torn. Causes - Biceps Tendon Tear You can tear a biceps tendon if you fall and try to catch yourself. You can tear a tendon if you try to lift something heavy. And, a tear can happen over time if you overuse your tendon and it becomes frayed and damaged. Symptoms - Biceps Tendon Tear A biceps tendon tear can cause a sudden, sharp pain in your upper arm. If the tendon tears completely, you may hear it pop when it happens. Your arm and shoulder may feel weak and tender. Your muscle may cramp, and it may bulge. Your arm may bruise. And, you may have trouble turning your palm face up or face down. Treatment - Biceps Tendon Tear Treatment options may include rest, ice, medications and therapy. You may need surgery to repair the tendon. Your healthcare provider can create a plan that's right for you.




Fracture of the Greater Tuberosity


Overview This is a shoulder injury. It's a break of the bony bump on the outer side of the humerus. That's the bone of your upper arm. The greater tuberosity is the place where three muscles of the rotator cuff attach. So a fracture here hurts your shoulder's stability and movement. Causes This type of fracture is caused by a traumatic injury. It can happen during a road accident or a fall. It can happen if your shoulder is dislocated. Your risk is higher if you have osteoporosis. That's a weakening of the bones that can develop as you get older. Symptoms Symptoms include pain and swelling in your shoulder. It may be hard for you to lift or move your arm. Your range of motion may be limited. Treatment Treatment depends on your needs. Your doctor may put your arm in a sling to give it time to heal, followed by physical therapy. But if your fractured bone has moved out of place, or if you have some other serious damage, you may need surgery. Your healthcare provider will create a plan that's right for you.




Fracture of the Shoulder Socket (Glenoid Fracture)


Overview This is a fracture of a part of the shoulder blade called the "glenoid." This is the socket that holds the head of the humerus (the bone of the upper arm). A glenoid fracture can allow the head of the humerus to slip out of the socket. Causes This type of fracture is usually caused by severe trauma. Falls and road accidents are common culprits. Symptoms Symptoms may include pain, bruising and swelling. You may not be able to move your arm. If you can, you may experience a grinding sensation when you move it. If a broken bone shifts out of place, you may notice a lump beneath your skin. Treatment Treatment depends on the type and severity of your fracture. Many fractures are treated by immobilizing the arm in a sling while the fracture heals. Others require surgery. Your healthcare provider can create a care plan that is right for your needs.




Frozen Shoulder (Adhesive Capsulitis)


Overview This is stiffening of your shoulder. It happens over time, and you may not know what caused it. With a frozen shoulder, it can be hard for you to be as active as you like. Causes We don't fully understand this condition. It's a problem with the shoulder's joint capsule. That's a membrane that surrounds the joint. With frozen shoulder, this membrane thickens. Bands of tissue we call "adhesions" develop. Frozen shoulder may be linked to swelling. It can develop after an injury. It can happen after surgery, or after your shoulder is immobilized for a period of time. And, it may be linked to diabetes and to other diseases. Symptoms Frozen shoulder is most often a problem for older people. It starts slowly, with mild pain. Over a few months, the pain gets worse. It can be hard for you to sleep. You begin to have trouble lifting your arm, or moving it backwards. With time, pain can lessen, but your shoulder may become so stiff that you can barely move it. Treatment A frozen shoulder will usually get better on its own, even without any treatment. However, this can take up to three years. You may benefit from treatment options such as medications, injections and physical therapy. Surgery can help, too. Your healthcare provider can create a plan that's right for you.




Glenoid Labrum Tear


Overview you have pain in your shoulder, you may have a torn labrum. That's the thick band of tissue that goes around your shoulder socket. It helps make the socket deeper. It cushions the bone of your upper arm and keeps it from slipping. Causes You can tear your labrum if you get hit hard on your shoulder, or if you fall and try to catch yourself with your arm. You can also tear it if you pull or lift something that's heavy. And, you can tear a labrum over time if you lift weights or play sports like baseball or tennis. Symptoms A torn labrum can be painful. It may hurt when you lift your arm high. You may notice that your shoulder grinds, pops, catches or locks up. It might feel unstable, and you might not be able to move it well. It may feel weak, and it may hurt even when you are resting. Treatment Your doctor may recommend rest, medications and physical therapy. If those don't help, you may need surgery. Your healthcare provider can create a care plan that is right for you.




Hill-Sachs Lesion


Overview This condition is a traumatic fracture of the humeral head that leaves an indentation in the bone. This changes the shape of the humeral head and can interfere with normal arm motion. Causes This condition is typically caused by dislocation of the shoulder. The humerus slips out of the socket and is compressed against the socket's rim, creating a divot in the ball of the humerus. Symptoms Symptoms can include pain, instability, and recurrent dislocations of the shoulder. Treatment Many smaller sized Hill-Sachs lesions can be treated with physical therapy. More severe and larger lesions may require surgery.




Muscle Imbalance in the Shoulder


Overview Some of the muscles in your shoulder have opposing roles. When you move your arm, certain muscles contract while their opposing muscles relax. But when a muscle becomes much stronger than its opposing muscle, your shoulder can become unstable. You may have trouble moving it normally. We call this a "muscle imbalance." Causes This can happen if you have a strength training routine that doesn't work your muscles evenly. It can happen if you perform repetitive motions at your job. You can develop a muscle imbalance if you play a sport that builds some muscles but not others. And, it can happen as a result of a shoulder injury. Symptoms A muscle imbalance can limit your arm's range of motion. You may feel pain, stiffness, weakness or numbness. Your shoulder may swell. And, you may have muscle spasms. Treatment A muscle imbalance can be treated with physical therapy. Your healthcare provider can create a plan that's right for you.




Osteoarthritis of the Shoulder


Overview Osteoarthritis, also called degenerative arthritis, is a gradual breakdown of cartilage in the joints. Cartilage is a tough, flexible connective tissue that protects the ends of bones in the joints. Osteoarthritis of the shoulder can severely impact a person's lifestyle. Causes and Risk Factors Osteoarthritis commonly develops as a result of the wear and tear of aging. It also frequently results from traumatic injury to the joint. Osteoarthritis of the shoulder is more common in older people, in women, and in people who have occupations that place increased stress on the shoulder. People who have certain diseases, bone deformities or a genetic predisposition are also at a higher risk. Progression In a healthy shoulder, the head of the humerus is covered by a layer of cartilage. Healthy cartilage allows the bone to glide smoothly within the joint. But in a shoulder with osteoarthritis, this cartilage begins to deteriorate and wear away. Repetitive motion or injury may speed this deterioration. Eventually, the bone of the humerus may rub directly against the bone of the shoulder socket. Bone Spur Formation This rubbing can cause the gradual growth of bony bumps along the edge of the joint. These bumps, called bone spurs (or osteophytes), can cause joint pain. Symptoms Symptoms of osteoarthritis of the shoulder may include pain in the shoulder and arm. Movement may increase this pain. The shoulder may feel tender when pressure is applied. The person may experience a grating sensation when moving the arm. The shoulder may feel stiff, and this stiffness may interfere with the arm's range of motion. Treatment Treatment options depend on the severity of the arthritis. In the early stages, the shoulder may be treated with non-steroidal anti-inflammatory medications, corticosteroid injections, and physical therapy. If these methods are not helpful and if the shoulder continues to deteriorate, surgery may be needed to repair or replace the joint.




Proximal Humerus Fracture (Broken Shoulder)


Overview This condition is a fracture of the head of the humerus - the "ball" of the shoulder's ball-and-socket. Causes This type of fracture can be caused by direct trauma to the shoulder. It commonly affects elderly people whose bones have been weakened by osteoporosis. Symptoms Symptoms include severe pain, swelling, and inability to move the arm. Treatment Treatment options depend on the severity of the fracture. If the bones have not shifted, the fracture may be treated with a sling. If the bones have become displaced, surgery is needed to realign and anchor the bones or to replace the joint.




Rotator Cuff Injuries


Overview The rotator cuff muscles and tendons hold your upper arm bone in your shoulder socket. A hard fall, repetitive arm motions or problems with the structure of your shoulder can injure the rotator cuff. Trauma and Overuse A sudden tear in the rotator cuff can be caused by a traumatic fall, or by lifting a heavy weight incorrectly. Tears can also develop gradually. Repetitive arm motions – especially overhead motions common in sports such as tennis and baseball – can place great stress on your muscles and tendons. Certain muscles may begin to overpower others. This muscle imbalance can lead to shoulder instability, which can result in a tear. Impingement In some shoulders, there is not enough space between the rotator cuff and the acromion (a bony projection of your shoulder blade). This lack of space can be caused by a poorly-shaped acromion. It can be caused by the growth of bone spurs, or by swelling in the joint. Lifting the arm can cause the acromion to pinch a rotator cuff tendon. This is called shoulder impingement. Over time, it can lead to rotator cuff tears. Aging Aging also raises your risk for a tear. As you age, the blood supply to your shoulder begins to decrease. Your shoulder has a more difficult time repairing itself after minor injuries. Tendons and muscles can gradually become damaged with the normal stress of everyday use. This can allow tears to happen more easily. Symptoms Rotator cuff injuries typically cause pain in your shoulder, even when you are at rest. The pain typically increases when you lift your arm. You may hear a grinding or a popping sound when you move your arm. Your arm may feel weak. If you have a severe rotator cuff tear, you may not be able to lift your arm at all. Treatment Treatment options depend on the severity of your injury. You may benefit from rest and medications. Your healthcare provider may recommend injections or physical therapy. If those methods are not effective, surgery may be needed.




Rotator Cuff Tear


Overview The rotator cuff is a group of muscles and tendons in each shoulder. It holds your upper arm bone in your shoulder socket. It keeps your arm stable while allowing it to lift and rotate. Too much stress on the rotator cuff can cause a tear. This can be a painful injury. Causes A rotator cuff tear can happen because of a fall with an outstretched arm. It can happen if you try to lift something heavy with a jerking motion. It can also happen over time as part of the normal wear and tear of aging, especially if you have done a lot of repetitive shoulder motions. Symptoms If you tear a rotator cuff, you may feel pain in your shoulder. It may hurt even when you are resting. It may hurt more when you lift or lower your arm. Your arm may feel weak when you try to move it. You may feel a crackling sensation when you move your shoulder certain ways. Treatment Your torn rotator cuff can be treated with a sling and with medications to help your pain. You may benefit from physical therapy. If these don't help, you may need surgery. Your healthcare provider can create a plan that is right for you.




Shoulder Dislocation


Overview The shoulder is a ball-and-socket joint. The ball of your upper arm bone fits into a socket in your shoulder blade. If the ball slips out, your shoulder has "dislocated." Causes You can dislocate a shoulder if you fall on your arm, or get hit hard. It can happen during a road accident. You can dislocate a shoulder playing football or volleyball. Skiiers and gymnasts also have a higher risk. Symptoms A dislocated shoulder causes pain. You may not be able to move your arm. Your shoulder may swell or bruise. And you may see a bump under your skin where the ball has shifted. Treatment A doctor resets the joint by moving your arm into different positions to put the ball back in place. Medication and an arm splint or a sling may help the shoulder heal. Physical therapy may help. If you have a severe dislocation, or if it happens a lot, you may need surgery. Your healthcare provider can create a care plan that is right for you.




Shoulder Impingement Syndrome


Overview This is a painful pinching of soft tissues in your shoulder. It happens when these tissues rub and press against a part of your shoulder blade called the "acromion." This can irritate your rotator cuff tendons, and also a soft sac called the "subacromial bursa." Causes You're at risk for shoulder impingement syndrome if you do a lot of overhead motions with your arms. It's a problem for swimmers, baseball players and tennis players. It's also a problem for painters and construction workers. It can result from a shoulder injury. And sometimes we don't know why it develops. Symptoms If you have shoulder impingement syndrome, your shoulder may feel tender. It may swell. You may feel pain and stiffness when you lift and lower your arm. You may feel sudden pain when you reach above your head. Your pain may spread from the front of your shoulder to your arm. The pain may get better with rest, but it may still hurt. Treatment Your shoulder may improve with medications and rest. You may benefit from steroid injections and physical therapy. If these don't help, you may need surgery. Your healthcare provider can create a care plan that is right for your needs.




Shoulder Separation


Overview This is an injury of the acromioclavicular joint (commonly called the "AC" joint). This is the joint where the clavicle meets the scapula. A shoulder separation is a stretching or a tearing of the ligaments that support these bones. This allows the bones to move out of position. Causes A separated shoulder is most commonly caused by traumatic injury. It can happen if you fall on your shoulder, or if you are struck on the point of your shoulder. Athletes who play contact sports such as football and hockey are susceptible to this injury. So are skiers and gymnasts. Symptoms Symptoms may include pain and weakness in your shoulder. You may not be able to move your shoulder through its full range of motion. You may have bruising and swelling. Your shifted clavicle may create a visible bump beneath your skin. Treatment Treatment options include rest, ice and medications. Your arm may be placed in a sling. You may benefit from physical therapy. A severe injury may require surgical repair. Your healthcare provider can create a plan that's right for you.




SLAP Tear (Superior Labrum from Anterior to Posterior Tear)


Overview This is a shoulder injury. It's a tear of the labrum. That's a ring of cartilage that surrounds the shoulder socket and helps hold the head of the humerus in place. This type of tear happens where the biceps tendon attaches to the labrum. Causes A SLAP tear can be caused by trauma to the shoulder. It can happen because of a road accident or a fall onto an outstretched arm. It can be caused by a forceful overhead motion, or when you try to catch something heavy. It can also be caused by repetitive motions. Throwing athletes and weightlifters can be injured this way. Symptoms Symptoms may include pain and loss of strength. You may not have your full range of motion. You may have popping, grinding or catching sensations when you move your arm. Your shoulder may feel unstable. And, it may be hard for you to lift and to throw. Treatment Treatment depends on your needs. Your shoulder may heal with rest, medications and physical therapy. Or, you may need surgery. Your healthcare provider will create a plan that's right for you.