Definition & Overview

The ability to move our arms in a wide variety of motions is made possible by the shoulders, which are a complex structure made up of bones, joints, tendons, and muscles. Because of their complex nature, they are prone to a variety of problems that are collectively referred to simply as shoulder problems.

The shoulder is made up of three main parts: Clavicle (collarbone), Humerus (upper arm bone), and Scapula (shoulder blade). Connecting these parts is a rounded socket called the glenoid. A combination of muscles and tendons called the rotator cuff ensure that the humerus is firmly attached to the glenoid.

Shoulder problems vary in severity. Some may result in a temporary reduction of movement while others may prevent the arms from moving completely. The four major categories of shoulder problems are fracture, instability, arthritis, and tendon inflammation.

Cause of Condition

Shoulder problems can be caused by wear and tear, injuries, and diseases of various parts of the body that directly affect the shoulders, such as gall bladder, heart, and liver diseases. The most common shoulder problems are fractures, rotator cuff tears, frozen shoulder, rotator cuff disease, dislocation, separation, and arthritis.

  • A fracture, which is commonly caused by excessive force on the bone due to a fall or a direct blow, typically involves the humerus and clavicle.

  • Rotator cuff tears are usually caused by over exertion of the arm muscles while playing sports or performing manual jobs that require heavy lifting or repetitive motions.

  • Frozen shoulders occur when they are not being used due to pain, disease, lack of fluid, or a growth of tissues that restrict their movement.

  • Rotator cuff diseases, such as bursitis and tendinitis, result in the inflammation of the tendons, which is excruciatingly painful and may even require surgical treatment.

  • Dislocations are a common problem and they occur when the ball in the shoulder pops out of its socket. This is a painful condition that is treated by pushing back the ball in. The shoulder will also be demobilized for a few days. It’s highly likely that a dislocation will happen again in the future.

  • Separation - If the ligaments that hold the collarbone and shoulder blade together are torn, the condition is referred to as a separation. If the tear is severe, it will likely need to be repaired through surgery.

  • Arthritis - Osteoarthritis or rheumatoid arthritis can affect the shoulders. Osteoarthritis is characterized by the wear and tear of a cartilage, while rheumatoid arthritis is an autoimmune disorder that affects the joints.

Key Symptoms

The most common symptoms of shoulder problems are pain, redness, and swelling. The arm movement is also typically restricted. In severe cases, the arm may be totally immobilized to a point that even a small movement will cause severe pain. If you’re unable to move your arms due to a painful shoulder, you should see your doctor as soon as possible. However, if you believe that you may have fractured your shoulder, calling emergency medical services or going to the nearest hospital emergency department is your best option. Fractures are considered medical emergencies and require immediate treatment.

Who to See & Types of Treatment Available

If you’re experiencing shoulder pains or restricted movement of the shoulders, your family doctor should be able to diagnose the condition. Some shoulder problems can be treated with rest, ice, and pain medications. If the problem is severe, your doctor may need to refer you to a specialist and/or surgeon for further diagnosis and treatment.

Your medical history will be reviewed and a physical examination will be conducted to evaluate your condition. Imaging tests, such as an X-ray, MRI, or CT-scan may also be requested to determine the cause and extent of the problem. Other tests may include an electromyogram (EMG) to evaluate nerve function, and an arthrogram to get a better picture of the muscles and tendons. If the tests provide inconclusive results, an arthroscopy, which is a surgical procedure to look inside the joint using a fiber-optic camera, will also be performed.

Once the diagnosis has been made, the diagnosing physician will immediately formulate the best and most appropriate treatment plan, which will be based on your condition and its severity. Treatment of shoulder problems typically includes the use of medications to control the pain. Patients are also usually advised to rest and to refrain from placing any stress or pressure on the shoulder. In some cases, the doctor may opt to use a sling to prevent excessive movement.

In severe cases, such as in the case of a dislocated shoulder or the presence of a rotator cuff tear, the primary course of treatment is surgery. There are different surgical procedures performed to treat these conditions. The doctor will choose which one to perform based on the extent and location of the damage. In cases wherein surgery cannot repair the damage, the doctor may advise the patient to undergo a shoulder replacement procedure, which involves replacing the damaged ends of the scapula (shoulder bone) or the humerus. In some cases, the doctor may need to install plastic or metal components to reconstruct the shoulder.

References:

  • DeLee JC, Drez D Jr, Miller MD, et al. Shoulder. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2009:chap 17.

  • Greiwe RM, Ahmad CS. Management of the throwing shoulder: cuff, labrum and internal impingement. Orthop Clin North Am. 2010;41:309-323.

  • Krabak BJ, Banks NL. Adhesive capsulitis. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Elsevier Saunders; 2008:chap 10.

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