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One of the most common injuries that bring patients into the urgent care is related to the shoulder.
The shoulder is an inherently unstable joint. The glenoid is shallow, allowing for a wide range of motion, with only a small portion of the humeral head articulating with the glenoid in any position. The anatomy of the shoulder allow for increased mobility, but also predispose the shoulder to increased risk of injury.
There can be numerous causes for shoulder pain, some of which are presented here.
Shoulder Impingement Syndrome: This occurs when the tendons of the rotator cuff and the subacromial bursa (a fluid-filled sac that separates the bones of the shoulder joint) are compressed between the bones of the shoulder. Doing work with the arms outstretched overhead can cause shoulder soreness but does not necessarily lead to impingement. Shoulder impingement is only diagnosed when symptoms continue and interfere with normal daily activity. Chronic impingement can lead to bursitis, rotator cuff tendinopathy, and if left untreated, thinning or tearing of the rotator cuff tendons.
Separated Shoulder: A separated shoulder is a condition that causes shoulder pain and swelling. It happens when certain ligaments in the shoulder joint tear or get stretched too much. Ligaments are strong bands of tissue that connect bones to other bones. The shoulder joint is made up of 3 bones: The collar bone, the shoulder blade, and the upper arm bone. The most common cause of a separated shoulder are falling on the shoulder or getting hit in the shoulder.
Biceps Tendonitis: Tendons are tough bands of tissue that connect muscles to bones. Repetitive activities and overuse can injur tendons leading to pain and impaired function. The biceps muscle is located in the front of the upper arms, and is used when lifting, bending the elbow, and reaching up over the head. The upper portion of the biceps muscle attaches to the front of the shoulder in two places and the lower portion attaches to the bone in the forearm. Lifting, pulling, reaching or throwing repeatedly can lead to biceps tendinopathy or even tears of the upper biceps tendon.
Frozen Shoulder: The term used to describe a stuff shoulder joint that has temporarily lost the ability to move freely; most people with frozen shoulder have difficulty reaching overhead and reaching to the low back. The stiffening is the body’s natural response to inflammation that develops in or near the shoulder. Stiffening is a protective reflex that protects the shoulder from further injury.
Rotator Cuff Injury: The rotator cuff is made up of 4 shoulder muscles and their tendons. One common injury is tendinopathy, and that is when people have a problem with 1 of their tendons. In most people with tendinopathy, the tendons are not inflamed or swollen. If they do get inflamed or swollen, doctors call it “tendonitis”. Another type of rotator cuff injury is a tear in a tendon. Tears can happen if a person falls on the shoulder or moves the shoulder too fast and with too much force. Tears can also happen as a tendon wears out over time.
Shoulder Arthritis: Fortunately, arthritis of the shoulder progresses slowly and is an uncommon problem. In almost every case, the shoulder has been injured months or years earlier, leading to an abnormal wearing down of the cartilage.
Shoulder Dislocation: Anterior dislocation of the shoulder is a painful condition that is usually caused by a blow to the abducted, externally rotated and extended arm (eg, blocking a basketball shot). Less commonly, a blow to the posterior humerus or fall on an outstretched arm can cause an anterior dislocation. Posterior shoulder dislocations are rare and are only about 2% of shoulder dislocations caused from a blow to the anterior portion of the shoulder.
Shoulder pain treatments are tailored specifically towards the cause of the patient’s pain. Shoulder dislocations are usually treated by re-locating the shoulder joint after x-ray examination to rule out fracture of any of the bones of the shoulder. Dysfunction of the tendons or ligaments of the shoulder are often treated with physical therapy, anti-inflammatory and pain medications and sometimes surgery.
Immobilization: Depending on the type of injury, a shoulder sling may be recommended to help reduce pain and help with healing. The patient should be careful not to remain in the sling for too long because the risks of frozen shoulder (ie. adhesive capsulitis) increase with shoulder immobilization.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO