Arthritis of the Shoulder

As with all joints, movement of the shoulder is permitted by smooth cartilage that allows for minimum friction when the joint moves. Unfortunately, as a result of injury, wear and tear, and other conditions, arthritis can develop when that cartilage breaks down. Cartilage doesn’t heal when damaged, so the body attempts to heal by making more bone, resulting in irregular joints and/or bone spurs. Arthritis is often accompanied by dull pain with motion or activity, which may progress over time, as well as weakness or loss of mobility. In order to relieve pain and restore function, we start with conservative approaches like physical therapy or steroid injections. If these treatments fail to provide relief, surgery may be necessary.

Biceps Tendon Tear

The biceps muscle is at the front of the upper arm, helping to bend your elbow and rotate your arm. The biceps tendons attach this muscle to bones in the shoulder and elbow. A biceps tendon tear occurs when the tendon separates from the bone, either partially or completely, which can occur at either the elbow or at the shoulder. A complete tear means the muscle has completely detached from the bone, and a partial tear means the tendon has been damaged and is at risk of tearing, or has not fully detached from the bone. A biceps tendon tear is often caused by overuse with repetitive motions of the shoulder or elbow, injury, or heaving lifting. Signs of a torn biceps tendon can include sharp pain at the shoulder or elbow, bruising on the upper arm or forearm near the elbow, weakness in the shoulder or elbow, or trouble rotating the arm. Symptoms can often be relieved with conservative treatments like physical therapy or steroid injections, and many with a torn biceps tendon can still function normally. To fully fix the torn tendon, surgery may be necessary. Tears at the elbow level more often require surgery.

Clavicle Fracture

A clavicle fracture is a break in the collarbone, which is one of the main bones in the shoulder. The clavicle connects your arm to your ribcage. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it breaks. Signs and symptoms of a clavicle fracture can include pain, swelling, bruising, inability to move the shoulder, grinding, and limited range of motion. The most common causes of clavicle fractures include falls, sports injuries, and trauma from a motor vehicle accident. Most clavicle fractures can be treated without surgery. Surgery may be necessary when there is a compound fracture involving multiple bone structures, if the fracture has broken through skin, or the bone is severely out of place.

Labrum Tear

The labrum is the cup-shaped cartilage that lines the ball-and-socket shoulder joint, providing cushioning support to the glenoid and the humerus, or the shoulder socket and the head of the upper arm bone. The labrum has two functions: 1.) deepen the shoulder socket to the ball, for the humerus to stay in place, and 2.) attach to other structures or tissues around the joint. Because of its role in the shoulder joint, the labrum can be torn a few different ways through trauma or injury to the shoulder. One type of labral tear is called a SLAP tear (Superior Labrum from Anterior to Posterior), which is a tear where the tendon from the bicep connects to the shoulder. Another type of tear, a Bankart tear, occurs when the shoulder is dislocated. Signs of a labrum tear, depending on what type, include shoulder instability, shoulder dislocation, pain, catching, locking, popping, or grinding, decreased range of motion, and loss of strength. Many labrum tears can be treated by managing pain symptoms with physical therapy, medication, and other conservative treatments. In some cases, surgery may be necessary. 

Rotator Cuff Tear

The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement of the arm. Rotator cuff tears are fairly common, in which these tendons and muscles may become torn or damaged due to injury or overuse. These tears are characterized by either full thickness or partial thickness, depending on severity; a full-thickness tear extends from the top to the bottom of a muscle or tendon, and a partial-thickness tear affects a portion of the muscle or tendon, not extending all the way through. While some tears can be treated without surgery, most patients with a rotator cuff tear will undergo a rotator cuff repair. When left untreated, a rotator cuff tear can cause severe pain and a decrease in the ability to to use the arm. Symptoms include pain and swelling in the front of the shoulder, pain triggered by raising or lowering the arm, a clicking sound when raising the arm, stiffness, and a loss of mobility and strength. 

Shoulder Dislocation

The shoulder joint employs a ball-and-socket mechanism, with the round top of the arm bone, or the humerus, fitting into a groove in the shoulder blade. A shoulder dislocation occurs when the humerus leaves the shoulder joint and the two bones are separated. The shoulder can dislocate in a few different ways; in an anterior dislocation, the bone moves forward and downward, often the result of falling on  an outstretched hand or on the shoulder itself. In an posterior dislocation, the bone moves backward; this type of dislocation may be caused by a direct blow to the front of the shoulder. As the most mobile joint in the body, the shoulder is the most likely to be dislocated. Symptoms of a shoulder dislocation include pain in the upper arm and shoulder, which can worsen with movement, swelling, bruising, and deformity of the shoulder. Following a shoulder dislocation, your surgeon may perform a reduction, in which the upper arm bone is moved back into the shoulder joint. The shoulder will then be immobilized with a sling while the injury heals. If non-surgical treatment does not restore mobility to the shoulder, surgery may be necessary. 

Shoulder Impingement

Shoulder impingement describes the process in which the tendons of the rotator cuff become pinched, or impinged, by bone or the bursa. In the shoulder, a lubricating sac called a bursa is situated between the rotator cuff and the top of the shoulder, or the acromion. Shoulder impingement occurs often with repetitive overhead motion, like painting, construction, swimming, etc. When the arm is raised to shoulder height or above, the space between the acromion and rotator cuff narrows, and if the acromion rubs against the tendon and bursa, irritation and pain can arise. Symptoms of shoulder impingement include weakness of the shoulder muscles, pain with overhead use of the arm, and/or difficulty reaching up behind the back. Treatment of shoulder impingement can include anti-inflammatory medications, steroid injections, and physical therapy. Surgery may be considered if conservative treatments don’t provide relief.

Shoulder Tendonitis

Inflammation of the muscle tendon is called tendonitis, and usually results when the tendon is being pinched by surrounding structures. Tendonitis of the shoulder typically occurs in the subacromial space, which is located at the top of the shoulder, formed by the coracoacromial arch. The chief tendons of the shoulder, the rotator cuff, and the long head of the biceps pass under this arch. Reduction of this space due to inflammation of the tendons creates a high risk of friction, rubbing, and irritation, setting the stage for tendonitis. While most cases of tendonitis occur in patients ages 40-60, the condition is also seen in young athletes. Symptoms of tendonitis can include pain with shoulder movement, tenderness or tightness, difficulty sleeping, difficulty with everyday tasks, and increased weakness or swelling. Treatment options can include physical therapy, steroid injections to reduce the inflammation, and surgery where conservative treatment doesn’t provide relief.