The Shoulder

It enables us to do everything from tossing a basketball to sweeping the floor. The shoulder, according to the American Physical Therapy Association (APTA), is the most flexible joint in the human body. Unfortunately, this flexibility, APTA says, can cause shoulder instability, and in turn, several painful shoulder problems. About 4 million people each year need medical attention for shoulder problems, according to the American Academy of Orthopaedic Surgeons.

Shoulder structure

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the shoulder joint is made up of three bones:

• clavicle (collarbone)
• scapula (shoulder blade)
• humerus (upper arm bone)

The bones are held in place by muscles, tendons and ligaments. There are a pair of joints that facilitate shoulder movement. The first is at the highest point of the shoulder blade where it connects to the collarbone. It is called the acromioclavicular joint. The second is called the glenohumeral, it's the ball and socket joint most of us call the shoulder joint.

Shoulder problems

Several factors are involved in shoulder disorders. APTA says the following are often to blame:

• the aging process
• overuse of the joint (Read about "Repetitive Stress")
• too little use of the joint
• injury or trauma

Athletes, according to APTA, like baseball players, swimmers and tennis players have a higher risk of developing shoulder problems. (Read about "Avoid Sports Injury")

AAOS says shoulder problems can generally be classified as either:

• Impingement - Impingement results from pressure on the rotator cuff as the arm is lifted. It is a common cause of shoulder pain, swelling, tenderness and reduced mobility. Impingement pain can be caused by inflammation, tears or other problems.
• Instability - Instability results when one of the shoulder joints is out of normal position. The shoulder may feel like it is out of place, and there may also be pain when the arm is raised.

Below find information about problems that can develop in our shoulders.

Dislocation

The shoulder joint is dislocated more frequently than any other major joint in the human body, according to the NIAMS. Usually, a strong force pulls the shoulder forward, backward or downward. Sometimes the joint pops the ball of the humerus right out of the shoulder socket. Dislocation can be either partial or complete. Both these types of dislocation can cause symptoms, including:

• pain
• instability
• swelling
• numbness
• weakness
• bruising
• muscle spasms

Dislocation can be seen on an x-ray. (Read about "X-rays") Treatment involves placing the ball back in the joint socket. This is followed by rest, and then rehabilitation.

See treatments and rehabilitation below.

Separation

Shoulder separation occurs when ligaments holding the collarbone and shoulder blade are partially or completely torn. NIAMS says falling on an outstretched hand or a blow to the shoulder usually causes this injury. The injury can be as mild as a sprain that results in a limited amount of pain. (Read about "Sprains") Or it can involve an actual tear to the ligament, which can be extremely painful and debilitating. Treatment depends on the extent of the injury. It may involve rest, ice and medications. If a complete tear is causing the problem, surgery may be considered, followed by rehabilitation. (Read about "Rehabilitation")

See treatments and rehabilitation below.

Tendinitis and Bursitis

Tendinitis is one of the most common shoulder problems according to APTA. It is the inflammation of a tendon. NIAMS says repeated motion or the aging process may also irritate and wear down tendons. Tendinitis is often accompanied by the inflammation of the bursa sacs. An inflamed bursa is called bursitis.

(Read about "Tendinitis and Bursitis")

See treatments and rehabilitation below.

Torn Rotator Cuff

The rotator cuff is a group of muscles and tendons that surround the shoulder joint. The American Academy of Family Physicians (AAFP) says a torn rotator cuff is a common cause of shoulder pain. It often starts when a tendon of the rotator cuff becomes inflamed. AAFP says the pain is usually felt when you try to lift something or raise your arm. You may also notice it at night. Tears in the cuff can come from the progressive worsening of tendinitis, overuse and strain. (Read about "Strains")

Initial symptoms of a rotator cuff injury can include:

• pain when lifting or lowering the arm
• weakness in the arm
• a cracking sensation

Over time, the pain may increase until it is present even when the arm is not being used. A rotator cuff injury is diagnosed with imaging studies, including x-rays, MRI and ultrasound (Read about "X-rays" "MRI - Magnetic Resonance Imaging" "Ultrasound Imaging") If the pain is not too severe, treatment options can include rest, ice and medications to relieve the pain and inflammation. Steroid injections may be used as well. If pain is severe, surgery may be needed. Depending on the extent of the injury, a tendon may simply need to be smoothed, or it may actually need to be reattached to the bone. Surgery can be arthroscopic or open surgery may be needed, again depending on the extent of the injury. Once the pain is better, a period of rehabilitation is also important.

See treatments and rehabilitation below.

Arthritis

Arthritis is a degenerative disease. According to NIAMS, two types of arthritis can affect the shoulder. They are osteoarthritis, which is usually caused by wear and tear and rheumatoid arthritis, which is an inflammation of one or several joints. Arthritis can also affect muscles, tendons and ligaments.

(Read about "Arthritis and Rheumatic Diseases" "Osteoarthritis" "Rheumatoid Arthritis")

See treatments and rehabilitation below.

Fracture

According to NIAMS, a fracture usually involves the clavicle or the neck of the humerus. The break in a bone usually occurs because of an impact like a fall or hit.

(Read about "Bone Fractures")

See treatments and rehabilitation below.

Frozen Shoulder

If you suffer from a frozen shoulder chances are you can hardly move your shoulder. Frozen shoulder is very common, affecting two percent of the population according to AAOS. Although the exact cause is not clear, frozen shoulder involves a thickening of the capsule that surrounds the shoulder. The condition, also called adhesive capsulitis, can result when the joint is immobilized for an extended period of time. For example, it is often caused by an injury that leads to under use because of pain. Other risk factors for frozen shoulder, according to NIAMS, include diabetes, stroke, accidents, lung disease and heart disease. (Read about "Diabetes" "Stroke" "Chronic Obstructive Pulmonary Disease" "Coronary Heart Disease")

Symptoms of frozen shoulder include:

• pain
• stiffness
• restricted movement.

Diagnosis is usually made on the basis of symptoms, although imaging tests such as x-rays and MRI can be used to rule out other conditions. (Read about "X-rays" "MRI - Magnetic Resonance Imaging") Frozen shoulder can often heal on its own without surgical intervention. Medications for pain are helpful. Rehabilitation, with stretching and range-of-motion exercises, is also a key part of treatment. (Read about "Rehabilitation") If frozen shoulder does not go away, even after extensive rehabilitation, surgery and manipulation may be needed to treat the joint capsule.

See treatments and rehabilitation below.

Treatments and Rehabilitation

Treatments for a shoulder problem will, of course, depend on the exact nature of the injury. A doctor could recommend some or all of the following, according to NIAMS:

• apply heat or cold to the sore area
• take medicine to relieve pain and inflammation (Read about "Medicine Safety")
• electrical stimulation of muscles and nerves
• ultrasound (Read about "Ultrasound Imaging")
• a cortisone injection near the inflamed area

The patient may need to wear a sling for a few days in some cases.

Exercises may be added to the treatment program to build flexibility and strength and restore the shoulder's function. If there is no improvement with these conservative treatments, the doctor may - for some problems - perform surgery. Surgical options include:

• Arthroscopic surgery - An arthroscope is a thin device with lights and a small camera lens at the end. It is inserted through a small incision in the skin. The camera magnifies the scene and displays it on a television screen. If repair work is needed, the doctor can use other small instruments and other small incisions to repair the damage. (Read about "Arthroscopy" "Endoscopy")
• Open surgery - Traditional open surgery may be needed for some shoulder problems.
• Shoulder replacement - In some cases, such as severe arthritis, the shoulder may need to be replaced (Read about "Joint Replacement" "Joint Resurfacing")

You should discuss the risks and benefits of the different types of surgery with your doctor.

Rehabilitation

Whether your treatment involves medication, surgery or exercise, APTA says a physical therapist will likely be involved in all phases of your shoulder's rehabilitation. (Read about "Rehabilitation") The goal of therapy is to increase your strength, and regain motion. In the past several years, APTA says there has been a shift in the approach to rehabilitation. Today physical therapists make it a top priority to get you moving again. Keeping the shoulder immobilized, according to APTA, can cause weakness and atrophy. Always consult your doctor before taking part in a rehabilitation regimen. The following are some stretching and strengthening exercises your therapist may suggest, according to AAFP.

• Range of motion - Your therapist can show you how to lean over and carefully rotate the shoulder in large circles AAFP says this can help avoid the complication of rotator cuff injury.
• Rotator cuff strengthening - These resistance exercises involve using rubber tubing or light weights.
• Upper extremity strengthening - This can be achieved with the use of weight machines or free weights.
• Aerobics - This exercise program will help improve the blood flow to the tendon or bursa and reduce soreness.

Your physical therapist, along with you physician can design a rehabilitation plan tailored to your shoulder condition. The goal, according to APTA, is to return you to normal activity as soon as possible with the skills to prevent this from happening again.

Related Information:

    Skeletal System

    The Knee

    Chronic Pain

    Avoid Sports Injury