Among the most mobile joints in the human body, healthy shoulders are crucial to our strength, balance and overall comfort in daily activities. Every year, more than 7 million people visit a doctor for a shoulder problem.
These problems can be caused by everyday activities such as swimming, tennis, cleaning and gardening. Injuries typically involve muscles, ligaments and tendons, but can also include fractures.
Fortunately, the experienced orthopedic specialists throughout the Crozer-Keystone Health System can identify, diagnose and treat shoulder issues of all varieties.
Common shoulder problems
Impingement is caused by excessive pressure on the shoulder muscles from the top portion of the shoulder blade. Impingement typically occurs during activities that require excessive overhead arm motion, and the friction can result in tendonitis or bursitis.
Injuries to the rotator cuff—the tendon and four shoulder muscles that hold the joint together—are very common, accounting for a large percentage of shoulder impingement cases.
Impingement symptoms include pain, local swelling, tenderness and stiffness. As the problem progresses without treatment, shoulder strength and range-of-motion may be limited.
Instability is caused when one of the shoulder joints is moved or forced (by injury) out of its normal position, sometimes resulting in dislocation of the shoulder joint.
The instability is felt most intensely when an affected individual raises their arm. They may also experience a sensation that the joint is “slipping out of place.”
Trauma is caused by a fall, impact from a heavy object or a high-speed car accident, and can result in a dislocation, fracture or soft-tissue injury (a tear of the ligament, tendon, muscle or joint capsule).
Shoulder dislocation pain is usually felt over the top of the shoulder. Some patients notice a prominent bump on the top of the shoulder
Individuals with shoulder fractures experience severe pain, swelling and bruising and an inability to move their shoulder.
- Osteoarthritis – “Wear and tear” arthritis that usually occurs in people over 50 years old.
- Rheumatoid arthritis – A systemic inflammatory condition that affects people of any age and can impact multiple joints of the body.
- Post-traumatic arthritis – A condition that develops after an injury, such as a fracture or rotator cuff tear.
The most common symptom of arthritis in the shoulder is pain, which can be aggravated by activity. Other symptoms include limited motion and pain that often changes with weather.
For most muscle and tendon injuries, shoulder exercises such as wall push-ups, shoulder press-ups and exercise band activities can help strengthen the shoulder and prevent further aggravation.
Anti-inflammatory medications or local injections of anesthetic or cortisone may also be prescribed to prevent pain and swelling. Many fractures and dislocations require resetting the joint or “putting it back in its socket.”
Arthritis can be treated with rest, physical therapy, ice and heat, anti-inflammatory and other medications.
When nonsurgical treatment doesn’t relieve pain, your Crozer-Keystone orthopedic physician may recommend surgery.
Surgeries are most often used for fractures that require fixation with plates, screws or rods inside the bone, or for dislocations that lead to soft-tissue injury.
Surgery is sometimes used to repair torn ligaments of the rotator cuff or to release impingement and create more space for the rotator cuff to move.
Surgical procedures such as joint replacement can also relieve arthritis pain and restore shoulder motion.
Shoulder spotlight: Rotator cuff injuries
Your rotator cuff is a group of muscles and tendons on your shoulder blade that connect to your upper arm bone. When the tendons of your rotator cuff tear, it can limit your ability to lift and rotate your arm.
Most rotator cuff tears are due to the natural wear and tear of the muscles and tendons from aging. Other causes can lead to injury, such as falling or being hit in the shoulder, and overuse of the muscles and tendons from activities that include lifting, painting and throwing.
Tears of the rotator cuff aren’t life-threatening, but can limit movement and cause severe pain. Even small shoulder and arm movements, like combing your hair, putting on a coat, or lifting groceries, can be difficult and cause pain.
People may also experience swelling from inflammation of the tendons. This can be the most common cause of pain. Also, rotator cuff tears may create a clicking, cracking or popping sound when the shoulder is moving, especially when lifting something heavy.
Patients can be treated for rotator cuff injuries nonsurgically and surgically. In most cases, nonsurgical treatment can provide pain relief and improve the shoulder’s function. Nonsurgical treatments may include rest and limited overhead activity, the use of a sling, anti-inflammatory medication, steroid injections, strengthening exercises and physical therapy.
Your orthopedic surgeon may recommend surgery if:
- Nonsurgical treatment doesn’t relieve symptoms
- The tear has just occurred and is very painful
- The tear is in the shoulder of the dominant arm of an active person
- Maximum strength in the arm is needed for overhead work or sports
If surgery is necessary, it can be done arthroscopically (inserting a scope and small instruments through a very small incision under video control), mini open repair (repairing through a small incision, typically 4 to 6 centimeters), and open surgical repair (traditional open surgical incision).