Shoulder Injuries and Disorders
Your shoulders are the most movable joints in your body. They can also be unstable because the ball of the upper arm is larger than the shoulder socket that holds it. To remain in a stable or normal position, the shoulder must be anchored by muscles, tendons and ligaments. Because the shoulder can be unstable, it is the site of many common problems. They include sprains, strains, dislocations, separations, tendinitis, bursitis, torn rotator cuffs, frozen shoulder, fractures and arthritis.
Usually shoulder problems are treated with RICE. This stands for Rest, Ice, Compression and Elevation. Other treatments include exercise, medicines to reduce pain and swelling, and surgery if other treatments don't work.
What Causes Shoulder Problems?
Many shoulder problems are caused by the breakdown of soft tissues in the shoulder region. Using the shoulder too much can cause the soft tissue to break down faster as people get older. Doing manual labor and playing sports may cause shoulder problems.
Shoulder pain may be felt in one small spot, in a larger area, or down the arm. Pain that travels along nerves to the shoulder can be caused by diseases such as:
- Gallbladder disease
- Liver disease
- Heart disease
- Disease of the spine in the neck
Doctors diagnose shoulder problems by using:
- Medical history
- Physical examination
- Tests such as x rays, ultrasound, and magnetic resonance imaging (MRI)
The most common shoulder problems are:
- Dislocation
- Separation
- Rotator cuff disease
- Rotator cuff tear
- Frozen shoulder
- Fracture
- Arthritis
Dislocation
Dislocation occurs when the ball at the top of the bone in the upper arm pops out of the socket. It can happen if the shoulder is twisted or pulled very hard.
To treat a dislocation, a doctor performs a procedure to push the ball of the upper arm back into the socket. Further treatment may include:
- Wearing a sling or device to keep the shoulder in place
- Rest
- Ice three or four times a day
- Exercise to improve range of motion, strengthen muscles, and prevent injury
Separation
A shoulder separation occurs when the ligaments between the collarbone and the shoulder blade are torn. The injury is most often caused by a blow to the shoulder or by falling on an outstretched hand.
Treatment for a shoulder separation includes:
- Rest
- A sling to keep the shoulder in place
- Ice to relieve pain and swelling
- Exercise, after a time of rest
- Surgery if tears are severe
In tendinitis of the shoulder, tendons become inflamed (red, sore, and swollen) from being pinched by parts around the shoulder.
Bursitis occurs when the bursa a small fluid-filled sac that helps protect the shoulder joint is inflamed. Bursitis is sometimes caused by disease, such as rheumatoid arthritis. It is also caused by playing sports that overuse the shoulder or by jobs with frequent overhead reaching.
Tendinitis and bursitis may occur alone or at the same time. Treatment for tendinitis and bursitis includes:
- Rest
- Ice
- Medicines such as aspirin and ibuprofen that reduce pain and swelling
- Ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow
- Gentle stretching and exercises to build strength
- Injection of corticosteroid drug if the shoulder does not get better in the first few weeks
- Surgery if the shoulder does not get better after 6 to 12 months
Rotator cuff tendons can become inflamed from frequent use or aging. Sometimes they are injured from a fall on an outstretched hand. Sports or jobs with repeated overhead motion can also damage the rotator cuff. Aging causes tendons to wear down, which can lead to a tear. Some tears are not painful, but others can be very painful.
Treatment for a torn rotator cuff depends on age, health, how severe the injury is, and how long the person has had the torn rotator cuff. Treatment for torn rotator cuff includes:
- Rest
- Heat or cold to the sore area
- Medicines that reduce pain and swelling
- Electrical stimulation of muscles and nerves
- Ultrasound
- Cortisone injection
- Exercise to improve range-of-motion, strength, and function
- Surgery if the tear does not improve with other treatments
Movement of the shoulder is very restricted in people with a frozen shoulder. Causes of frozen shoulder are:
- Lack of use due to chronic pain
- Rheumatic disease that is getting worse
- Bands of tissue that grow in the joint and restrict motion
- Lack of the fluid that helps the shoulder joint move
- A doctor putting the bones into a position that will promote healing
- Medicines to reduce pain and swelling
- Heat
- Gentle stretching exercise
- Electrical stimulation of muscles and nerves
- Cortisone injection
- Surgery if the shoulder does not improve with other treatments
A fracture is a crack through part or all of a bone. In the shoulder, a fracture usually involves the collarbone or upper arm bone. Fractures are often caused by a fall or blow to the shoulder.
Treatment for a fracture may include:
- A doctor putting the bones into a position that will promote healing
- A sling or other device to keep the bones in place
- After the bone heals, exercise to strengthen the shoulder and restore movement
- Surgery
Arthritis can be one of two types:
- Osteoarthritis a disease caused by wear and tear of the cartilage
- Rheumatoid arthritis an autoimmune disease causing one or more joints to become inflamed
If these treatments for arthritis of the shoulder dont relieve pain or improve function, surgery may be needed.