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Shoulder Pathologies

Learn about different shoulder conditions, their symptoms and treatment options.

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MGF Notes

Practical summary of the shoulder in primary care: examination, key tests, instability and imaging.

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Rotator cuff injuries

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of the humerus firmly positioned in the glenoid cavity. Rotator cuff injuries can cause a dull ache in the shoulder, which often worsens when using the arm away from the body. Rotator cuff injuries are common and increase with age. They may occur earlier in people whose professions require repetitive overhead movements.

Common Symptoms

  • Pain at rest and at night, particularly if lying on the affected shoulder
  • Pain when lifting and lowering your arm or with specific movements
  • Weakness when lifting or rotating your arm
  • Crackling sensation when moving your shoulder in certain positions

Treatment Options

  • Rest and activity modification
  • Physical therapy
  • Medications for pain and inflammation
  • Steroid injections
  • Surgical repair for severe tears

Shoulder Instability

Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse. Once a shoulder has dislocated, it is vulnerable to repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability.

Common Symptoms

  • Pain in the shoulder
  • Repeated shoulder dislocations
  • Repeated instances of the shoulder giving out
  • A persistent sensation of the shoulder feeling loose, slipping, or 'hanging'

Treatment Options

  • Physical therapy to strengthen shoulder muscles
  • Activity modification to avoid positions that provoke instability
  • Bracing to restrict movement and prevent dislocation
  • Surgical repair for recurrent instability

Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years. Your risk of developing frozen shoulder increases if you are recovering from a medical condition or procedure that prevents you from moving your arm.

Common Symptoms

  • Dull or aching pain in the shoulder
  • Limited range of motion
  • Stiffness in the shoulder
  • Difficulty with everyday activities such as reaching, dressing, or sleeping

Treatment Options

  • Anti-inflammatory medications and pain relievers
  • Range-of-motion exercises
  • Corticosteroid injections
  • Physical therapy
  • Surgical intervention in severe cases

Arthritis or osteoarthritis of the shoulder

Arthritis is inflammation of one or more of your joints. The most common types of arthritis in the shoulder are osteoarthritis, post-traumatic arthritis, and rheumatoid arthritis. Osteoarthritis is a degenerative condition that destroys the smooth outer covering (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing friction, pain, and limiting range of motion.

Common Symptoms

  • Pain that worsens with activity and improves with rest
  • Limited range of motion
  • Stiffness in the shoulder joint
  • Swelling and tenderness around the joint

Treatment Options

  • Pain relievers and anti-inflammatory medications
  • Physical therapy and exercise
  • Corticosteroid injections
  • Shoulder replacement surgery for advanced cases

Labral Tears (SLAP Lesions)

The labrum is a piece of fibrocartilage (rubbery tissue) attached to the rim of the shoulder socket that helps keep the ball of the joint in place. When this tissue is torn, it is called a labral tear. A specific type of labral tear is called a SLAP lesion. SLAP stands for Superior Labrum Anterior and Posterior. In this injury, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum.

Common Symptoms

  • Pain with overhead activities
  • Catching, locking, popping, or grinding sensation
  • Decreased range of motion
  • Feeling that the shoulder is unstable
  • Loss of strength

Treatment Options

  • Rest and activity modification
  • Physical therapy
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Arthroscopic surgery for significant tears

Biceps Tendonitis

Biceps tendonitis is an inflammation of the tendon that connects the biceps muscle to the shoulder or forearm. The biceps muscle is in the front of your upper arm. It helps you bend your elbow and rotate your arm. It also helps stabilize the shoulder joint. Biceps tendonitis often develops gradually due to overuse or age-related wear and tear.

Common Symptoms

  • Pain or tenderness in the front of the shoulder that may worsen with overhead lifting or activity
  • Pain that moves down the arm
  • Clicking sound or sensation in the shoulder
  • Shoulder and arm weakness

Treatment Options

  • Rest and avoiding activities that aggravate symptoms
  • Ice to reduce pain and swelling
  • Physical therapy exercises
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Steroid injections
  • Surgery in severe or persistent cases