The Shoulder

Shoulder impingement, a common cause of shoulder pain, arises from inflammation in the fluid-filled sac (bursa) above the rotator cuff. This inflammation often results from the compression of the rotator cuff between the humeral head and the acromion bone.

Symptoms typically develop gradually and include pain during overhead activities or reaching behind the back. Unlike some shoulder conditions, strength loss is uncommon, and overall shoulder mobility is usually maintained.

Diagnosis is primarily through physical examination and X-rays, with MRIs used less frequently. Most patients improve with anti-inflammatories, physical therapy, and cortisone injections, though surgery is rarely needed.

Frozen shoulder is marked by a gradual loss of shoulder motion, often affecting women aged 40 to 60. Unlike other conditions, it usually isn't linked to trauma but instead develops slowly due to an unexplained inflammatory process that thickens the shoulder capsule, reducing mobility and causing pain. This condition is also associated with diabetes and thyroid disorders.

Symptoms start with general shoulder pain, progressing to significant motion restriction and pain, particularly at night. In later stages, pain decreases but movement remains severely limited, impacting daily activities.

Diagnosis relies on physical exams, as X-rays and MRIs are less useful. Treatment includes cortisone injections, anti-inflammatory medications, and physical therapy, with surgery considered if symptoms persist beyond three months.

Shoulder dislocations are traumatic events often caused by falls or forced shoulder movements, such as in contact sports. Dislocation occurs when the humerus bone moves out of its normal position, causing severe pain and immobility.

Immediate relocation of the shoulder is crucial to relieve pain and restore movement, confirmed by X-rays. Post-dislocation, a sling is used temporarily, followed by physical therapy to regain strength and range of motion.

Shoulder instability often follows an initial traumatic dislocation, leading to labrum tears. The labrum, a cartilage structure, provides stability, and its damage can cause recurrent dislocations.

AC separations, or shoulder separations, involve tearing ligaments around the collarbone, affecting the acromioclavicular joint. These injuries usually result from direct trauma, such as falls. Diagnosis is made via X-rays, and treatment depends on the injury grade, ranging from sling use for minor cases to surgical reconstruction for severe ones.

Osteoarthritis is the most common type of shoulder arthritis, affecting the glenohumeral and acromioclavicular joints. It results from age-related wear and tear, leading to cartilage loss, pain, and stiffness. Other causes include inflammatory conditions like rheumatoid arthritis and past injuries.

Symptoms gradually worsen over time, including pain and limited motion, sometimes accompanied by crepitus (grinding noises). Diagnosis is primarily through X-rays, with treatment options including physical therapy, cortisone injections, and in severe cases, shoulder replacement surgery.

Shoulder fractures, often resulting from falls or high-energy impacts, commonly occur in the collarbone or the upper humerus. These fractures require surgical evaluation, with treatment options including immobilization or surgery using plates and screws for stabilization.

SLAP (Superior Labrum from Anterior to Posterior) tears involve damage to the labrum, crucial for shoulder stability. These injuries are common in throwing athletes or those who fall on an outstretched arm. Symptoms include deep shoulder pain, weakness, and a clicking sensation. Diagnosis involves a physical exam and MRI.

Treatment starts with rest, physical therapy, and anti-inflammatories, with surgical repair considered if symptoms persist.

Biceps tendinitis, caused by repetitive arm use, leads to pain in the shoulder's front part. Diagnosis is through physical exams, with treatment including physical therapy, anti-inflammatories, and rest.

Biceps ruptures, where the tendon tears from its insertion point, can occur in athletes or older individuals. Symptoms include acute pain, reduced motion, and noticeable arm deformity. Treatment varies by age and activity level, ranging from surgery to physical therapy.

Calcific tendonitis involves inflammation and calcification of the rotator cuff tendons, often due to chronic irritation from subacromial impingement. Symptoms include pain, reduced motion, and a clicking sensation. Diagnosis is through X-rays and sometimes MRIs.

Treatment includes physical therapy, anti-inflammatories, and cortisone injections. In severe cases, newer treatments like shock wave therapy or surgical decompression may be considered.