Shoulder joint
The shoulder is a complex joint composed of three bones: the scapula (shoulder blade), clavicle (collarbone) and humerus (upper arm bone). The shoulder joint is a ball–and–socket joint, which allows for a wide range of movement, including flexion (bringing the arm forwards), extension (taking the arm backwards), abduction (lifting the arm away from the body) and rotation (turning the arm). The shoulder joint is supported by muscles, ligaments and tendons, including the rotator cuff and deltoid muscles. Shoulder pain is one of the most common complaints in the medical field and can be caused by a variety of factors. The most common causes of shoulder pain include tendonitis, bursitis, arthritis, rotator cuff tears, impingement syndrome, fractures and dislocations. Tendonitis is an inflammation of the tendons in the shoulder, and is often caused by repetitive overhead activities such as throwing or lifting. Bursitis is an inflammation of the bursa, a fluid–filled cushion that cushions the shoulder joint. Arthritis is an inflammation of the joint itself and can be caused.
Shoulder joint basic anatomy
The shoulder joint, also known as the glenohumeral joint, is a ball–and–socket joint located between the arm and the torso. It is the primary joint of the shoulder and allows for a wide range of movement. The shoulder joint is composed of three bones: the humerus, the scapula, and the clavicle. The head of the humerus fits into a shallow depression on the scapula known as the glenoid fossa. The joint is stabilized by a number of ligaments and muscles. The shoulder joint is surrounded by a joint capsule, which is made up of a fibrous membrane that is lined with synovial membrane. This membrane secretes synovial fluid, which lubricates the joint and helps with movement. The shoulder joint is also surrounded by several muscles that help to stabilize and move the shoulder. These muscles include the supraspinatus, infraspinatus, subscapularis, teres minor and major, and the biceps brachii. The shoulder joint is also stabilized by a number of ligaments, including the glenohumeral ligaments, the coracohumeral ligament
Common conditions affecting shoulder
Rotator cuff tear: This is a tear in one or more of the tendons or muscles that surround the shoulder joint. A rotator cuff tear can cause pain, weakness, and difficulty moving the shoulder. The rotator cuff is a group of muscles and tendons that surround the shoulder joint and help to move and stabilize the arm. A rotator cuff tear is a tear in one or more of these muscles or tendons. The rotator cuff can be torn as a result of an injury, such as a fall, or from repetitive strain, such as from throwing a ball or lifting weights.
Symptoms of a rotator cuff tear may include:
- Pain when lifting the arm or reaching overhead
- Weakness in the arm
- Difficulty sleeping on the affected side
- A crackling sensation when moving the shoulder
- A “dead arm” feeling
Rotator cuff tears can be treated with a variety of methods, including physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and surgery. The treatment will depend on the severity of the tear and the patient’s symptoms.
Frozen shoulder (adhesive capsulitis): This is a condition that causes the shoulder joint to become stiff and painful. It can be caused by injury or surgery, and it can also occur spontaneously. It is characterized by a tightening and thickening of the joint capsule, which is a sac of connective tissue that surrounds the shoulder joint. This thickening and tightening of the capsule can limit the movement of the shoulder joint, leading to stiffness and pain. Frozen shoulder is more common in people who are middle-aged or older, and it is more common in women than in men. It can also occur in people who have diabetes or who have had a stroke or a heart attack.
Symptoms of frozen shoulder may include:
- Pain, especially when moving the shoulder
- Stiffness, which may get worse over time
- Limited range of motion in the shoulder joint
Frozen shoulder can be treated with a variety of methods, including physical therapy, pain medication, and corticosteroid injections. In some cases, surgery may be necessary to release the tightened capsule and improve shoulder mobility.
Osteoarthritis: This is a degenerative joint disease that can cause pain, stiffness, and difficulty moving the shoulder joint.
Acromioclavicular (AC) joint arthritis is a type of osteoarthritis that affects the joint between the acromion (a bony projection on the shoulder blade) and the clavicle (collarbone). Osteoarthritis is a degenerative joint disease that causes the cartilage in the joint to wear away, leading to pain, stiffness, and difficulty moving the joint.
Symptoms of AC joint arthritis may include:
- Pain in the shoulder, especially when lifting the arm or reaching overhead
- Stiffness in the shoulder, especially after periods of inactivity
- Swelling or tenderness in the AC joint
- A grinding sensation when moving the shoulder
AC joint arthritis can be treated with a variety of methods, including physical therapy, pain medication, and corticosteroid injections. In severe cases, surgery may be necessary to repair or reconstruct the joint. The treatment will depend on the severity of the arthritis and the patient’s symptoms.
Subacromial impingement and Bursitis: This is an inflammation of the bursae (small fluid-filled sacs) in the shoulder joint. It can cause pain, swelling, and difficulty moving the shoulder.
Subacromial bursitis is an inflammation of the subacromial bursa, which is a small fluid-filled sac located under the acromion (a bony projection on the shoulder blade). It can cause pain, swelling, and difficulty moving the shoulder. Subacromial bursitis is often caused by repetitive strain injuries, such as from throwing a ball or lifting weights, or from poor posture.
Impingement syndrome is a condition that occurs when the tendons or bursae (small fluid-filled sacs) in the shoulder become compressed or pinched. This can cause pain, swelling, and difficulty moving the shoulder. Impingement syndrome is often caused by repetitive strain injuries or by structural abnormalities of the shoulder joint.
Symptoms of subacromial bursitis and impingement syndrome may include:
- Pain in the shoulder, especially when lifting the arm or reaching overhead
- Swelling or tenderness in the shoulder
- A clicking or cracking sensation when moving the shoulder
- Weakness in the arm
Treatment for subacromial bursitis and impingement syndrome may include physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and surgery. The specific treatment will depend on the severity of the condition and the patient’s symptoms.
Tendinitis: This is an inflammation of a tendon in the shoulder joint. It can cause pain, swelling, and difficulty moving the shoulder.
Dislocated shoulder: This occurs when the upper arm bone (humerus) is displaced from the shoulder blade (scapula). It can cause severe pain and difficulty moving the shoulder. This can cause the shoulder joint to become unstable and cause severe pain. Shoulder dislocations are usually caused by a fall or a blow to the shoulder, and they can also occur as a result of a sports injury.
Symptoms of a shoulder dislocation may include:
- Severe pain in the shoulder
- Inability to move the shoulder
- Swelling or bruising around the shoulder
- A visibly deformed shoulder
Shoulder dislocations should be treated as a medical emergency. The shoulder should be immobilized and the patient should be transported to a hospital for treatment. Treatment may include reducing the dislocation (putting the shoulder back in place), pain medication, and physical therapy. In some cases, surgery may be necessary to repair any damage to the joint.
Labral tear: This is a tear in the labrum, which is a ring of cartilage around the shoulder joint. It can cause pain, instability, and difficulty moving the shoulder. The labrum helps to stabilize the shoulder joint and allows for a range of motion. A labral tear can occur as a result of an injury, such as a fall or a car accident, or from repetitive strain, such as from throwing a ball or lifting weights.
Symptoms of a labral tear may include:
- Pain in the shoulder, especially when lifting the arm or reaching overhead
- A feeling of instability or “catching” in the shoulder
- Difficulty moving the shoulder through its full range of motion
- A popping or clicking sensation in the shoulder
Labral tears can be treated with a variety of methods, including physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections. In some cases, surgery may be necessary to repair or remove the damaged tissue. The treatment will depend on the severity of the tear and the patient’s symptoms.
A labral tear is a tear in the labrum, which is a ring of cartilage around the shoulder joint. The labrum helps to stabilize the shoulder joint and allows for a range of motion. A labral tear can occur as a result of an injury, such as a fall or a car accident, or from repetitive strain, such as from throwing a ball or lifting weights.
Symptoms of a labral tear may include:
- Pain in the shoulder, especially when lifting the arm or reaching overhead
- A feeling of instability or “catching” in the shoulder
- Difficulty moving the shoulder through its full range of motion
- A popping or clicking sensation in the shoulder
Labral tears can be treated with a variety of methods, including physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections. In some cases, surgery may be necessary to repair or remove the damaged tissue. The treatment will depend on the severity of the tear and the patient’s symptoms.
Shoulder arthroscopy
Shoulder arthroscopy is a surgical procedure in which a small camera (arthroscope) is inserted into the shoulder joint through a small incision. The arthroscope allows the surgeon to see inside the joint and diagnose or treat various conditions.
Indications for shoulder arthroscopy may include:
- Rotator cuff tear
- Frozen shoulder (adhesive capsulitis)
- Osteoarthritis
- Bursitis
- Tendinitis
- Labral tear
- Impingement syndrome
During the procedure, the patient will be placed under general or regional anesthesia. Small incisions will be made around the shoulder joint, and the arthroscope will be inserted through one of these incisions. The surgeon will use the arthroscope to visualize the inside of the joint and diagnose or treat the condition.
Complications of shoulder arthroscopy may include infection, bleeding, nerve or blood vessel injury, and stiffness or limited range of motion in the shoulder joint.
There are several different techniques that can be used during shoulder arthroscopy, including:
- Debridement: This involves removing damaged or diseased tissue from the shoulder joint.
- Repair: This involves suturing or repairing damaged tendons or ligaments in the shoulder joint.
- Reconstruction: This involves reconstructing or replacing damaged or diseased structures in the shoulder joint.
- Release: This involves releasing or stretching tight structures in the shoulder joint to improve mobility.