Shoulder Problems

October 21, 2022by wahaj


Arthritis, an inflammatory disease make the shoulder joint stiff, painful and inflamed. Activities especially those that encompass raising arms are tough to execute. This disease itself is incurable but symptoms could be managed through proper treatment. Rheumatoid arthritis, osteoarthritis, and posttraumatic arthritis (occur after an injury like shoulder dislocation or bone fracture) are some of the types that distress the shoulder joint. Likewise, untreated rotator cuff tear and avascular necrosis (a condition where the blood supply to the humerus head is interrupted leading to bone death) gradually give way to shoulder arthritis.

The foremost symptom is pain that gradually aggravates with time, during certain activities, particularly at night, which brings about sleeping discomfort. Limited range of motion and snapping, grinding, or clicking sound is heard as shoulder move. A doctor will give a physical examination at first stance looking for weakness, range of motion through assisted and non-assisted arm movement, signs of previous injuries or surgery, tenderness, and pain when pressure is applied. X-ray is ordered to figure out if some other issue is sourcing pain.

Treatment could be carried through conventional as well as surgical ways. An orthopedist implies that giving up activities responsible for shoulder pain, resting the joint, physical therapy, steroid injections to the shoulder for instant relief, and oral medications are non-surgical solutions. Whereas arthroscopic surgery is instigated to clean out the shoulder joint. To treat crucial cases shoulder joint replacement surgery is opted under which either the humerus head is replaced by a prosthetic one or the total joint replacement is conceived. Keeping in view persisting condition reverse shoulder arthroplasty is also an option where the position of ball and socket is reversed, a ball is attached to shoulder bone while a socket to the upper arm bone.


Bursa, the fluid-filled sac acts as a cushion to prevent friction between soft tissues and bones. Increased friction and repetitive use of the shoulder could stress out the bursa leaving it inflamed and swelled. This condition is referred to as bursitis which causes swelling, stiffness, and sharp pinching shoulder pain when arms are raised overhead for work. The medical consultant looks for swelling and checks the range of motion by moving the arm. X-ray, MRI or CT scan is ordered to scrutinize internal condition. For infection prevalence, fluid from the affected bursa is extracted using a needle to set out for laboratory tests.

Mild bursitis could be treated non-surgically through physical therapy, and rest. Oral medicines are prescribed to ease pain and inflammation. Severe pain is managed by injecting steroids to the shoulder as it imparts instant relief and certain antibiotics are recommended if an infection is spotted. Irrepressible symptoms need surgical maintenance for which arthroscopy is performed making a small incision for removing damaged tissues irritating bursae or excessive fluid from bursae is removed to make space for easy gliding of joint. In situations where just fluid suction is not enough to relieve pain, surgical removal of the bursa becomes essential, but in seldom cases.


High mobility of the shoulder joint upsurge its vulnerability to dislocate. A dislocation results when a ball attached to the upper arm bone is forced out of the socket in a shoulder bone. Medical assistance helps to relocate a displaced joint and prevent future dislocation. Joint deformity could be viewed through the naked eye, swelling, bruising, pain and immobility are easy to recognize symptoms. A patient may also face numbness, weakness, tingling sensation, and shoulder muscles spasm. Contact sports, hard hit to shoulder joint like in a vehicle accident and sudden fall is leading reasons for dislodgment.

Visible signs could be inquired through physical examination where an orthopedist look for tender areas, swelling and deformity. He tries to move the shoulder to check immobility issues then prescribe an x-ray to verify inner damages inspecting bone fractures and soft tissue injuries. The doctor will try to gently relocate the bone through external pressure. Depending on pain intensity a sedative, painkiller or general anaesthesia may be administered before bone manipulation. Surgery opts when the future dislocation is likely to reoccur. It imparts essential strength and helps to repair affected blood vessels or nerves. The Joint is immobilized using a splint, cast or brace for a time being to heal properly. Painkillers and anti-inflammatory medicines are advised for oral intake to ease discomfort. Afterwards, physical therapy is provided and the patient is urged to exercise joint for quick recovery and regain lost motion.

Frozen shoulder (adhesive capsulitis)

The shoulder joint and its components like bones, tendons and ligaments are enclosed within a layer of connective tissue referred to as the shoulder capsule. This capsule’s tightening and thickening around the shoulder joint limits the motion and trigger pain. The exact reason is not obvious but this condition is encountered among diabetic patients and those having their shoulder joint immobilized for long period like after a fracture or joint surgery. Experiencing shoulder pain and limited range of motion are prominent symptoms.

Diagnosis is based on the evaluation of joint movement through active and passive range of motion. The patient is asked to move the shoulder joint then the doctor himself check the range of motion by moving the patient’s arm. He may also inject anaesthetic medicine into the shoulder for painless physical assessment. Although signs are apparent, however subsiding other suspects through imaging tests like x-rays or MRI is mandatory to build a specific treatment strategy.

Painkillers and anti-inflammatory medicines are prescribed to relieve pain. Physical therapy and exercises are guided by experts in the field to improve the range of motion. In a few cases, the doctor may unconscious the patient through anaesthesia or relaxant and move his shoulder joint to lose a tightened capsule. Frozen shoulder usually eases naturally on its own within 12 to 18 months but if a condition still exists surgical procedures are considered under which steroid injections are inoculated into the shoulder for quick pain relief initially. Joint distension is another way for treatment by introducing sterile water into the shoulder capsule for stretching tissue to bring about stress-free joint motion. As a last resort repairs are made arthroscopically to resolve unruly frozen shoulder matter. 

Impingement syndrome

Shoulder impingement originates as a rotator cuff rubs against the top of a shoulder bone known as the acromion. The rotator cuff supports shoulder rotation and arm lifting, pressure over this thick band of muscles bring about pain and irritation. With repetitive use, tendons connecting the rotator cuff becomes swollen and catch on the acromion. This illness is most witnessed in swimmers, athletes and those who frequently use shoulder joints. Symptoms perceived encompasses pain while moving arms upward or backwards which gradually turns into slight consistent pain in the arm. Affected arm and shoulder felt weak with the pain voyages from shoulder front to the side of the arm. The pain usually aggravates at night causing sleeping disorders.

On consultation, an orthopedist figures out the reason through discussion over routine activity. He may ask for medical history to see the status of past injuries if any. The patient is made to move his affected shoulder in variable directions to spot unusual motion. To rule out other reasons like bone spur or arthritis that could be a reason to impingement imaging tests such as x-ray or MRI for more detailed internal visuals is ordered.

Various treatment methods can be implied depending on the austerity of impingement. Home care is advised with shoulder immobilization through a brace or splint for mild ones. Rest from shoulder stressing activities helps to improve. The doctor will guide physical therapy, practicing helpful exercises to regain muscles strength and joint motion. Oral medicines to relieve pain and inflammation is prescribed. Severe conditions lead to arthroscopic surgery creating room for an unhindered motion of the rotator cuff. Surgical repairs are made to the rotator cuff in case of tears.

Loose or foreign bodies

A trauma, injury especially sports injuries could collapse shoulder cartilage dislodging its fragments. These pieces may get trapped in a thin membrane around the shoulder joint called synovium. Many of the patients feel no symptoms, but in others, it can lock the joint inducing pain, causing instability and restricting the joint’s range of motion. An orthopedist at first-hand diagnoses through physical examination by moving shoulder joint to see if patient pain due to motion and also check a range of motion. Internal evaluation is conducted through imaging tests which gives clear image stranded loose bodies.

Minor cases where fragments are not painful could be handled through medicines while severe ones need to be addressed surgically. Arthroscopic procedures let the surgeon observe fragments in real-time by insertion of the device through a pinhole while tools for surgery from other incisions. For large fragments, open surgery may also opt but surgeons prefer to break larger pieces into smaller components so can be removed arthroscopically due to its promising results and the patient’s quick recovery ahead. Arthroscopy minimizes the probability of arising complications as the procedure is made through a small incision.

Rotator cuff tear

The band of thick muscles and tendons around the shoulder is named a rotator cuff. Its role is vital in imparting stability to a shoulder joint and ensuring smooth gliding of the ball within the shoulder socket. The risk of such tears increases with growing age however people having repetitive use of the shoulder involving overhead activities like in construction work could get this ailment earlier in life. Further, rotator cuff tears can also occur in response to an injury or prolonged lifting of heavy-weight. Pain is the major sign that shows off as a dull and deep ache often causing sleeping discomfort. The patient feels weakness in the arm and difficulty in moving the shoulder backwards or even combing the hair.

Diagnosis includes strength appraisal by pressing the shoulder on various parts and checking mobility issues through arm movement in various directions. To clarify other suspects imaging tests like x-rays, MRI or more detailed CT-scan is conceived. The treatment plan laid down over condition prevails light issue could be sorted through rest, ice, and compression. Unbearable pain that is interfering with sleep and routine activities is handled through direct steroid inoculation into a shoulder. Physical therapy targeting rotator cuff are guided to practice at home for muscle flexibility and strength. Surgery is brought in as a last resort for repair including methods:

  • Open tendon repair to stitch back torn tendon through a larger cut.
  • A tendon transfer is made by extracting the nearest healthy tendon and fixing it in place of a damaged one that is tough to sew back.
  • Tendon repair through a small incision using an arthroscope.
  • Under crucial circumstances, shoulder replacement surgery is advised. With the advent of reverse shoulder arthroplasty, prosthetic joints could be stabilized more efficiently. Here the ball is attached to the shoulder blade and socket over the arm bone.

Rotator cuff tendinitis

Rotator cuff tendinitis is the Inflammation of tendons aiding shoulder movement. This disorder is also referred to as impingement syndrome. Tendinitis arises gradually with time if a person keeps his shoulder in a single position for long, sleep over the shoulder, lift heavy weights, do activities that involve lifting of arms overhead, or repetitively use shoulder joint. Sportspeople are more susceptible to such inflammation. Symptoms deteriorate slowly from mild interval pains to unceasing aches. Pain and swelling occur on the shoulder front and side of the arm, pain instigates as the arm is lifted or lowered, a clicking sound is heard while raising the arm, the joint becomes stiff, motion is restricted, and the arm becomes weak. Critical pain brings about sleeping discomforts that need prompt dealing.

An orthopedist presses on various shoulder areas searching for tenderness and pain. He may ask the patient to move his arm in different directions testing the range of motion. Further confirmation is made through internal imaging scans which verify tendinitis.

The abrupt requirement is to relieve pain and inflammation which is managed through rest, ice, compression and taking oral medicines to ease discomfort. Then, strengthening exercises are conducted under the supervision of a physical therapist to regain muscle flexibility and lost range of motion. Direct injection of steroids to the shoulder could provide fast relief in severe pain. The door is open to surgical repair if conventional methods are not advantageous. Arthroscopy through small incision preferably conceived however open surgery sets best for large tears but avoided as much possible. The torn tendon is sewn back to the bone or the tendon graft is fixed in place to regenerate.


A shoulder separation is the tearing of ligaments connecting collarbone to shoulder acromion. A hard contact, direct fall on the shoulder with force, vehicle accidents, and sports injuries are the prominent reasons for this disorder. Pain occurs at the instance of injury which restricts joint motion. Bruising appears with swelling ahead, tenderness could be felt over the injured area, and shoulder deformity may occur which is a notable sign while diagnosis. The doctor will explore the patient’s medical history inquiring about previous injuries and other health conditions. He physically observes the range of motion, and test muscles strength. An imaging test is ordered for verifications of the internal damages.

A treatment plan is built over the nature of an injury as mild ones could be treated within 2 to 12 weeks while extreme ones demand more time. The non-surgical strategy demands a sling for putting the shoulder in correct alignment while healing with Icing and medicine intake to reduce pain and inflammation. Patients are urged to rest properly and avoid lifting heavy weights a few weeks even after recovery. Surgical procedures are recommended for severe injuries under which the end of a collar is shaved so it doesn’t rub against the shoulder blade, ligaments are sewn back to the collarbone but if a tear is severe tendon graft is secure in place to deliver ground for ligament reconstruction.

Torn labrum

The labrum is soft cartilage in cup shape within the end of a shoulder socket providing a frictionless surface for smooth gliding of ball in it. Traumatic injuries like shoulder dislocation, torn tendons of biceps, or rotator cuff injuries and repetitive use of an upper arm, sudden fall over the outstretched arm, or hard hit to shoulder are leading reasons for such tears. With labral tear sensations like popping, grinding, catching and locking are observed with the pain while working. The shoulder becomes unstable, range of motion is limited, and weakness is felt in the arm. In a few instances, a patient feels like a shoulder joint will slip out.

Diagnosis is conducted through discussion over the medical history of a patient asking about past shoulder injuries. The range of motion, joint stability and pain through arm or shoulder movement is figured out. Scanning tests are performed to evaluate the inner thing. Labrum won’t show off in x-ray but it helps to elaborate other damages. Labrum tear is observed through more detailed imaging tests like MRI or CT-scan. If still unsatisfied the doctor will execute an arthroscopic diagnosis to examine as per his requirement with a tiny camera inserted through a small incision over the shoulder.

Slight tears heal on their own with proper rest. Anti-inflammatory medicines and painkillers are prescribed for relief. Under the observation of experts, physical therapy is provided to impart strength. However, surgical repairs are conducted for crucial tears. Cartilage fragments are removed through arthroscopy and necessary repairs are made so cartilage could heal naturally.

SLAP tears

The shoulder is a ball and socket joint that assists in arm movement. Cartilage or labrum is a soft tissue coverage over the socket which provides a frictionless surface for smooth movement of a ball within the socket. An injury could damage the cartilage, SLAP tears are one such injury that befalls to the top of a labrum where tendons of the biceps are connected. SLAP is the shortened form of Superior Labral tear from the Anterior to Posterior. Chronic injuries in sports comprising repetitive raising of arms overhead and sudden fall over outstretched arm could bring about such ailment. Growing age is another factor as cartilage become weak with passing time.

Some of the notable indications include pain induction when lifting arms overhead, keeping a shoulder in one position, and holding heavy things. The shoulder and arm felt weak, and the range of motion is restricted. Locating the exact point of pain is tough but it feels like a deep ache within the shoulder area. The movement will bring about popping, locking, grinding and clicking sensation. On a visit to a doctor, a shoulder is examined physically and later arthroscopically for clearer vision. The doctor will move a patient’s arm to see the severity of pain and range of motion. Arthroscopy reveals the particular reason to shoulder pain. However, medical history is overviewed and discussed to explore patients’ past health issues. The condition can be cured non-surgically through physical therapies, medications and rest. Arthroscopic repairs are made if results through conventional methods are not promising.


A shoulder fracture is a breakage to the shoulder blade, collar bone or arm bone which could be slight to severe. In some cases, it’s just bone-cracking while in others bone shatters into pieces calling for surgical repairs. High impact sports, vehicle accidents or a fall could fracture shoulder bones. Non-displaced or mild fractures could be treated through medicines, physical therapies to regain strength or to improve mobility, and rest by joint immobilization. Bones hold natural regeneration ability but abrasive fractures need surgery to promote healing in correct alignment. Through surgery bone fragments and damaged tissues are removed, bone is fastened to its place using surgical hardware, a bone graft may also be secured to trigger the bone healing process. The shoulder joint is immobilized using a cast, splint, or brace as the bone heals to sidestep misalignment and bone non-union complications.

Bruising, redness, swelling, shoulder deformity and tenderness are visible symptoms examined under physical evaluation. Shoulder instability or pain are other signs doctors discuss and observe through assisted and non-assisted shoulder movement. The internal view is made through scanning tests like x-rays for bones and tissues but to have a more detailed and in-depth examination CT-scan or MRI is demanded.

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