The shoulder has the greatest range of motion and is one of the most mobile joints in the body, but is also the most unstable joint. This makes it susceptible to injury.
Injuries to the shoulder can occur in bone, tendons, muscle and soft tissue. Some of the most common injuries seen by orthopaedic surgeons include:
Rotator cuff tear
– can be an acute tear from a fall onto an outstretched arm or from lifting a heavy object with the arm extended. Rotator cuff tears also developed from degeneration associated with age. Symptoms can begin from a spontaneous event or be a slow progressive progress. Complaints of pain, loss of mobility including reaching overhead, and weakness are common. Treatment is based on nature of the injury. Many can be treated non-surgically with rest, activity modification, NSAIDs, and physical therapy. Surgery may be required for larger tears and failure to improve with non-surgical treatment.
– similar to a rotation cuff tear, SLAP injuries can be from an acute, traumatic event or the degenerative type. This is a tear along the cartilaginous rim of the shoulder where the bicep tendon attaches. This is commonly seen in overhand athletes. Symptoms of a SLAP tear include a popping or catching type sensation, a dull throbbing ache, pain in certain positions, painful overhead activity, loss of range of motion, lack of strength, and feeling of instability. Treatment usually begins with non-surgical care including NSAIDs to decrease inflammation and physical therapy to improve function and strength. Surgery may be required to repair or debride torn labrum
– also known as a frozen shoulder. This condition can develop at any age but is most common in middle age. Significant stiffness becomes apparent limited range of motion and usually ac-companied by pain. There are many potential causes including the development of scar tissue from an injury, prolonged periods of immobilization of the shoulder, diabetes, and other medical conditions. Treatment involves the use of NSAID medication to decrease inflammation and aggressive physical ther-apy. Corticosteroid injections may be helpful for some. A surgical manipulation under anesthesia is an option for some who fail to improve.
– is a significant injury to the shoulder and commonly results from contact sports, falls onto outstretched arm and motor vehicle accidents. A sudden force combined with rotation of the shoulder results in the humeral head being pulled out of the glenoid. Associated injuries include the potential for tears to the surrounding muscles, tendons, and fibrocartilaginous rim. Neurovascular injury can also occur with this type of injury. The chances of re-dislocating is greater after the first occurrence. This is condition that does require immediate medical care by an orthopaedic surgeon. If the shoulder does not pop back into place on its own, reduction of the dislocation will need to be performed.
– a fall directly onto the shoulder can cause injury to the acromioclavicular joint (AC Joint). This joint is outside of the capsule of the shoulder and forms from the clavicle and acromion. A significant injury can result in the attached ligaments being torn thereby altering the alignment of the joint. Treatment is based on severity of the injury. In mild cases where there is a sprain or partial tear of the supporting ligaments, non-operative care is recommended. In cases where there is a complete tear with deformity of the joint, surgery may be required.
There are other injuries that can occur to the shoulder. Many are the result of arthritic conditions in which the supporting tendons, ligaments and soft tissue weaken with age and become more susceptible to injury.