Diseases & injuries of the shoulder

Pain and limited function of the shoulder can have many different causes. Degenerative changes of the tendons or injuries of the shoulder lead to restricted range of motion and limited daily activities. Typical symptoms and problems are explained on this page.

In case of pain or limited function of the shoulder you should consult an orthopaedic shoulder specialist. Only with the correct diagnosis of the shoulder problem an adequate treatment can follow.

Problems of the shoulder & orthopaedic treatment

In osteoarthritis, a degenerative joint disease, the cartilage breaks down, causing pain, swelling and narrowing of the AC-joint space. Local pain over the lateral end of the collarbone limits horizontal movements of the arm.

Accurate injections into the AC-joint can calm the inflamed and painful joint.

In some cases, only arthroscopic surgery with removal of rubbing bone is effective in relieving pain.

In the healthy shoulder joint, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion. In osteoarthritis, a degenerative joint disease, the cartilage breaks down, causing pain, swelling and problems moving the shoulder joint.

Treatment in early stages of this chronic disease, consists of anti-inflammatory drugs, physical therapy and corticosteroid injections to manage the symptoms. Also, intra-articular injections with hyaluronic acid can be helpful.

In severe stages of osteoarthritis, a total shoulder replacement is the only solution to improve shoulder function.

Rotator cuff arthropathy is a combination of a massive chronic rotator cuff tear and glenohumeral cartilage destruction that is caused by superior migration of the humeral head. This leads to an increasing loss of function of the shoulder joint. Patients complain about pain, weakness and restricted range of motion.

In some cases, a reverse total shoulder replacement is necessary, where ball and socket of the shoulder joint are reversed.  This design leads to a much more stable shoulder joint that can function without a rotator cuff. The large deltoid muscle that covers the shoulder can more effectively lift the arm, providing a better function of the shoulder.

More information: http://orthoinfo.aaos.org/topic.cfm?topic=A00504

Impingement of the shoulder means that the space between the acromion and rotator cuff narrows and the acromion rubs against (or “impinge” on) the tendons and the bursa of the shoulder. Inflammation of the bursa (bursitis) and tendon (tendinitis) cause irritation and pain of the shoulder joint.

Non-surgical treatment consists of physical therapy, anti-inflammatory drugs and corticosteroid injections.

When non-surgical treatment does not relieve pain, a small surgical procedure might be helpful. An arthroscopic procedure creates more space by removing the inflamed portion of the bursa and the impinging bone spur of the acromion (subacromial decompression).

More information: http://orthoinfo.aaos.org/topic.cfm?topic=A00032

Calcifying tendinitis is a special form of tendinitis, that is characterized by deposits of hydroxyapatite in the tendons of the rotator cuff. The disorder causes pain, inflammation and restricted range of motion of the shoulder joint.

Therapy consists of anti-inflammatory drugs and corticosteroid injections. Extracorporeal shock wave therapy (ESW) is a gentle treatment to dissolve the calcific deposit.

Sometimes arthroscopic surgery is required to remove the calcific deposit.

In case of a shoulder dislocation the ligaments in the front of the shoulder are injured. The labrum (the cartilage rim around the edge of the glenoid/socket) often tears (Bankart lesion). A severe dislocation can lead to continued dislocations, giving out, or a feeling of instability. In younger patients, surgical reconstruction is recommended.

Over 3 little portals the torn labrum is reconstructed arthroscopically with small suture anchors. At the same time a capsula shift is performed to regain stable joint conditions.

More information: http://www.orthoinfo.org/topic.cfm?topic=A00529

The tendons of the rotator cuff form a covering around the humeral head. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate the arm.

A rotator cuff tear leads to painful restricted range of motion in the shoulder. Increasing loss of function can follow over the time in chronic tears.

In many cases the torn tendon requires surgical reconstruction to regain full function of the shoulder joint. Reconstruction can be done either arthroscopically or mini-open over a small skin incision

More information: http://www.orthoinfo.org/topic.cfm?topic=A00406

The frozen shoulder is a special disease of the shoulder.

More information: http://orthoinfo.aaos.org/topic.cfm?topic=A00071