The shoulder is a very resilient joint. It can take alot of abuse, repetitive use, and even small strains and mild to moderate osteoarthritis without bothering us for attention. However, at somepoint, if the injury is significant, or if small traumas add up overtime, the shoulder begins to scream out for attention and block us from doing certain motions–typically reaching overhead, or carrying things away from the body. Even sleeping on the shoulder, or performing prolonged static activities such as holding a book to read, driving, or washing mirrors and windows can be intolerable.
Some of my patients become so stiff that the shoulder seems to be stuck in position, preventing them from reaching, combing their hair, putting on clothes or even brushing their teeth with the affected arm.
There are many structures in the shoulder which can be injured–the rotator cuff which consists of 4 tendons to the muscles that run all of the arm’s overhead activities.; the biceps tendon which attaches to the muscle that flexes the forearm and hand uptoward the shoulder; the main ball and socket shoulder joint (glenohumeral joint) and the smaller joint at the end of the collarbone that connects to the shoulder blade (acromioclavicular or AC joint), or the bones of the upper arm (humerus) and shoulder blade (glenoid) or collarbone itself (clavicle).
Rotator cuff injuries can come in the form of a tendonitis (swelling/irritation), a partial tear or a complete tear. Sometimes the undersurface of the acromion (the tip of the shoulder when you touch the top of your shoulder) can rub on the underlying rotator cuff tendons and cause irritation called “impingement” or shoulder bursitis.
Most minor shoulder injuries–after a thorough physical examination to rule out any larger issues–can be treated with rest, gentle stretches, anti inflammatory medications such as Advil or Aleve, and in some cases physical therapy. More major injuries, or those that do not seem to get better after a few weeks many require investigation.
Investigations include an ultrasound, Xray or MRI of the shoulder to view the structures and determine the exact nature of the symptoms. Sometimes a CT scan, or an MR-arthrogram where dye is injected into the shoulder to better see the joint structures, are used.
If a full thickness rotator cuff tear is found and the symptoms and physical examination match well with the location of the tear noted on the investigations, surgery may be recommended. Partial thickness rotator cuff tears do not typically require surgery, although some progress to full thickness tears over time. Impingement syndrome, if severe, may require arthroscopic surgery to decompress or remove some of the bone at the undersurface of the acromion and prevent further irritation or compression of the underlying tendons during overhead activity.
Nonoperative treatments for shoulder injuries range from home stretching and rest, to cortisone injections and physical therapy modalities. An injectin of an anesthetic into the AC joint, the glenohumeral joint, or in the space beneath the acromion can help identify which area is causing symptoms to better determine the diagnosis and the best treatment.
There are some excellent exercises for shoulders that can help prevent “frozen shoulder” syndrome or severe stiffness after injuries. See our website for more information at www.orthopedicsurgery.ca.