We can help you get relief from shoulder pain and injury
The shoulder joint has the greatest range of motion of any joint in the body. Because of this mobility, the shoulder is more likely to be injured or experience wear and tear issues.
The shoulder joint is a complex ball and socket joint that allows for almost 360 degrees of motion for the arm. The true shoulder joint is called the glenohumeral joint where the arm bone, humerus, articulates with the glenoid part of the shoulder blade bone, or scapula. There are a few smaller joints around the shoulder like the acromioclavicular (AC) joint, coracoclavicular joint, and more medial the sternoclavicular joint. Around the shoulder and surrounding joints are many ligaments that provide support and many degrees of movement for the arm. There are also tendons, most well known, the rotator cuff, among others. Bones, ligaments, and tendons are susceptible to injury. Sports players are at higher risk or shoulder injuries, such as baseball players, golf players, tennis players, basketball players, and other sports. People with active lifestyles can also injure shoulders during weightlifting, exercising, parents or grandparents playing with kids, and even during leisure activities such as dog walking.
VSMD Approach
At VSMD, we diagnose shoulder injuries and issues by analyzing medical history, conducting a physical exam, and using imaging such as ultrasound and x-ray. Based on the findings, the doctor may recommend a conservative treatment to reduce pain and swelling and allow the shoulder to heal properly. In case of a tear or fracture to the area, the doctor may prescribe a more involved approach to initiate the healing process.
For most shoulder issues, a non-surgical regiment with frequent evaluation by the doctor is the best course. At VSMD, we treat each patient through a holistic lens. Our doctors not only evaluate the shoulder but also accompanying systems.
Causes of Shoulder Pain and Injury
There are many injuries that can occur at and near the shoulder joint whether from contact, impact, pull, or overuse. Below are some common injuries and conditions that affect the shoulder region.
Common problems include:
Rotator Cuff Injuries
Rotator cuff tears can be partial or full tears of one or more of the 4 tendons that help move the shoulder and keep the ball end of the joint (humerus head) in the socket (glenoid of the scapula) – – the reason it is called the “rotator cuff”. Tendinopathy (without complete tear) of the rotator cuff is the most common cause of shoulder pain. The most commonly torn tendon of the rotator cuff is the muscle-tendon unit that helps lift the arm away from the body (supraspinatus). Rotator cuff injuries may happen with repetitive overhead use of the arm, but can also occur after suffering trauma, such as after falling on an outstretched hand.
Risk Factors for rotator cuff injury include repetitive overhead use of the arm, especially in individuals over 40 years of age, athletes that participate in sports that have a high risk for falling, and previous injury to the shoulder.
Symptoms may include gradual or sudden onset of pain, pain at night or during rest, pain that increases with overhead motions.
Labral Tears
The labrum is a fibrous band of tissue that lines the socket part of the ball and socket joint. It helps to keep the ball of the joint in place by creating a vacuum around it and allowing for smooth gliding, rotational motion. With repetitive use, repeated injury, and with trauma (like a shoulder dislocation or subluxation) the labrum may get damaged and torn.
When a part of the labrum tears, it causes pain and limits range of motion, especially overhead motions. Other symptoms may include popping, clicking, or locking of the shoulder.
Little League Shoulder
Little League Shoulder is an apophysitis of the top of the arm bone, humerus, where it articulates in the shoulder joint. Apophysitis refers to inflammation of the growth plate and is typically due to repetitive motions that aggravate the growth plate. As the name suggests, little league shoulder is common in youth baseball players and is associated with overhead throwing and pitching. This injury is also seen in other sports like volleyball and tennis. Risk factors for developing little league shoulder include repetitive overhead throwing, high pitch or throw counts, underdeveloped throwing technique or poor throwing/ pitching form, and recent growth spurt.
Symptoms may include a gradual onset of pain in the shoulder that is worse during overhead activities and limited range of motion at the shoulder due to pain.
Calcific Tendonitis
Calcific tendonitis is the development of calcium deposits within a tendon. It is a phenomenon that is poorly understood and is likely caused by disruption of the normal repair process of a damaged tendon. It is most commonly seen in the rotator cuff tendons but also seen in the patellar and achilles tendons. Other risk factors of calcific tendonitis are women between 30-50 years old, thyroid disease, and diabetes.
Symptoms may include pain related to activity, limited range of motion, and pain over the tendons when palpated.
Frozen Shoulder
Frozen shoulder, also known as adhesive capsulitis, is a condition that is poorly understood. It is thought that the shoulder capsule (rotator cuff and ligaments that line the ball and socket joint) becomes inflamed and irritated causing “freezing” of the shoulder. When this process starts it is typically painful and range of motion is decreased. As it progresses, the range of motion continues to decline prior to a “thawing” phase. Risk factors for developing frozen shoulder may include medical conditions like diabetes, thyroid disease, and autoimmune disease, shoulder injury, and tendonitis.
Symptoms may include pain with certain activities that progressively gets worse, limited range of motion of the shoulder that progressively gets worse, both of which can last for months.
Bursitis
Bursitis is a condition in which there is inflammation of a bursa. A bursa is a small fluid-filled sac that protects bony prominences from friction caused by tendon and ligament, external factors like repetitive motions or direct pressure to bones, or infection. The shoulder has multiple bursae that are susceptible to injury due to trauma or overuse.
Symptoms of bursitis may include pain and swelling or limited range of motion due to pain.
Shoulder Dislocation and Subluxation
Shoulder dislocation occurs due to a forceful impact from the front or side of the shoulder. It is the most commonly dislocated joint in the body. The arm bone, or humerus, dislocation is usually in front and below the shoulder joint; however, may dislocate behind the joint. This disruption of the ball and socket joint is more common in young athletes in contact sports, people who have joint laxity, and people who have previously dislocated their shoulder. Shoulder dislocations usually occur when the arm is violently forced out and away from the body. Damage to the ligaments and bone often occur, which may lead to recurrent dislocations. Less energy may be needed to cause repeat dislocations because of the damage from the original injury. When the shoulder joint does not fully dislocate but pops out and then back in, it is called subluxation.
Symptoms may include shoulder pain, inability to move the arm normally, a feeling of the shoulder being out of place, and a visible deformity of the shoulder.
Shoulder Separation
A shoulder separation is an injury to the acromioclavicular (AC) joint, which is located at the end of the collar bone (clavicle) on top of the shoulder. This injury may also be called AC sprain or separation. There are several ligaments which hold the AC joint together. The most common cause of a shoulder separation is landing on either the side or top of the shoulder with the arm at the patient’s side. In hockey, it commonly occurs when a player is driven in the boards, striking the point of the shoulder. This occurs in other contact/collision sports and in activities where high-energy falls are common, such as skiing and cycling.
Symptoms may include pain on top of the shoulder, pain with movement of the shoulder, and a new bump or prominence on top of the shoulder.
Sternoclavicular (SC) Joint Sprain
An SC sprain is an injury to the joint where the clavicle (collarbone) meets the sternum (breastbone). These injuries are rare, requiring an accident with a lot of force, such as a tackle in football or rugby. Most SC sprains occur when an athlete is struck on the back or side of the shoulder. Typically, the resulting injury is a sprain, but it is also possible to dislocate the joint. The clavicle can be dislocated forwards or backwards with regard to the sternum.
Symptoms may include pain at the clavicle or sternum or a bump or divot at the SC joint. Pain may be made worse by lifting the arm away from the body and in front of the body.
Arthritis
Arthritis, osteoarthritis, or degenerative change is a common condition that causes pain, swelling, and reduced motion of the shoulder. There is not one single cause of arthritis but the changes caused by arthritis to the shoulder joint can increase over time. These changes can be seen as early as the 30s and are much more common with each decade one ages over 50 years old. Arthritis may or may not be painful. When the arthritis gets irritated or inflamed is typically when pain starts. Depending on the severity of the arthritis and pain, there are various treatment options but there is no cure for this disease.
Stingers or Burners
Stingers, also known as burners, are common injuries in contact sports, such as football and rugby, wrestling, hockey, basketball, and boxing. A stinger results from either direct contact or stretching of nerves as they exit the neck and travel down the arm on the same side as injury.
Symptoms can include pain described as electrical sensation down the arm or as burning pain.