Rotator Cuff Tears

The shoulder rotator cuff is comprised of four muscles and their tendons that control the function of the shoulder that connects the upper arm bone (humerus) with the shoulder blade (scapula). The rotator cuff is responsible for holding the ball of the humerus firmly into the shoulder socket and, along with the deltoid muscle, helps to raise the arm.

A tear in the rotator cuff is the separation of the tendons in the joint from the bone. It is not an uncommon injury and occurs in people of all ages. However, it usually occurs in individuals over 40 who engage in repeated overhead movements from sports, work or daily life activities. As people get older, the muscle and tendon tissue becomse less elastic, making them more susceptible to injury. A traumatic injury to the shoulder may also cause a tear.

Symptoms

Generalized pain in the shoulder is the most common symptom of a rotator cuff tear. This is often more severe at night. Depending on the severity of the damage, a loss of motion and strength in the shoulder can also result. Generally, pain down the outer aspect of the arm, and pain with lifting objects away from the body or overhead, signify a rotator cuff tear.

Causes

Rotator cuff disease may be the result of either a substantial injury to the shoulder or to progressive degeneration or wear and tear of the tendon tissue. Repetitive overhead activity, heavy lifting over a prolonged period of time, and the development of bone spurs in the bones around the shoulder may irritate or damage the tendon.

 

Labral Tears

The labrum is a piece of fibrocartilage (rubbery tissue) attached to the rim of the shoulder socket that helps keep the ball of the joint in place. When this cartilage is torn, it is called a labral tear.

Causes

Shoulder labral tears can result from a variety of activities or events. Most often the labrum is torn secondarily to a dislocation or some form of trauma like a fall while skiing or sudden impact while playing sports. When the shoulder dislocates, excessive stress is usually directed to the labrum, causing it to tear.

Also common among athletes is recurrent micro-trauma. As opposed to a solitary traumatic event, repetitive overhead motions and activities can progressively damage the labrum causing pain and labral damage. Individuals whose work entails lifting heavy objects are also susceptible, but a simple slip and fall on the ice can result in a labral tear.

Although many labral tears can be treated non-surgically with a comprehensive physical therapy program to strengthen the surrounding muscles, certain tears require surgery. Additionally, an athlete with a labral tear who plays a contact sport is at high risk for re-dislocation, which may cause even greater damage, so surgery is usually recommended. For a predictable and faster return to sports activity, arthroscopic repair of the labrum is a highly successful treatment. In older patients, repair of the labrum may not be indicated because healing rates are poor and may be associated with stiffness

Symptoms

  • Popping, clicking, or catching in the shoulder.
  • Pain when you move your arm over your head or throw a ball.
  • A feeling of weakness or instability in the shoulder.
  • Aching pain. People often have a hard time describing or pointing to exactly where the pain is, but most often it is associated with front shoulder pain radiating to the biceps and back shoulder pain near the joint line.

Frozen Shoulder

In frozen shoulder, the shoulder capsule thickens and becomes tight. Stiff bands of tissue — called adhesions — develop. In many cases, there is less synovial fluid in the joint.

Symptoms

Pain from frozen shoulder is usually dull or aching. It is typically worse early in the course of the disease and when you move your arm. The pain is usually located over the outer shoulder area and sometimes the upper arm.  The hallmark sign of this condition is being unable to move your shoulder – either on your own or with the help of someone else. It develops in three stages:

Freezing

In the”freezing” stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.

Frozen

Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult.

Thawing

Shoulder motion slowly improves during the “thawing” stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

Causes

The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Diabetes. Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these individuals. The reason for this is not known.

Other diseases. Some additional medical problems associated with frozen shoulder include hypothyroidism, hyperthyroidism, Parkinson’s disease, and cardiac disease.

Immobilization. Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one measure prescribed to prevent frozen shoulder.

Shoulder Arthritis

Osteoarthritis is the most common type of shoulder arthritis and generally affects patients over 50 years of age. The condition is also known as “wear and tear” arthritis because of the progressive wearing away of the cartilage of the shoulder joint. As the surface wears down, the labrum tears (usually at the back of the joint) and bone is exposed making the shoulder painful and mobility progressively more difficult. Shoulder arthritis is also common in those who have had a prior shoulder injury like a fracture or rotator cuff tear. There may also be a genetic predisposition to shoulder arthritis.

Rheumatoid arthritis can also affect the shoulder joints and can affect people of any age. It is a systemic condition that causes inflammation in the joints that can be damaging to the cartilage and bone.

Symptoms

  • Pain with activity
  • Loss of mobility
  • Pain and Stiffness
  • Swelling (usually difficult to see in the shoulder)
  • Grinding or catching feeling

Causes

The incidence of shoulder arthritis increases with age.  Generally it is seen in people over 50; however, younger people can get it after suffering trauma to the shoulder, such as a fracture or dislocation.  Arthritis of the AC (acromioclavicular) joint tends to occur at a younger age than arthritis of the shoulder (glenohumeral) joint.  There is a genetic predisposition to arthritis, so it can be hereditary as well.

Impingement Syndrome

Shoulder impingement is a common shoulder condition in adults involved in activities that involve repetitive overhead motion. Shoulder impingement can occur when the rotator cuff tendon and overlying lubricating sac, or bursa, are contacted by two bones of the shoulder with overhead motion. The condition can be an important cause of shoulder bursitis and/or rotator cuff tendinitis.

If tendons are injured for a long period of time, the tendon can actually tear in two, resulting in a rotator cuff tear. This causes significant weakness and may make it difficult for the person to elevate his or her arm. Some people can have rupture of their biceps muscle as part of this continuing impingement process.

Symptoms

Early symptoms of shoulder impingement may be mild. With time, however, the pain is persistent, and can affect every day activities such as putting on a coat or blouse, reaching overhead, and sleeping. Pain may radiate down the arm from the front or the side of the shoulder down towards the elbow. Any shoulder motion can be painful, particularly reaching above shoulder level and behind the back. As the condition progresses, the rotator cuff tendon can fray and eventually tear.

Causes

Shoulder impingement can occur with activities that require repetitive overhead motions such as painting, construction, swimming, baseball, and tennis. Bone and joint abnormalities can also cause shoulder impingement. When your arm is raised to shoulder height or above, the space between the acromion and rotator cuff narrows. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain.

 

Biceps tendonitis

Biceps tendinitis occurs when there is an inflammation or irritation of the tendons in the upper biceps. Also known as the long head of the biceps tendon, it is a chord-like structure that connects the biceps muscle to the shoulder bones.

Biceps tendonitis
Courtesy of orthoinfo.aaos.org

Symptoms

  • Pain and tenderness in the front of the shoulder that seems to worsen with overhead lifting
  • Pain that moves down the upper arm bone
  • An occasional snapping sound or sensation in the shoulder.

Causes

The cause of biceps tendinitis can be due to a number of lifetime activities. As people age, their tendons become weaker. The condition can worsen due to overuse by repetitive shoulder motions of certain occupations such as painting, while doing chores or through sports activity. Activities such as swimming, baseball, and tennis also put people at risk for developing biceps tendinitis.

 

Collarbone Fracture

Also known as a clavicle fracture, a collarbone fracture is fairly common and can happen to people at any age.

The collarbone (clavicle) lies between the shoulder blade (scapula) and the ribcage (sternum) which connects the arm to the body.

Collarbone
Courtesy of orthoinfo.aaos.org

 

Symptoms

A clavicle fracture is extremely painful. Other symptoms include:

  • A sagging shoulder
  • Difficulty lifting the arm, accompanied by a grinding sensation
  • A bump or deformity over the break
  • Bruising, swelling or tenderness

Causes

Most collarbone fractures occur from a hard hit to the shoulder. A fall on an outstretched arm may also cause a fracture to the clavicle. Sometimes during birth, a baby’s collarbone can fracture as a result of passing through the birth canal.

 

AC Sprain or Separation

A shoulder separation is not truly an injury to the shoulder joint. The injury actually involves the acromioclavicular joint (also called the AC joint). The AC joint is where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). Separation of the two bones forming this joint is caused by damage to the ligaments connecting them. It is sometimes also referred to as a shoulder separation injury. The acromioclavicular joint is formed by the outer end of the clavicle or collar bone and the acromion process of the scapular or shoulder blade.

Symptoms

Symptoms include sudden onset of pain at the time of injury, often as a result of a fall onto the shoulder or onto an outstretched arm. Or from direct impact in a collision sport. Moving the arm above the head is likely to be painful and the athlete is likely to suffer a significant loss of function.

There will be tenderness and swelling and inflammation over the acromioclavicular joint itself. When pressing in there will be point tenderness over the site of injury. In particular, the athlete is likely to have pain on moving their arm out to the sides and upwards (abduction). With more severe injuries a visible deformity in the form of a lump or bump on top of the shoulder is likely.

Causes

An AC joint separation or AC joint sprain is usually caused by fall onto the side of the arm and is usually accompanied by a high-velocity fall or more violent trauma such as getting tackled in football or a bicycle or car accident.

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