Shoulder Conditions: Types and Information

Shoulder pain can be caused by a variety of shoulder conditions and injuries. The shoulder is a complicated and sensitive joint and is essential for almost every movement. Inflammations and injuries can damage it and lead to shoulder pain and restricted movement.

The so-called shoulder girdle is formed by two bones on each side of the shoulder, i.e. the two clavicles (claviculae) and shoulder blades (scapulae). Together with the humerus, the shoulder blade forms the shoulder joint. The scapula also forms two bony projections, the acromion, and the coracoid.

The shoulder joint is mainly stabilized by four muscles and their tendons, the so-called rotator cuff. The four muscles (supraspinatus muscle, infraspinatus muscle, teres minor muscle and subscapularis muscle) move from the shoulder blade to the humerus, where they attach their tendons. For this reason they lie around the head of the humerus like a cuff and form a “roof” over the shoulder joint. The space below the acromion, the subacromial space, is often affected by wear and tear problems in the shoulder joint. A bursa facilitates the sliding process between the tendons and the bony acromion. This can lead to shoulder pain due to inflammation, for example.

The shoulder joint is primarily moved and mobilized by muscles and tendons, which results in a large range of motion. However, this increases the risk of instability and the shoulder joint is therefore easily injured.

The illustration above shows the upper arm with its humeral head and the shoulder blade from the front. The relatively small area of the joint connecting the two bones is visible. In addition to the muscles, the upper arm has, among other things, a further aid to stabilization in the shoulder joint. This consists of a cartilaginous lip that supports the spherical head of the humerus in the same way that a saucer with a small depression prevents a cup from slipping.

This cartilage lip is called the labrum glenoidale. If a part of this cartilage lip is torn off, the shoulder joint will dislocate again and again, even without the use of force, because stability is impaired. This link leads directly to the page about the therapy of the labrum glenoidale tear.

The shoulder is a mainly muscle-guided joint. This means that the articulated joint consists mainly of muscles. In contrast, the hip joint could be seen as the hip joint, where an important part of the stability of the hip joint is guaranteed by ligaments that are very strong and can resist enormous forces.

This muscle guidance proves to be a great advantage when considering the mobility gained through it. However, there is also a major disadvantage of this type of connection between two bones. Compared to the hip joint, the stability is much lower and therefore the vulnerability of the shoulder joint is much greater.

Looking at the shoulder conditions or injuries, three specific diagnoses are particularly striking because of their frequency:

  • Shoulder pain when moving the arm (impingement syndrome)
  • Torn tendon of the deeper layers of the shoulder muscles (rotator cuff rupture)
  • The repeated dislocation of the shoulder (recurrent shoulder dislocation)

Several factors and shoulder conditions can contribute to shoulder pain

The shoulder is one of the most stressed joints in our body and is under heavy strain, especially for tennis players but also for various professions such as craftsmen. Inflammation of the shoulder can have many causes but is always associated with pain and reduced mobility, which often considerably restricts everyday activities, as even everyday dressing is often difficult. For this reason, an inflammation in the shoulder should always be treated by an expert doctor.

In the following you will find the most important and most frequent shoulder conditions and injuries of the shoulder joint and the muscle and ligament apparatus involved, classified according to how they originated.

Bicep tendonitis

The term biceps tendon inflammation refers to the presence of inflammatory processes in the area of the biceps tendon. In most cases, these inflammatory processes affect the long tendon of the biceps muscle. It is therefore not directly an inflammation of the muscle. It is usually caused by wear and tear, often in throwing sports. The treatment of biceps tendon inflammation depends mainly on the underlying cause.

Read more about Bicep Tendonitis: Causes. Symptoms, and Treatment

Subacromial bursitis

Subacromial bursitis is the inflammation of a bursa in the shoulder joint. It is one of the most common shoulder conditions and is accompanied by severe pain. It is often caused by incorrect loading. The therapy consists in particular of immobilizing and protecting the shoulder. If the pain cannot be brought under control, the use of medication is recommended.

Read more about Subacromial bursitis: Causes, Symptoms, and Treatment

Rotator cuff tendonitis

Inflammation in the area of the rotator cuff is one of the most common shoulder conditions. The inflammation of the muscles can be caused by various underlying shoulder conditions. The most common causes of inflammation in the area of the rotator cuff include impairment of the tendon sheaths, constriction syndromes and traumatic changes to the bony structures of the shoulder joint.

Read more about Rotator cuff tendonitis: Causes, Symptoms, and Treatment

Biceps tendon tear

The long biceps tendon usually tears as a result of wear and tear even at low loads. A biceps tendon rupture results in restrictions of the muscle function to varying degrees depending on the affected tendon. There are several options for the treatment of a biceps tendon rupture, a doctor should always be consulted.

Read more about Biceps tendon tear: Causes, Symptoms, and Treatment

Shoulder ligament stretching

During extreme movements, the ligaments and muscles of the shoulder are tensed and block further movement in this direction. However, if a movement is now carried out with so much momentum that the ligaments cannot withstand this tension, the ligaments are stretched, or in the more extreme case, the ligaments are torn. They can occur during sports or everyday activities and are often accompanied by pain. It is important to take care of the shoulder afterward.

Read more about Shoulder ligament stretching: Causes. Symptoms, and Treatment

Shoulder ligaments tear

A torn ligament of the shoulder is a rupture of the ligament structures located there, which contribute to the stability of the joint. Tearing of the ligament structures often occurs during a fall with direct force applied to the shoulder joint and when the arm is stretched out, resulting in severe pain. There are various treatment options available.

Read more about Shoulder ligaments tear: Causes, Symptoms, and Treatment

Rotator cuff tear

Rotator cuff tear is one of the most common shoulder conditions. If a rotator cuff tear occurs, the tendon sheath of these rotators, most commonly the supraspinatus tendon, tears because of its anatomically tight position under the acromion. Such a tear occurs either as a result of a severe accident, e.g. a fall on the outstretched arm or as a result of degeneration (wear) of the weakened supraspinatus tendon. Various options and exercises are available for treatment.

Read more about Rotator cuff tear: Causes, Symptoms, and Treatment

Shoulder Contusion

Shoulder Contusion is an injury to the shoulder, usually caused by a fall or impact trauma. A contusion can cause bruising and swelling due to the force applied to the affected tissue. A contusion of the shoulder is painful, often the affected shoulder cannot be loaded as usual. It usually heals without consequences.

Read more about Shoulder Contusion: Causes, Symptoms, and Treatment

Acromioclavicular dislocation

Acromioclavicular dislocation is a dislocation of the lateral end of the clavicle towards the acromion with injury to the stabilizing capsule/ligament apparatus of the acromioclavicular joint. The most common cause is a fall on the shoulder with direct force application on the acromioclavicular joint. It manifests itself mainly in three symptoms: pain directly above the shoulder joint, swelling of the shoulder area and relieving posture.

Read more about Acromioclavicular dislocation: Symptoms and Treatment

Shoulder joint instability

Instabilities occur primarily in the shoulder joint, which can be explained by the anatomy of the shoulder joint. Shoulder joint instability can be congenital or occur after an accident. It usually manifests itself through severe pain. Treatment of shoulder joint instability can essentially be carried out in two different ways: Conservative and surgical therapy. Shoulder joint instability is one of the most common shoulder conditions.

Read more about Shoulder joint instability: Causes, Symptoms, and Treatment

Shoulder dislocation

A dislocation of the shoulder joint is generally described as a very painful displacement of the shoulder joint. There are various causes for the occurrence of a shoulder dislocation. The most common, however, is a levering movement of the upper arm with simultaneous external rotation, in which the arm moves away from the body. It is usually accompanied by severe pain. The therapy can be conservative or surgical.

Read more about Shoulder dislocation: Causes, Symptoms, and Treatment

SLAP lesion

Injuries and damage to the labrum-biceps complex are called slap lesions. The reason why a SLAP lesion is triggered can be acute but also chronic, e.g. due to overloading. If it is a chronically developed slap lesion, the patient may not notice anything at first. If the lesion progresses and is not treated, the patient will usually report pain when under heavy strain. In the case of a manifest slap lesion, the surgical treatment method is often the only therapeutically sensible procedure.

Read more about SLAP lesion: Causes, Symptoms, and Treatment

Calcified shoulder

A lime shoulder is a shoulder in which lime has been deposited. This occurs most frequently in the area of the tendon of the supraspinatus muscle, but in principle it can also affect any other tendon of the shoulder muscles. The result is an inflammatory process in the shoulder joint, which leads to sometimes severe pain. Various causes can be considered for a calcified shoulder.

Read more about Calcified shoulder: Causes, Symptoms, and Treatment

Shoulder cartilage damage

If there is cartilage damage, i.e. a kind of tear in the cartilage tissue, pain may occur, which may need to be treated. This can be a small tear, but it can also be much more extensive under certain circumstances. The reasons for cartilage damage cannot always be diagnosed. It often manifests itself in the form of severe pain. There are two concretely different therapeutic approaches for cartilage damage in the shoulder joint: conservative and surgical.

Read more about Shoulder cartilage damage: Symptoms and Treatment

Frozen shoulder

Frozen shoulder describes a temporary stiffening of one or both shoulders with severely restricted mobility, which is accompanied by an adhesion of the sliding layers of the shoulder joint. The development of primary shoulder stiffness is still unknown. The treatment of shoulder stiffness is always conservative and aims at a gentle mobilization of the shoulder joint.

Read more about Frozen shoulder: Causes, Symptoms, and Treatment

Summary

The shoulder is a very complicated joint, which makes it particularly vulnerable to damage. Causes of shoulder pain can include injuries, general wear and tear, and inflammatory conditions such as osteoarthritis.

The treatment of shoulder pain will very much depend on the cause of the problem. However, a person can usually treat mild shoulder pain at home by resting, applying ice packs, and taking OTC medications.

People with severe pain or pain that does not get better with home treatment should see a doctor. Also, see a doctor straight away for shoulder dislocations and other serious injuries.

References

  1. Pentland WE, Twomey LT. Upper limb function in persons with long term paraplegia and implications for independence: part II. Paraplegia. 1994;32:219–224. [PubMed] [Google Scholar]
  2. Fullerton HD, Borckardt JJ, Alfano AP. Shoulder pain: a comparison of wheelchair athletes and nonathletic wheelchair users. Med Sci Sports Exerc. 2003;35:1958–1961. [PubMed] [Google Scholar]
  3. Sie IH, Waters RL, Adkins RH, Gellman H. Upper extremity pain in the postrehabilitation spinal cord injured patient. Arch Phys Med Rehabil. 1992;73:44–48. [PubMed] [Google Scholar]
  4. Dalyan M, Cardenas DD, Gerard B. Upper extremity pain after spinal cord injury. Spinal Cord. 1999;37:191–195. [PubMed] [Google Scholar]
  5. Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury: a survey and longitudinal study. Spinal Cord. 2005;43:704–712. [PubMed] [Google Scholar]
  6. Escobedo EM, Hunter JC, Hollister MC, et al. MR imaging of rotator cuff tears in individuals with paraplegia. AJR Am J Roentgenol. 1997;168:919–923. [PubMed] [Google Scholar]
  7. Brose SW, Boninger ML, Fullerton B, et al. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury. Arch Phys Med Rehabil. 2008;89:2086–2093. [PubMed] [Google Scholar]
  8. Samuelsson KA, Tropp H, Gerdle B. Shoulder pain and its consequences in paraplegic spinal cord-injured, wheelchair users. Spinal Cord. 2004;42:41–46. [PubMed] [Google Scholar]
  9. Bayley JC, Cochran TP, Sledge CB. The weight-bearing shoulder: the impingement syndrome in paraplegics. J Bone Joint Surg Am. 1987;69:676–678. [PubMed] [Google Scholar]
  10. Gutierrez DD, Thompson L, Kemp B, Mulroy SJ. The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia. J Spinal Cord Med. 2007;30:251–255. [PMC free article] [PubMed] [Google Scholar]
  11. Alm M, Saraste H, Norrbrink C. Shoulder pain in persons with thoracic spinal cord injury: prevalence and characteristics. J Rehabil Med. 2008;40:277–283. [PubMed] [Google Scholar]
  12. Mulroy SJ, Thompson L, Kemp B, et al. ; for the Physical Therapy Clinical Research Network (PTClinResNet). Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Phys Ther. 2011;91:305–324. [PubMed] [Google Scholar]
  13. Nawoczenski DA, Ritter-Soronen JM, Wilson CM, et al. Clinical trial of exercise for shoulder pain in chronic spinal injury. Phys Ther. 2006;86:1604–1618. [PubMed] [Google Scholar]
  14. Popowitz RL, Zvijac JE, Uribe JW, et al. Rotator cuff repair in spinal cord injury patients. J Shoulder Elbow Surg. 2003;12:327–332. [PubMed] [Google Scholar]
  15. Goldstein B, Young J, Escobedo EM. Rotator cuff repairs in individuals with paraplegia. Am J Phys Med Rehabil. 1997;76:316–322. [PubMed] [Google Scholar]
  16. Lal S. Premature degenerative shoulder changes in spinal cord injury patients. Spinal Cord. 1998;36:186–189. [PubMed] [Google Scholar]
  17. Finley MA, Rodgers MM. Prevalence and identification of shoulder pathology in athletic and nonathletic wheelchair users with shoulder pain: a pilot study. J Rehabil Res Dev. 2004;41:395–402. [PubMed] [Google Scholar]
  18. Sinnott KA, Milburn P, McNaughton H. Factors associated with thoracic spinal cord injury, lesion level and rotator cuff disorders. Spinal Cord. 2000;38:748–753. [PubMed] [Google Scholar]
  19. Gagnon D, Nadeau S, Noreau L, et al. Quantification of reaction forces during sitting pivot transfers performed by individuals with spinal cord injury. J Rehabil Med. 2008;40:468–476. [PubMed] [Google Scholar]
  20. Gagnon D, Nadeau S, Noreau L, et al. Comparison of peak shoulder and elbow mechanical loads during weight-relief lifts and sitting pivot transfers among manual wheelchair users with spinal cord injury. J Rehabil Res Dev. 2008;45:863–873. [PubMed] [Google Scholar]21. Kulig K, Rao SS, Mulroy SJ, et al. Shoulder joint kinetics during the push phase of wheelchair propulsion. Clin Orthop Relat Res. 1998:132–143. [PubMed] [Google Scholar]
  21. Oyster ML, Karmarkar AM, Patrick M, et al. Investigation of factors associated with manual wheelchair mobility in persons with spinal cord injury. Arch Phys Med Rehabil. 2011;92:484–490. [PubMed] [Google Scholar]
  22. Sonenblum SE, Sprigle S, Lopez RA. Manual wheelchair use: bouts of mobility in everyday life. Rehabil Res Pract. 2012;2012:753165. [PMC free article] [PubMed] [Google Scholar]
  23. Tolerico ML, Ding D, Cooper RA, et al. Assessing mobility characteristics and activity levels of manual wheelchair users. J Rehabil Res Dev. 2007;44:561–571. [PubMed] [Google Scholar]
  24. Soslowsky LJ, Thomopoulos S, Esmail A, et al. Rotator cuff tendinosis in an animal model: role of extrinsic and overuse factors. Ann Biomed Eng. 2002;30:1057–1063. [PubMed] [Google Scholar]
  25. Mulroy SJ, Winstein CJ, Kulig K, et al. ; Physical Therapy Clinical Research Network. Secondary mediation and regression analyses of the PTClinResNet Database: determining causal relationships among the International Classification of Functioning, Disability and Health levels for four physical therapy intervention trials. Phys Ther. 2011;91:1766–1779. [PubMed] [Google Scholar]
  26. Sabick MB, Kotajarvi BR, An KN. A new method to quantify demand on the upper extremity during manual wheelchair propulsion. Arch Phys Med Rehabil. 2004;85:1151–1519. [PubMed] [Google Scholar]
  27. Perry J, Gronley JK, Newsam CJ, et al. Electromyographic analysis of the shoulder muscles during depression transfers in subjects with low-level paraplegia. Arch Phys Med Rehabil. 1996;77:350–355. [PubMed] [Google Scholar]

Leave a Comment