The human shoulder has the largest range of motion of any joint in the human body and is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons.
The articulations between the bones of the shoulder make up the shoulder joints. The major joint of the shoulder is the glenohumeral joint, which “shoulder joint” generally refers to. In human anatomy, the shoulder joint comprises the part of the body where the humerus attaches to the scapula, the head sitting in the glenoid fossa. The shoulder is the group of structures in the region of the joint.
The shoulder must be mobile enough for the wide range actions of the arms and hands, but also stable enough to allow for actions such as lifting, pushing and pulling. The compromise between mobility and stability results in a large number of shoulder problems not faced by other joints such as the hip.
What Causes Shoulder Problems?
Many shoulder problems are caused by the breakdown of soft tissues in the shoulder region. Using the shoulder too much can cause the soft tissue to break down faster as people get older. Doing manual labor and playing sports may cause shoulder problems.
Shoulder pain may be felt in one small spot, in a larger area, or down the arm. Pain that travels along nerves to the shoulder can be caused by diseases such as:
- Gallbladder disease
- Liver disease
- Heart disease
- Disease of the spine in the neck.
How Are Shoulder Problems Diagnosed?
Doctors diagnose shoulder problems by using:
- Medical history
- Physical examination
- Tests such as x rays, ultrasound, and magnetic resonance imaging (MRI).
How Are Shoulder Problems Treated?
Shoulder problems are most often first treated with RICE (Rest, Ice, Compression, and Elevation):
- Rest. Don’t use the shoulder for 48 hours.
- Ice. Put an ice pack on the injured area for 20 minutes, four to eight times per day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice wrapped in a towel.
- Compression. Put even pressure (compression) on the painful area to help reduce the swelling. A wrap or bandage will help hold the shoulder in place.
- Elevation. Keep the injured area above the level of the heart. A pillow under the shoulder will help keep it up.
If pain and stiffness persist, see a doctor to diagnose and treat the problem.
What Are the Most Common Shoulder Problems?
The most common shoulder problems are:
- Rotator cuff disease
- Rotator cuff tear
- Frozen shoulder
The symptoms and treatment of shoulder problems vary, depending on the type of problem.
Dislocation occurs when the ball at the top of the bone in the upper arm pops out of the socket. It can happen if the shoulder is twisted or pulled very hard.
To treat a dislocation, a doctor performs a procedure to push the ball of the upper arm back into the socket. Further treatment may include:
- Wearing a sling or device to keep the shoulder in place
- Ice three or four times a day
- Exercise to improve range of motion, strengthen muscles, and prevent injury.
Once a shoulder is dislocated, it may happen again. This is common in young, active people. If the dislocation injures tissues or nerves around the shoulder, surgery may be needed.
A shoulder separation occurs when the ligaments between the collarbone and the shoulder blade are torn. The injury is most often caused by a blow to the shoulder or by falling on an outstretched hand.
Treatment for a shoulder separation includes:
- A sling to keep the shoulder in place
- Ice to relieve pain and swelling
- Exercise, after a time of rest
- Surgery if tears are severe.
Rotator Cuff Disease: Tendinitis and Bursitis
In tendinitis of the shoulder, tendons become inflamed (red, sore, and swollen) from being pinched by parts around the shoulder.
Bursitis occurs when the bursa—a small fluid-filled sac that helps protect the shoulder joint—is inflamed. Bursitis is sometimes caused by disease, such as rheumatoid arthritis. It is also caused by playing sports that overuse the shoulder or by jobs with frequent overhead reaching.
Tendinitis and bursitis may occur alone or at the same time. Treatment for tendinitis and bursitis includes:
- Medicines such as aspirin and ibuprofen that reduce pain and swelling
- Ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow
- Gentle stretching and exercises to build strength
- Injection of corticosteroid drug if the shoulder does not get better
- Surgery if the shoulder does not get better after 6 to 12 months.
Rotator Cuff Tear
Rotator cuff tendons can become inflamed from frequent use or aging. Sometimes they are injured from a fall on an outstretched hand. Sports or jobs with repeated overhead motion can also damage the rotator cuff. Aging causes tendons to wear down, which can lead to a tear. Some tears are not painful, but others can be very painful.
Treatment for a torn rotator cuff depends on age, health, how severe the injury is, and how long the person has had the torn rotator cuff. Treatment for torn rotator cuff includes:
- Heat or cold to the sore area
- Medicines that reduce pain and swelling
- Electrical stimulation of muscles and nerves
- Cortisone injection
- Exercise to improve range-of-motion, strength, and function
- Surgery if the tear does not improve with other treatments
Movement of the shoulder is very restricted in people with a frozen shoulder. Causes of frozen shoulder are:
- Lack of use due to chronic pain
- Rheumatic disease that is getting worse
- Bands of tissue that grow in the joint and restrict motion
- Lack of the fluid that helps the shoulder joint move
Treatment for frozen shoulder includes:
- Medicines to reduce pain and swelling
- Gentle stretching exercise
- Electrical stimulation of muscles and nerves
- Cortisone injection
- Surgery if the shoulder does not improve with other treatments
A fracture is a crack through part or all of a bone. In the shoulder, a fracture usually involves the collarbone or upper arm bone. Fractures are often caused by a fall or blow to the shoulder.
Treatment for a fracture may include:
- A doctor putting the bones into a position that will promote healing
- A sling or other device to keep the bones in place
- After the bone heals, exercise to strengthen the shoulder and restore movement
Arthritis of the Shoulder
Arthritis can be one of two types:
- Osteoarthritis—a disease caused by wear and tear of the cartilage
- Rheumatoid arthritis—an autoimmune disease causing one or more joints to become inflamed
Osteoarthritis of the shoulder is often treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen. People with rheumatoid arthritis may need physical therapy and medicine such as corticosteroids.
If these treatments for arthritis of the shoulder don’t relieve pain or improve function, surgery may be needed.
What Research Is Being Done on Shoulder Problems?
Scientists are studying shoulder problems to find ways to:
- Improve surgery
- Improve function and reduce pain
- Correct movement patterns that cause shoulder pain in some people with spinal cord damage
- Develop new medicines that help muscles and tendons heal
- Prevent and treat rotator cuff tears
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