Shoulder

Shoulder Anatomy and Function

The shoulder is one of the most versatile and complex joints in the human body, allowing for a wide range of movement, including lifting, pushing, pulling, and rotation. This joint consists of three primary bones: the clavicle (collarbone), scapula (shoulder blade), and humerus (upper arm bone). These bones are supported by an intricate network of muscles, ligaments, and tendons that work together to maintain both stability and flexibility.

The shoulder’s versatility enables us to perform everyday tasks and engage in various physical activities. However, due to its range of motion, the shoulder is also more susceptible to injury and wear over time. Injuries or conditions affecting the shoulder can lead to pain, stiffness, and reduced function, impacting one’s quality of life.

Common Causes of Shoulder Pain

Shoulder pain can arise from several sources, including trauma (such as a fall or accident), overuse, and chronic conditions. Some of the most common causes of shoulder pain include arthritis, tendonitis, bursitis, and rotator cuff injuries. Overuse injuries, often associated with repetitive motions, can lead to inflammation and degeneration of shoulder components, further restricting movement.

Golden State Orthopedics & Spine (GSOS) approaches shoulder pain and injuries with a multi-faceted treatment plan. They aim to alleviate pain, restore function, and help patients return to their daily activities. Physicians at GSOS are experienced in non-surgical and surgical treatments, ensuring a tailored approach for each patient’s needs.

Common Shoulder Injuries and Conditions Treated at GSOS

  1. Arthritis: Shoulder arthritis involves the degeneration of joint cartilage, leading to pain, stiffness, and limited mobility. Osteoarthritis, the most common form, results from wear and tear, whereas rheumatoid arthritis is an autoimmune disorder that attacks joint tissue.
  2. Bursitis: Bursitis occurs when the bursa (small fluid-filled sacs that cushion bones and reduce friction) becomes inflamed, often due to repetitive motion. This condition is commonly seen in people who frequently lift objects overhead.
  3. Chronic Pain: Chronic shoulder pain can have various origins, including underlying conditions like arthritis or unresolved injuries. Long-term pain can be debilitating, affecting both sleep and daily function.
  4. Dislocated Shoulder (Shoulder Separation): A dislocation occurs when the upper arm bone is forced out of its socket, often from a fall or traumatic injury. A shoulder separation affects the acromioclavicular (AC) joint, where the collarbone meets the shoulder blade.
  5. Rotator Cuff Tear: The rotator cuff is a group of muscles and tendons that stabilize the shoulder joint. Tears can result from acute injury or degeneration due to aging. Symptoms include pain, weakness, and reduced range of motion.
  6. Fractures: Shoulder fractures involve breaks in one of the three shoulder bones, typically resulting from a high impact fall or accident. Fractures are particularly common in the clavicle and humerus.
  7. Frozen Shoulder (Adhesive Capsulitis): This condition is characterized by stiffness and pain in the shoulder joint, often developing gradually and worsening over time. It’s commonly seen in people recovering from an injury or surgery.
  8. Inflamed Shoulder (Shoulder Impingement): Shoulder impingement occurs when the shoulder blade exerts pressure on the rotator cuff, causing inflammation and pain. This condition can be exacerbated by repetitive overhead motions.
  9. Shoulder Instability: Shoulder instability happens when the joint’s supporting structures are loose or damaged, causing frequent dislocations. This condition can be the result of trauma or genetic factors.
  10. Polymyositis (PM): Polymyositis is an inflammatory muscle disease that leads to muscle weakness, primarily in the shoulders, hips, and thighs. It’s a rare condition and is thought to have an autoimmune component.
  11. Reflex Sympathetic Dystrophy (RSD) Pain Disorder: RSD is a chronic pain condition usually following an injury. Patients experience persistent pain, often with symptoms like swelling and temperature changes in the affected area.
  12. SLAP Tear: A SLAP tear involves an injury to the labrum, the cartilage that lines the shoulder socket. SLAP stands for “superior labrum anterior and posterior,” referring to the location and direction of the tear. These injuries are common in athletes and can result from repetitive motion.
  13. Sports Injuries: Sports injuries in the shoulder range from overuse conditions like tendonitis to acute injuries such as dislocations and fractures. These injuries are particularly common in sports that involve repetitive arm movements.
  14. Tendonitis and Biceps Tendonitis: Tendonitis in the shoulder often affects the biceps tendon, which connects the upper arm muscle to the shoulder. It is typically caused by overuse or aging, leading to pain and swelling in the front of the shoulder.

At GSOS, the initial approach to shoulder pain typically involves non-surgical treatments. These treatments aim to alleviate pain, reduce inflammation, and restore mobility without invasive intervention. Common non-surgical treatments include:

  • Physical Therapy: A tailored physical therapy program can strengthen shoulder muscles, improve flexibility, and restore range of motion. Physical therapy is especially effective for conditions like rotator cuff injuries and frozen shoulder.
  • Medications: Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended to reduce pain and inflammation.
  • Corticosteroid Injections: Corticosteroid injections can provide temporary relief by reducing inflammation in the shoulder joint. These injections are particularly effective for conditions like bursitis and arthritis.
  • Cold and Heat Therapy: Alternating cold and heat packs can help manage pain and inflammation, promoting blood flow and easing muscle stiffness.
  • Activity Modification: In cases of overuse injuries, modifying activities to avoid repetitive strain can help prevent further damage and allow the shoulder to heal.

When non-surgical methods are insufficient, GSOS physicians are trained to perform advanced shoulder surgeries to repair damage and restore functionality. Some common surgical procedures include:

  • Arthroscopy: Arthroscopy is a minimally invasive procedure that uses a small camera and specialized instruments to diagnose and treat shoulder problems. It’s commonly used for rotator cuff repairs, labral repairs (including SLAP tears), and shoulder impingement.
  • Open repair: This treatment option is also known as the traditional approach. The surgeon will repair the tendon through an incision that is several inches long. The deltoid muscle will need to be detached for the surgeon to have a better view of the shoulder and gain access to the torn tendon.
  • Mini-open repair: This procedure starts arthroscopically when the surgeon removes bone spurs and treats other structures within the joint. Then the surgeon will use a small incision to repair the tendon. The benefit of this option is that it avoids the need to detach the deltoid muscle.
  • Arthroscopic Subacromial Decompression: This is a treatment option for shoulder impingement syndrome, which is an injury to the muscles between the bones in the shoulder. The surgery starts with the arthroscope entering the shoulder joint. Once in the joint, the surgeon looks for tears in the muscles, tendons, and ligaments. After the joint is examined the physician will smooth off spurs that are contributing to inflammation and impingement on the rotator cuff.
  • Rotator Cuff Repair: Rotator cuff repair surgery involves reattaching torn tendons to the upper arm bone. This procedure can be performed arthroscopically or through open surgery, depending on the severity of the tear.
  • Shoulder Replacement: In cases of severe arthritis or significant joint damage, shoulder replacement surgery may be necessary. This procedure involves replacing damaged parts of the shoulder joint with artificial components, relieving pain and improving mobility.  There are multiple types of shoulder replacement surgeries, also known as shoulder arthroplasty. An orthopedic surgeon will decide on the best option depending on the type of damage, symptoms and patient’s age.
    • Total shoulder replacement: The entire shoulder joint is replaced with an artificial ball and socket.
    • Reverse shoulder replacement: An orthopedic surgeon will change the position of the ball and socket joint when placing the prosthetics. This treatment is ideal for patients with large rotator cuff tears and for those with cuff tear arthropathy, also known as shoulder arthritis. After surgery, the deltoid muscle controls the arm and not the rotator cuff.
    • Partial shoulder replacement or stemmed hemiarthroplasty: In this treatment option the ball aspect of the shoulder joint is repaired with an artificial ball.
    • Resurfacing hemiarthroplasty: The surgeon will replace the joint surface of the humeral head with a prosthesis cap. The advantage of this surgical option is that it preserves the bone. This is helpful for young or active patients to avoid the risk of artificial replacements wearing or loosening.
  • Labral Repair (SLAP Tear Repair): SLAP tear repair involves reattaching the torn labrum to the shoulder socket. This procedure is often performed arthroscopically and is common among athletes who experience repetitive shoulder motion.
  • Shoulder Stabilization: This surgery is needed when the shoulder is considered unstable, meaning it dislocates frequently or slips partially out of the joint. When surgery is needed the common treatment option at GSOS is the arthroscopic shoulder stabilization approach. This surgery uses arthroscopy to reattach the loose or torn ligaments to the joint using implants called suture anchors. These anchors will relocate, tighten and hold in place injured joints. Over time the sutures will disintegrate.
  • Fracture Repair: Shoulder fracture repair may require surgical intervention if the bone fragments are displaced. The surgery involves realigning the bones and securing them with plates, screws, or rods.

Shoulder pain and injuries can significantly impact daily life, making simple tasks challenging and uncomfortable. Golden State Orthopedics & Spine (GSOS) provides a comprehensive range of treatments to address shoulder pain, from conservative methods like physical therapy to advanced surgical interventions. The highly trained orthopedic specialists at GSOS work closely with patients to develop personalized treatment plans, helping them regain strength, mobility, and confidence in their shoulder function.

For more information on shoulder care, consult GSOS’s experienced team of specialists, who are dedicated to providing expert care with the latest advancements in orthopedic treatment.