Introduction
The shoulder joint is a complex joint connecting the upper arm to the trunk of the body, and it engages in various movements in association with multiple muscles and tendons surrounding it. This joint is more prone to injuries and pathological conditions due to its varied range of movements, from rotation to flexion to complete 360-degree circumduction (full circular motion). The shoulder conditions can affect the soft tissues surrounding the joint and cause pain, instability, and immobility in the shoulder. Pathologic conditions of the shoulder can be acute (sudden) or chronic (long-term). This article will discuss the various shoulder pathologies in detail.
What Are the Common Pathological Conditions of the Shoulder?
1. Shoulder Sprains: This condition occurs when the ligaments of the shoulder joint get excessively stretched beyond their normal limits. Ligaments are the bands of flexible connective tissues that connect two bones and secure them. Shoulder sprain can cause pain, swelling, and bruising in the shoulder joint.
Common Causes:
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Abnormal twisting of the hands.
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A direct blow over the shoulder.
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Repetitive stress.
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Overuse.
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A fall with an extended arm.
Typically, the diagnosis of this condition involves conducting a physical examination and employing radiographic investigations such as X-rays to gain a better understanding of the injury. The customary approach to treating osteoarthritis (OA) often involves implementing the R.I.C.E. method, which entails rest, applying ice, compression, and elevation.
2. Shoulder Impingement: This particular condition ranks among the frequent causes of shoulder pain. It manifests when the shoulder's tendons experience impingement against adjacent tissue or bone during upward arm movements. Shoulder Impingement affects the group of tendons or muscles called the rotator cuff. The affected individuals usually have constant pain in the arm, especially while lifting the arm above the head.
Common Causes:
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Age-related wear and tear.
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When the fluid-filled sac between the shoulder's tendons and the acromion (a bony projection on the outer edge of the shoulder) becomes irritated and inflamed.
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Age-related development of bony growth (spurs) on the acromion.
Typically, the diagnosis of this condition involves a physical examination where the doctor assesses the range of motion in the affected arm. Sometimes, the doctor may perform imaging tests such as X-rays to look for the growth of bony spurs. The primary objective of treating this condition is to alleviate pain and restore the functional capabilities of the shoulder joint. The doctor will recommend the R.I.C.E method and other over-the-counter anti-inflammatory medications to relieve pain in the affected area. The doctor may recommend the patient to a physical therapist to improve the range of movements of the arm. The doctor may recommend steroid injections in the bursa to relieve pain and swelling in patients with severe pain. Rarely do patients require surgical management for this condition.
3. Rotator Cuff Tear: The group of muscles and tendons surrounding the shoulder joint is called the rotator cuff. This condition occurs when there is partial or complete damage to the rotator cuff muscles. Rotator cuff tear commonly occurs in individuals who are excessively involved in sports activities like basketball or tennis, and it can also occur in individuals who are indulged in occupations involving excessive arm movements.
Common Causes:
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Progressive wear and tear of the tendon.
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Trauma.
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Heavy lifting.
The condition is diagnosed through a physical examination of the shoulder joint and an assessment of the movements. This condition is mainly treated through conservative management, like physiotherapy, to improve the flexibility and strength of the shoulder joint. Patients with severe pain may require steroid injections in the shoulder joint. In cases where conservative treatment fails to improve, surgical management of the condition may be necessary. The orthopedic surgeon will use various techniques to repair the rotator cuff tear.
4. Frozen Shoulder: Frozen shoulder is a painful condition of the shoulder characterized by stiffness and limitations in the movement of the shoulder joint.
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This condition occurs more commonly in females than males, especially between the ages of 40 to 60.
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Currently, the exact cause of this condition remains elusive. The affected individuals undergo three phases of this condition: freezing, frozen, and thawing.
Patients usually have restrictions with active and passive range of motion, especially while performing external rotation and abduction movement of the arm. This condition is diagnosed through detailed history taking and physical examination. The doctor may perform various tests of combined motion by palpating the shoulder blade from behind the patient. Radiographic investigations may be performed to rule out other differential diagnoses. The primary mode of management is physiotherapy. The physiotherapist will help improve the shoulder's range of motion and the body's posture and relieve pain. They will tailor an individualized program of stretching and strengthening exercises.
5. Shoulder Trauma: Fractures of the shoulder involves a break in any one or more of the bones of the shoulder joint in the collarbone (clavicle), upper arm bone (humerus), and shoulder blade (scapula). Shoulder joint dislocation takes place when the upper arm bone's ends dislocate from their usual position, detaching from the cup-shaped socket found in the shoulder blade.
Common Causes:
Fractures:
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Direct blow to the shoulder joint.
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Road traffic accidents.
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Fall.
Dislocations:
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Forceful external twisting of the shoulder joint.
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Sports-related injuries.
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A direct hard blow over the shoulder joint.
How Is Shoulder Pathology Addressed?
The affected individual may develop severe pain, swelling, bruising, deformity, and immobility. A dislocated shoulder and an outward rotated arm may develop prominence in the shoulder joint. Shoulder joint injuries are generally diagnosed through radiographic investigation like X-rays to visualize the bony structures for a break in the discontinuity of the bone or dislocated shoulder. Conservative management includes immobilizing the shoulder joint with a sling for three to eight weeks to provide enough time for the fractured bones to heal. Severe fracture cases require surgical management that involves surgical reduction and fixation of broken fragments with plates, screws, or wires. In patients with a dislocated shoulder, the healthcare provider may perform closed removal with gentle maneuvers to bring back the dislocated shoulder to its place.
Conclusion
The shoulder joint is a complex joint comprising several tendons, ligaments, muscles, and bones. Pathologies of the shoulder joint can cause pain, swelling, and restricted arm movements. Each shoulder joint pathology's recovery time varies and often requires immediate diagnosis and treatment.
