Dr. Vikash Kapoor

Shoulder Problems

The commonly faced problems of a human shoulder are described below -

1) Frozen shoulder

Frozen shoulder which has also been termed as Adhesive Capsulitis is a condition that is mostly faced by women aged between 40 to 60 years. Research says women are more susceptible to this problem rather than men. There is no specific reason for this condition to develop but sometimes it is experienced by the patients after meeting with a traumatic injury or an accident. Frozen shoulder mainly restricts a person's shoulder joint motion resulting in contracted capsule and formation of scar tissues. The contraction and the formation together make it difficult for a person to perform normal activities by making the shoulder joint scarred and stiff.

Dull pain, limitation in the movement of the shoulder joint, and pain while performing activities where it is needed to raise arms above the head - these are the symptoms mostly found in the patients who are suffering from this condition.

Risk factors - Patient who have been dealing with the problems of Endocrine Disorders, Type I & II Diabetes, Thyroid, Parkinson's Disease, Heart Disease or other similar systemic condition are likely to develop the condition mentioned above. This condition is also very common among those who have been taking Antiretroviral medications for a prolonged period of time.

2) Tendoniti

A bunch of fibrous tissues which are tough but flexible in nature is known as tendon. Tendon plays a crucial role by working as a connector between the muscles and the bones of a human body. Tendon mainly aims at transmitting the force originated from the muscle contraction to the bones. Depending on the shapes and sizes activities of the tendons vary from each other. For instance, tendons smaller in size are eligible for controlling the movements of fingers. At times, due to different sorts of reasons inflammation occurs in the tendons which makes the muscle pulling action painful. This inflamed condition of the tendons is known as Tendonitis.

There is one particular area inside the tendon that is comparatively more prone to injury and the same if often described as the watershed zone of tendons. In this area quantity of blood supply is very poor and this weakness results in difficulty while delivering essential nutrients as well as oxygen to heal tendons with a sooner effect. Most of the tendon injuries are experienced by the patients due to the overuse of the tendons. Usually people aged between 40 to 60 years are found complaining about this kind of condition.

Pain related to tendon and muscle movements, tendon swelling and uneasiness, a feeling of tenderness over tendons - these are some of the common symptoms of Tendonitis.

3) Bursitis

A structure that works as a protector for the soft tissues by reducing friction between tendons, bones and ligaments, is called bursa. This sac like structure is filled with lubricating fluid and mainly aims at giving protection to the soft tissues from injuries caused by immense pressure formed in the nearby bones. Bursae are found throughout the body and the joints that are more prone to get extreme pressure, experience the problem of Bursitis more frequently. Bursitis is nothing but an inflamed Bursa that becomes irritated due to the increased pressure and repetitive use in the areas of joints like elbows, knees, shoulders, feet, hip and also the one that is located in the buttocks (lower part).

There are some common reasons found for which in most of the cases patient suffer from this condition:

• Problem of Arthritis in a nearby joint

• Pressure on bursa for a prolonged period of time due to long hours sitting or any other similar kind of activity

• Excessive stress on the joints which is very unusual too

• Movements of certain joints repetitively

• Any injury caused by sudden fall or due to the regular use of shoes that are imperfect for a person

• Patients suffering from Gout, Pseudogout and Rheumatoid Arthritis are likely to experience this condition more than those who do not have the symptoms mentioned above.

• Infection is stated as the another reason for which people suffers from Septic Bursitis. It mainly occurs due to several kinds of skin infections.

Pain that restricts movement of the joints, swelling, tenderness - these are known as some of the commonest Bursitis symptoms experienced by the majority of the patients.

Various types of Bursitis:

• Subacromial bursitis - affected area is shoulder

• Scapulothoracic bursitis - affected area is upper back

• Elbow bursitis

• Ischial (pelvic) bursitis

• Hip bursitis

• Knee bursitis

• Retrocalcaneal bursitis - affects heel

• Intermetatarsal bursitis - affects foot

4) Rotator Cuff Disease

The shoulder joint is stabilized by a group of four tendons namely the Rotator Cuff. These four tendons are connected with the four muscles that allow the shoulder to move in different directions. Each of these four muscles has unique role to perform to keep the shoulder movements functional.

The Subscapularis Muscle - used for internal rotation where the arms are turned inwardly

The Supraspinatus Muscle - required for arm elevation and moving the arms away from body

The Infraspinatus Muscle - responsible for arm lifting at the time of external rotation

The Teres Minor Muscl - like the Infraspinatus Muscle, this muscle also assists when the arms are turned outwardly

When the Rotator Cuff is damaged due to an accident, repetitive strains or any other similar kind of injury, then it is defined as a Rotator Cuff disease. Inflammation and degeneration due to aging are the two main causes of this kind of condition. Inflammation may occur due to Arthritic conditions or for the problems related to Bursitis and Tendonitis. However, it is essential to mention here in this context that people getting involved in repetitive overhead motions are more affected with the Rotator Cuff disease.

Shoulder pain is considered to be the commonest symptom of the Rotator Cuff Disease. Sometimes the pain is felt all of a sudden and that too after a few days of the trauma the patient has experienced. Originating mainly from the front part of the shoulder the pain gradually increases as a result of which it becomes difficult to continue with the shoulder movement at various directions. Along with pain inflammation occurs too and most of these problems start at bedtime. However, arresting the problems at the very initial stage is important otherwise the pain and inflammation of the Rotator Cuff Disease can lead to other major issues like frozen shoulder.

5) Rotator Cuff Tear

As stated above, Rotator Cuff is made up of four tendons that are connected with four muscles. If a tear is found in any one of those four tendons then the condition is defined as a Rotator Cuff Tear. Out of all the conditions that can affect a human shoulder Rotator Cuff Tear is known as the most common one. Torn Rotator Cuff restricts regular shoulder movement by making it painful and inflamed. If the condition is not treated properly then gradually it makes the shoulder weak and incapable of performing daily activities like combing hair, stressing out arms to hold an object, getting dressed etc.

Rotator cuff tear has become one of the common causes of disability and pain among the middle aged and old adults. This continuous pain occurs due to the torn tendon which fails to get attached to the head of humerus due to the tear. Though in most of the cases tears are found in the supraspinatus muscle and tendon but other parts too get involved in the same. Depending on the severity of the conditions two types of tears have been observed:

1. Partial tear

2. Full thickness or complete tear

Symptoms of a Rotator Cuff Tear are -

• Pain when lying on the shoulder which is inflamed

• Certain movements like lowering or lifting arm are painful

• Arm rotation is weak

• At the time of moving shoulder crackling sensation is felt

There is a noticeable difference in the pain in accordance with the type of Rotator Cuff Tear. If a tear occurs due to sudden fall it will arouse severe pain along with a weakness in the shoulder and a snapping sensation. On the contrary if the tear develops gradually and slowly then a mild pain will be experienced initially.

6) Dislocation

When the humeral head is removed forcibly from the socket then the condition is clinically defined as shoulder dislocation. There are many reasons for which a dislocation can occur. Those who are young experience this due to severe sports injury or sudden fall. The old generation faces the same problem for some other obvious reasons like aging of the ligaments and cartilages that support a human shoulder. However, it is required to be mentioned here that only weakening of ligaments cannot make a shoulder dislocated. At this situation too some force is applied as a result of which patient experiences shoulder dislocation.

Depending on the positioning of the humerus head after it is injured there are two types of shoulder dislocation cases found in the medical history. If the humeral head is moved to the front part of the joint then the condition is medically termed as anterior dislocation. 90 - 92% shoulder dislocation cases are found to be of the anterior types. Posterior dislocation occurs when humeral head is moved backward toward the blade of human shoulder.

Apart from these two mentioned above there are certain rare sorts of dislocations found such as Intrathoracic and Luxatio Erecta.

7) Separation

The joint of a human shoulder consists of - the clavicle, the scapula and the humerus. When the clavicle and the scapula come together the patient is diagnosed with the problem of Shoulder Separation. The joint between the clavicle and the scapula is known as the Acromioclavicular Joint where the shoulder separation mainly occurs when the AC joint is disrupted. This is why the same condition is also termed as AC Separation.

One prominent cause for the AC or shoulder separation is a sudden fall and that too onto the shoulder directly. This kind of sudden fall stabilizes the AC joint by injuring the surrounding ligaments. Initially patient complaints of having mild pain but if the deformity is severe then the pain also increases with time and takes a prolonged period of time to give pain-free movements to the patient.

8) Fractures

A sudden fall, severe collision, dreadful road accidents - these are the commonest causes of getting the clavicle or proximal humerus fractured. Since the scapula remains under a protection by the chest and muscles surrounded it is only found fractured is a massive trauma is experienced by the patient.

Pain, restricted shoulder movement, bruises, swelling, deformation, grinding sensation are some common symptoms found in the patients suffering from shoulder trauma.