Shoulder Impingement
Shoulder impingement is one of the most common causes of shoulder pain. It occurs when the rotator cuff becomes irritated by rubbing beneath the acromion during overhead activities. Patients commonly experience pain with reaching overhead, lifting, and often pain at night. Impingement is frequently the beginning of a process that may improve with treatment or gradually progress to a partial or full-thickness rotator cuff tear if left untreated.
Rotator Cuff Tear
The rotator cuff is a group of muscles and tendons that surround the shoulder and are essential for normal shoulder strength and function. Over time, continued impingement or age-related wear can result in a partial or complete tear of the rotator cuff. Rotator cuff tears may also occur following an injury, often in a tendon that has already begun to degenerate. Once a rotator cuff tendon is torn, it does not heal on its own and may gradually enlarge over time. In some patients, a chronic tear may eventually become irreparable.
Irreparable Rotator Cuff Tear
Some rotator cuff tears become too large or have been present for too long to be repaired successfully. These tears can lead to persistent pain, weakness, and eventually the inability to raise the arm. Over time, they may also lead to progressive destruction of the shoulder joint and advanced shoulder arthritis. Fortunately, several effective treatment options remain available depending on the patient and the condition of the shoulder.
Shoulder Arthritis
Shoulder arthritis occurs when the smooth cartilage covering the ball and socket gradually wears away. As the cartilage deteriorates, the joint becomes painful, stiff, and more difficult to move. Shoulder arthritis usually develops gradually over time, although previous injuries can also contribute.
Frozen Shoulder
Frozen shoulder, also known as adhesive capsulitis, usually develops gradually without a significant injury. It often begins with increasing pain followed by progressive stiffness and loss of motion. It occurs much more commonly in middle-aged women than in men. Most patients improve without surgery.
Shoulder Instability
Shoulder instability is most commonly associated with an injury that forces the shoulder out of the socket, resulting in a dislocation. Once this occurs, the shoulder may continue to feel loose or unstable and can repeatedly slip out of place. Younger patients are at the greatest risk of recurrent instability, while older patients are more likely to also have an associated rotator cuff tear.
AC Joint Arthritis & Injuries
The AC joint is the small joint on the top of the shoulder where the collarbone meets the shoulder blade. It commonly develops arthritis with age and may also be injured during falls or contact sports. Sometimes it is the primary source of pain and often can be treated during rotator cuff surgery if needed.
Biceps Tendon Disorders
The biceps is a unique tendon because it travels within the shoulder joint before exiting into the upper arm. It works closely with the rotator cuff and commonly becomes inflamed, worn, or partially torn. Tears of the biceps tendon can also provide important clues that a larger problem may be occurring within the shoulder.
Labral Tears
The labrum is a ring of cartilage that surrounds the shoulder socket and helps stabilize the shoulder joint. Labral tears may occur after a shoulder dislocation leading to instability, or they may develop gradually from wear and tear associated with degenerative conditions including arthritis.