Disorders of the shoulder

The shoulder is a complicated and sensitive joint and is indispensable for almost any movement. Inflammation and injury can damage them and cause pain and restricted mobility.
The following are the most important and common diseases and injuries of the shoulder joint and the involved muscular and ligamentous apparatus, classified according to their origin.

Classification of diseases of the shoulder

Below are the most common disorders and injuries of the shoulder divided into:

  1. Inflammation around the shoulder
  2. Injuries to the shoulder
  3. Shoulder disorders as a result of wear and incorrect loading

Inflammation around the shoulder

Inflammation of the shoulder joint

The shoulder is one of the most heavily loaded joints in our body and is heavily loaded especially in tennis players but also in various professions such as craftsmen. An inflammation in the shoulder can have many causes, but is always associated with pain and decreased mobility, which usually limits the daily activities considerably because even the everyday dress is often difficult. Therefore, inflammation in the shoulder should always be treated by a knowledgeable doctor.

Biceps tendinitis

The term biceps tendon inflammation refers to the presence of inflammatory processes in the area of ​​the biceps tendon. In most cases, these inflammatory processes affect the long tendon of the two-headed muscle. It is not directly a muscle inflammation. Mostly it is based on wear, often in throwing. The treatment of biceps tendon inflammation depends mainly on the underlying cause.

Bursitis acromialis - bursitis

A subacromial bursitis is the inflammation of a bursa in the shoulder joint. It is one of the most common shoulder diseases and is associated with severe pain. Often a faulty load is the cause. The therapy consists especially in calming and protecting the shoulder. If the pain can not be controlled, the use of medication makes sense.

For more information on this topic, see: Bursitis subacromialis and bursitis

Inflammation of the rotator cuff

Inflammation in the rotator cuff is one of the most common diseases of the shoulder. The muscle inflammation can be caused by various underlying diseases. The most common causes of rotator cuff inflammation include tendon sheath impairment, bottleneck syndrome and traumatic changes in the bony structures of the shoulder joint.

Injuries to the shoulder

Biceps tendon rupture

The long biceps tendon usually tears as a result of wear even at low loads. In a biceps tendon rupture, depending on the affected tendon different degrees of restriction of the function of the muscle. To treat a biceps tendon tear, there are several options to choose from and a doctor should always be consulted.

Ligament extension in the shoulder

During extreme movements, the ligaments and muscles of the shoulder are strained and block another movement in that direction. If, however, a movement is carried out with so much momentum that the ligaments can not withstand this pull, it leads to a ligament extension, or in the more extreme case, to a torn ligament. They can arise during sports as well as in everyday activities and are often associated with pain. After that is important the protection of the shoulder.

Torn ligament in the shoulder

A torn ligament of the shoulder is a rupture of the band structures lying there, which contribute to the stability of the joint. Often tearing of the band structures occurs in a fall with direct force on the shoulder joint and with the arm outstretched, resulting in severe pain. There are various options available for the treatment.

Rupture of the rotator cuff

If a rotator cuff tear occurs, the tendon coat of these rotators, most often the supraspinatus tendon, tears under the shoulder roof due to its anatomically close position. Such a tear is caused either by a serious accident, for example, by a fall on the outstretched arm, or as a result of degeneration (wear) of the weakened supraspinatus tendon. There are various options and exercises available for the treatment.

Contusion of the shoulder

A bruised shoulder is a shoulder injury that usually results from a fall or impact trauma. In the event of a bruise, the impact on the affected tissue can cause bruising and swelling. Bruising of the shoulder is painful, often the affected shoulder can not be loaded as usual. It usually heals without consequences.

Shoulder joint blasting

A shoulder articulation is a dislocation of the lateral end of the collarbone to the shoulder roof with injury to the stabilizing capsular / ligaments of the Schultereckgelenk. The most common cause is the fall on the shoulder with direct application of force to the shoulder joint. It manifests itself mainly in three symptoms: pain directly above the shoulder joint, swelling of the shoulder and relieving posture.

Shoulder joint instability

Instabilities occur preferably in the shoulder joint, which can be explained by the anatomy of the shoulder joint. A shoulder joint instability may be congenital or occur after an accident event. It usually manifests itself in severe pain. Treatment of shoulder instability can be done in two main ways: conservative and operative therapy.

shoulder dislocation

As a shoulder dislocation is called a usually very painful displacement of the shoulder joint. There are different causes for the occurrence of a shoulder luxation. Most commonly, however, is a levering movement of the upper arm with simultaneous external rotation, in which the arm moves away from the body. It is usually associated with severe pain. The therapy can be conservative or surgical.

SLAP lesion

Injuries and damage to the labrum-biceps complex are referred to as slap lesion. The reason why a SLAP lesion is triggered may be more acute, but also more chronic, eg due to overwork, nature. If it is a chronic slap lesion, it may be that the patient initially does not notice. As the lesion progresses and is not treated, the patient will usually experience pain in heavy exposures. In the case of a manifest slap lesion, the surgical treatment method is often the only therapeutically sensible procedure.

Shoulder disorders as a result of wear or incorrect loading

Shoulder osteoarthritis

The shoulder arthrosis (omarthrosis) is one of the wear-related shoulder diseases. The shoulder arthrosis is characterized by a cartilage consumption in the shoulder joint. Known causes of shoulder arthrosis are mechanical overloads, damage to the rotator cuff. The symptoms are rather uncharacteristic and are expressed in shoulder pain and restricted mobility of the shoulder. Both conservative and surgical treatment methods come into consideration.

calcific

A lime shoulder is a shoulder in which lime has settled. This happens most often in the tendon area of ​​the supraspinatus muscle, but can in principle also affect any other tendon of the shoulder musculature. The consequence of this is an inflammatory process in the shoulder joint, which leads to sometimes severe pain. There are several causes that may be considered for a calculus shoulder.

Cartilage damage in the shoulder joint

If there is cartilage damage, ie a kind of tear in the cartilage tissue, it can cause pain that may need to be treated. It may be a small crack, but may also take on significantly larger proportions. The reasons for cartilage damage can not always be clearly diagnosed. He often expresses himself in the form of severe pain. There are two distinctly different therapeutic approaches to cartilage damage in the shoulder joint: Conservative and operative.

Impingement syndrome

An impingement syndrome is an impairment of the function of the shoulder joint, which can arise as a result of chronic overstress, for example in tennis or golfers, swimmers or throwers. Often, however, one can not recognize any actual cause that triggers the disease, in these cases, there is a constriction due to the plant under the shoulder roof. Those affected usually complain of moderate to severe shoulder pain.

Frozen shoulder

The Frozen shoulder describes a temporary stiffening of one or both shoulders with severely limited mobility, which is associated with a gluing of the gliding layers of the shoulder joint. The development of the primary shoulder stiffness is not yet known. The treatment of the shoulder stiffness is basically conservative and has the gentle mobilization of the shoulder joint to the goal.

  • Frozen shoulder
  • These symptoms indicate a stiff shoulder

For anatomical understanding of the shoulder

The so-called shoulder girdle is formed by two bones on each shoulder side, ie by the two clavicles ( claviculae ) and shoulder blades ( scapulae ). The scapula forms the shoulder joint together with the humerus. In addition, the scapula forms two bony prominences, the acromion and the coracoid .

The shoulder joint is significantly stabilized by four muscles and their tendons, the so-called rotator cuff. The four muscles (supraspinatus muscle, infraspinatus muscle, teres minor muscle, and subscapularis muscle) move from the scapula to the humerus, where they attach to their tendons. For this reason, they lay around the head of the humerus like a cuff and form a "roof" over the shoulder joint. The space under the shoulder- roof, the subacromial space, is often affected by wear problems in the shoulder joint. A bursa facilitates sliding between the tendons and the bony shoulder roof. This can lead to shoulder pain, for example, through inflammation.

The shoulder joint is primarily moved and mobilized by muscles and tendons, resulting in a large range of motion. However, this increases the risk of instability, making the shoulder joint vulnerable.

In the image below, the upper arm with his humeral head and the scapula are shown from the front. One recognizes the relatively small area of ​​the joint, which connects both bones together. In addition to the muscles, the upper arm has, among other things, another help for stabilization in the shoulder joint. This consists in a cartilaginous lip which supports the spherical humeral head, such as a saucer with the small depression preserves a cup from slipping.
This cartilaginous lip is called the labrum glenoidale. If a part of this cartilaginous lip is torn off, then again and again it comes to the balling out of the shoulder joint even without violence, because the stability is impaired. This link leads directly to the page on the treatment of the tear of the labrum glenoidale.

The shoulder is a mainly muscle-guided joint. This means that the articulated connection consists largely of muscles. In contrast, one could see the hip joint, in which an important part of the stability of the hip joint is ensured by bands that are very resilient and can withstand enormous forces.
This muscle guidance proves to be a great advantage, considering the mobility gained thereby. However, there is also a great disadvantage of this type of connection between two bones. The stability is much lower compared to the hip joint and thus the vulnerability of the shoulder joint is significantly greater.

If one looks at the nature of the illnesses or injuries, three special diagnoses are particularly noticeable because of their frequency. These are the

  • Shoulder pain during movement of the arm (impingement syndrome, ie: "Impindschment")
  • the tendon tear of the deeper layers of the shoulder muscles ( rotator cuff rupture )
  • repeated shoulder excursion (recurrent shoulder dislocation)

Without appropriate expertise, no conclusions can be drawn on the cause of these diseases, so here is an explanation.

Figure shoulder joint
  1. Humeral Head - Caput humeri
  2. Shoulder joint socket -
    Cavitas glenoidalis
  3. Scapula - Scapula
  4. Clavicle - clavicle
  5. Schultereck - Acromion
  6. Schulte stretching collarbone
    Joint -
    Articulatio acromioclavicularis
  7. Deltoid - M. deltoideus
  8. Raven beak extension -
    Processus coracoideus
  9. Coracoid-Schultereck-
    Tape -
    Lig. Coracoacromiale
  10. Joint cavity -
    C avitas articularis
  11. Fibrocartilage ring -
    Labrum glenoidale
  12. Biceps, long head -
    M. biceps brachii
  13. Bursae -
    Bursa subacromialis
  14. Upper arm shaft -
    Corpus humeri
Illustration Muscles of the right shoulder: A - front view and B - back muscles

shoulder muscles

  1. Scapula-hyoid bone -
    Musculus omohyoideus
  2. Front Stair Muscle -
    Muscular scanelus anterior
  3. Head turner -
    M. sternocleidomastoid
  4. Clavicle - clavicle
  5. Deltoid - M. deltoideus
  6. Raven Spine Procession Upper Arm Muscle -
    Coracobrachialis muscle
  7. Unterschulterblattmuskel -
    M. subscapularis
    (second layer)
  8. Two-headed humeral muscle
    (Biceps) - M. biceps brachii
  9. Big Breast Muscle -
    Pectoralis major muscle
  10. Shoulder blade lifter -
    (second layer) -
    Musculus levator scapulae
  11. Upper bones muscle -
    Muscle supraspinatus (second layer)
  12. Scapular bone -
    Spina scapulae
  13. Small round muscle -
    Musculus teres minor
  14. Underbird muscle -
    Musculus infraspinatus
  15. Large round muscle -
    Musculus teres major
  16. Trapezius muscle -
    Trapezius muscle
  17. Wide back muscle -
    Latissimus dorsi muscle
    rotator Cuff
    = 4 muscles (7th + 11th + 13th + 14th) -
    covered by the deltoid muscle

Common shoulder disorders | Mr Ravi Singh (December 2019).


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