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Just what is wrong with your shoulder?

19 December 2017

The winter weather always tends to make our joints ‘feel older’ than they really are -but despite its name ‘Frozen Shoulder’ has nothing to do with the frost and snow!

In fact you are much more likely to develop the condition while hunched in front of a computer in a warm office than yomping through snow-cover countryside, according to Mr Richard Evans, a Consultant Orthopaedic Surgeon at Spire Cardiff Hospital.

He explained: “The complex nature of the shoulder means that there is a lot that can go wrong with the joint and surrounding soft tissues leading to pain and loss of function. It is particularly prone to problems through poor posture, wear and tear, repetitive stress and acute injuries.

Here he looks at five common problems, how they develop and how they can be treated.

 

Frozen shoulder:  

What is it: Inflammation and thickening of the capsule lining that surrounds the shoulder joint.  It usually occurs with no obvious cause but can be associated with a minor injury or after a period of immobilisation.

Symptoms: Pain is felt in the upper arm that can often lead to a lack of sleep. Stiffness and pain can make it difficult to carry out many of the simple tasks of daily living.

Treatments: Painkillers and anti-inflammatory medication will reduce the pain while physiotherapy may help to control symptoms. A steroid injection into the affected area can help reduce inflammation and pain.

Keyhole surgery is considered if other treatments fail with the surgeon releasing the thick and inflamed lining to allow the shoulder to function freely.

 

Rotator cuff damage

What is it: The rotator cuff is a group of muscles, which wrap closely around the shoulder joint to keep it joint in the correct position and control shoulder and arm movements. The tendons are prone to damage through long-term wear-and-tear, after an accident or fall or, in some cases,  a combination of both.

Symptoms: The pain is felt over the shoulder and upper arm made worse by reaching away from the body or behind the back. Movements are weak and restricted making it difficult to raise the arm above shoulder height.

Treatments: Non-invasive treatments are similar to those in frozen shoulder but a complete rotator cuff tear will not heal and usually get worse. In these cases a surgical repair is the best option with the tendon being secured back onto the bone.

 

Shoulder arthritis

What is it: Arthritis of the shoulder is a degenerative wear process of the smooth cartilage lining of the ball (humeral head) and socket (glenoid) joint. The worn surfaces can then grind on each other causing pain.

Symptoms: Deep-seated pain that develops over months to years, worse with activity and often felt at night. Joint stiffness may make it difficult to carry out simple activities of daily living.

Treatments: Cortisone injections into the shoulder joint may provide some temporary relief but it is also sensible to modify or limit the actual use of the shoulder.

Shoulder replacement removes the arthritic joint surfaces and replaces them with artificial components. The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket. A reverse total shoulder replacement - when the socket and metal ball are switched - means the metal ball is attached to the shoulder bone and the plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the rotator cuff to lift the arm.

 

Bursitis/tendonitis

What is it: The rotator cuff tendons pass through a relatively narrow space made up of bone and ligament at the top of the shoulder. Catching and rubbing in this area leads to inflammation of the tendons and the surrounding bursa tissue. This can be aggravated by poor shoulder posture but is often mechanical in nature due to bone and ligament thickening.  

Symptoms: Pain, usually an aching sensation that comes on gradually and is felt over the shoulder and upper arm. It may be made worse by reaching away from the body or behind the back but the range of motion is usually better compared to frozen shoulder. It is common to feel pain at night making it difficult to sleep.

Treatments: Similar to frozen shoulder. If non-invasive treatments fail keyhole surgery (arthroscopic subacromial decompression) involves removing the inflamed bursa with release of the tight ligament and removal of the thickened bone.

 

Shoulder instability

What is it: The shoulder consists of a ball and a shallow socket surrounded by soft tissues, which includes the capsule lining the joint, ligaments, and the rotator cuff muscles.

It is a relatively loose joint to allow great flexibility in movement but this makes it vulnerable to dislocation particularly contact sports. When the shoulder dislocates it tears tissues attached to the rim of the socket and stretches the ligaments of the joint leaving a weak point around the shoulder.

Symptoms: The shoulder may start to dislocate frequently requiring multiple hospital visits for relocation. Sometimes the shoulder only slips partially out of the socket (sublux) and it may be possible to return it into position yourself.

There may be a feeling of insecurity and apprehension when the arm is in certain positions such as when the hand is raised above the head and away from the body and will almost certainly affect your ability to play certain sports.

Treatments: Physiotherapy is helpful to regain mobility and strength of the shoulder.

Surgery (arthroscopic stabilisation) may be considered after the initial episode of dislocation (particularly in high level sports people) or if the shoulder repeatedly dislocates.

Surgery is also used to treat patients whose shoulders feel unstable but do not fully dislocate. This is carried out using keyhole (arthroscopic) techniques to reattach the ligaments and labrum back to the socket to make it more stable.

 

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