The shoulder has the greatest range of motion, responsible for lifting
and for getting your hand in the right position for any task from
lifting groceries, driving and dressing, to swimming and hitting the
tennis ball. The shoulder can be easily injured and become unstable
because of the large range of its motion and the shoulder socket is
shallow. Shoulder pain can be localized or can radiate to other parts of
the body, including the arms, chest and back.
Your shoulder is formed by three bones that make up two major joints:
the humerus or arm
the scapula or shoulder blade
the clavicle or the collarbone
The shoulder joint is surrounded by tendons, ligaments and muscles that
support it and these soft tissues can become damaged from overuse or
underuse, from accidents and from conditions that cause gradual
deterioration such as arthritis, bursitis and tendinitis.
These three bones form two major joints:
the shoulder joint or glenohumeral
the AC or acromioclavicular joint
The joints allow your arm to rotate in a full circle and elevate it
upward, downward, forward and backward and more. Each joint is
surrounded by cartilage to pad the meeting of the bones, ligaments that
connect the bones and muscles, and the tendons attach the muscles to the
Injuries such as a joint shoulder dislocation and separation, a broken
collarbone, a frozen shoulder, fractures in the upper arm bone or
shoulder blade, and torn tendons as in rotator cuff tears can cause
severe pain and immobilize your shoulder.
A dislocated joint is an emergency. If your shoulder looks abnormal in
the way that it hangs or moves or you have numbness, seek medical
attention. Treatment depends on which joint you dislocate and the
severity of the injury. It might include manipulations or surgery to
reposition your bones, medication, a splint or sling, and
Dislocation occurs when the bones on opposite sides of a joint do not
line up. Dislocations can involve any of the three joints.
Shoulder separation or “separated shoulder” occurs when your collarbone
does not meet the shoulder blade properly at the point where the two
bones normally meet. It is caused by damage to the ligaments holding the
joint in place, which often occurs when the ligaments are partially or
totally torn during a fall on an outstretched hand or a powerful hit to
the shoulder joint.
A dislocation of the sternoclavicular joint interrupts the connection
between the collarbone and the breastbone or sternum.
The most common dislocation is when the ball component of the shoulder
joint comes out of its socket in the glenohumeral joint. It can be
dislocated toward the front or the back. In most cases, this is caused
by a powerful force pulling the shoulder outwards and causing the ball
to come out of the socket. The forward dislocation is caused by the arm
being forcefully twisted outward when the arm is above the level of the
shoulder, from falls or a direct blow to the shoulder. Posterior
dislocations are much less common than anterior dislocations and can
occur from seizures or electric shocks when the muscles of the shoulder
contract and forcefully tighten.
Ballplayers are at particular risk for future dislocations as the joints
are under a lot of pressure. The arm will not look normal and the
shoulder can dislocate downwards, backwards or forwards.
Dislocation can also cause damage to the soft tissues that support the
joint, which may include tearing or straining the ligaments and tendons.
The treatment for a ball and joint dislocation is typically a procedure
called a reduction that involves putting the ball back into the socket.
Rotator Cuff Tendinitis
Tendons are cord-like bands of tissue that connect muscles to bone and
tendon tissue is made of a tough, fibrous substance called collagen that
can withstand quite a bit of force and tension. Overtime, tendons can
become inflamed and painful and tendon injuries can result in the
shoulder joint as well as in the elbow, knee and ankle.
Doctors may use different terms to describe a tendon injury including
tendinitis, tendinosis or tendinopathy. Many common sports afflictions,
including tennis elbow, golfer’s elbow, swimmer's shoulder, and jumper's
knee are actually forms of tendinitis/tendinosis.
Your arm is kept in your shoulder socket by your rotator cuff, a
collection of muscles and tendons that stabilize the shoulder. The
rotator cuff is comprised of four tendons and muscles that originate
from the “wing bone” or the shoulder blade and together they combine to
form a cuff over the upper end of the arm, the head of the upper arm
bone or humerus.
The rotator cuff helps to lift and rotate the arm and to stabilize the
ball of the shoulder within the joint. Rotator cuff tendinitis is
irritation or inflammation of the tendons and muscles that help move
your shoulder joint. It is also called shoulder impingement.
Shoulder tendinitis or impingement occurs when the tendons of the
rotator cuff and the bursae, the fluid-filled sacs that cushion them,
are pinched in the narrow space beneath the bony edge of the shoulder
blade. Rotator cuff tendinitis can develop over time as the result of a
minor injury, or as a result of repetitive motions that lead to
inflammation in the bursae.
It is a common injury in athletes who use overhead throwing or lifting
motions, young athletes who use their arms overhead for swimming,
baseball, and tennis and those who do repetitive lifting or overhead
activities using the arm, such as paper hanging, construction, or
Tendinitis causes pain throughout the shoulder joint extending as far as
the elbow that may be manageable at first but typically worsens over
time. Other symptoms include decreased range of motion and strength in
the shoulder; after a prolonged period, it may be difficult to lift the
arm over the head. Usually symptoms appear after a period of overuse of
the shoulder joint, with increased pain described as a constant tooth
ache that radiates down the front of the arm. The pinching may become
worse when the arm is raised away from the side of the body.
Treatment is often nonsurgical, with medications to reduce inflammation
and physical therapy. If the shoulder does not improve with these
treatments, surgery may be required.
Rotator Cuff Tear
Tendinitis in the shoulder can lead to a tear called a rotator cuff
tear. A rotator cuff tear can occur suddenly or gradually from many tiny
tears from overuse and aging. The gradual kind of injury can be caused
by chronic wear and tear with the breakdown of the tendon.
Some athletes who have a lot of throwing movement in their sport or
heavy weight lifting are more prone to rotator cuff tears including
pitchers in baseball, swimmers and tennis players, golfers, basketball
players, tennis players, runners and even people who bowl.
Some occupations, hobbies and sports involve repeating the same motions
over and over, and this can damage a tendon: typing, clicking a mouse,
clenching a steering wheel or using power tools, gardening, shoveling,
raking and painting. Sudden tears are more likely when there has already
been wear and tear on the tendon. Abrupt stress causes one of the
tendons to pull away from the bone or tear in the middle of the tendon.
You can also tear a rotator cuff by falling on your shoulder or using
your arm to break a fall and lifting heavy weights.
The incidence of tendon injury increases with age, and it's especially
common after age 40. Some medical conditions can increase the risk,
including arthritis, gout, and thyroid disorders.
Pain, usually with overhead activities
Catching, locking, popping, or grinding sound when you use the
Occasional night pain or pain with daily activities
A sense of instability in the shoulder
Decreased range of motion
Loss of strength
Because the rim of the shoulder socket is soft tissue, x-rays will not
show damage to it. The doctor may order a computed tomography (CT) scan
or magnetic resonance imaging (MRI) scan. In both instances, a contrast
medium may be injected to help detect tears. Ultimately, however, the
diagnosis will be made with arthroscopic surgery.
Sudden, severe trauma can damage the tendons instantly, and may require arthroscopic
surgery, a minimally invasive procedure using a camera to repair the
Swimmer’s shoulder is an overuse injury that affects the tendons,
muscles and ligaments in the shoulder. Pain occurs when the connective
tissue or tendons in the shoulder rub against the shoulder blade.
Inflammation occurs from the repetitive overhead arm motions that are
involved in activities such as the freestyle swimming stroke and use of
a kickboard. As a swimmer fatigues, the muscles of the rotator cuff
become less efficient and the tendon starts to rub against the bone.
Overtraining can lead to this pain if the swimmer continues to swim with
fatigues muscles. The muscles have to work harder in a weakened
condition and the swimmer has to perform more strokes to cover the same
distance, which means muscles are being overused that are already
Treatment to reduce pain and inflammation, and physical therapy are the
first approach. If the injury has not improved, surgery may be
Shoulder Arthritis and Bursitis
Osteoarthritis, the “wear-and tear” type of arthritis and rheumatoid
arthritis, the autoimmune form that causes pain and inflammation, can
affect the shoulder joint causing pain, inflammation and limitation of
Bursitis, the inflammation of the fluid-filled sacs that rest over the
rotator cuff tendons and cushion them, can cause pain with overhead
activities or pressure on the upper, outer arm.
Frozen shoulder, also known as adhesive capsulitis, or “sticky
inflammation” occurs when a capsule forms and tightens around the
shoulder joint causing pain and restriction of movement. It is a common
complication of a rotator cuff tear or broken arm. Certain diseases can
also increase your likelihood of developing a frozen shoulder: diabetes,
hyperthyroid, hypothyroid, cardiovascular disease and tuberculosis and
if you're recovering from a medical condition or procedure that prevents
you from moving your arm—such as a stroke or a mastectomy.
It typically develops slowly with three stages and occurs on one side,
most often in the 40 plus age group:
Freezing stage. Any movement of your shoulder causes
pain, and your shoulder's range of motion starts to become
Frozen stage. Pain may begin to diminish during this
stage. However, your shoulder becomes stiffer, and using it
becomes more difficult.
Thawing stage. The range of motion in your shoulder
begins to improve.
Frozen shoulder is usually managed with surgery only after nonsurgical
treatment has failed.
Pinched Nerve in the Shoulder—Sciatica
A pinched nerve is a compression of a nerve in the shoulder when too
much pressure is applied to the tissue in the area from an injury to the
bone or cartilage in the shoulder, or by an injury to the muscles and
tendons. Repetitive motions, Carpal tunnel syndrome, poor posture,
excess weight, and some medical conditions such as rheumatoid arthritis
and bone spurs from osteoarthritis can cause the spine to stiffen and
limit the space for the nerves in the shoulder. Your arm may feel numb
or with decreased sensation, or with a “pins and needles” tingling, or
even feel that the entire arm has fallen asleep. There may even be a
sharp, burning pain.
Cubital Tunnel Syndrome
The ulnar nerve is one of three main nerves in your arm. It travels down
from your neck into your hand and can be constricted in several places
along the way. The elbow is the most common place. The spot where the
ulnar nerve is closest to your skin is in the area called the “funny
bone”. With a shock-like symptom similar to the pain you feel when you
hit your “funny bone” in your elbow, this condition may occur if you
frequently bend, lean on or hit your elbows n your sporting or daily
The ulnar nerve is especially prone to compression at the elbow because
it travels through a very narrow space without much soft tissue to
protect it. As the nerve stretches over the bony ridge in the elbow, it
can become irritated and fluid buildup adds to the compression. The
symptoms can cause aching pain on the inside of the elbow or affect your
a feeling of your fingers falling asleep, especially when your
elbow is bent—making it harder for your hand to manipulate
numbness and tingling that comes and goes when you are driving
or holding the phone with a bent elbow
your grip may feel weakened when you are typing or playing an
muscle wasting—as sign that the condition is very severe. See
You are more at risk for developing cubital tunnel syndrome if you:
have had previous fractures or dislocations in the elbow
have bone spurs or arthritis in the elbow
have swelling in the elbow joint
have cysts near the elbow joint
engage in repetitive and prolonged activities that require the
elbow to be bent or flexed
Nonsurgical treatment such as bracing and physical therapy is usually
recommended first, unless there is muscle wasting. Your doctor may
recommend surgery if the nonsurgical methods so not improve your
condition, the ulnar nerve is very compressed or compression has caused
Most of the time, both the radius and ulna bones are broken in forearm
fractures. The radius is the bone closest to the thumb and the ulna is
closest to the body. A forearm fracture affects your ability to rotate
your arm, and bend or straighten both the wrist and elbow. The most
common causes of forearm fractures include:
Fall on an outstretched arm, often during sports or from a
A broken forearm usually causes immediate pain. Because both bones are
usually involved, forearm fractures often cause an obvious
deformity—your forearm may appear bent and shorter than your other arm.
You will most likely need to support your injured arm with your other
Additional symptoms include:
Bruising (not as common as in other broken bones)
Inability to rotate arm
Numbness or weakness in the fingers or wrist (rare)
Sometimes the bones break into pieces that may or may not be lined up.
Treatment of broken bones follows one basic rule: the broken pieces must
be put back into position and prevented from moving out of place until
they are healed. Because the radius and ulna rely on each other for
support, it is important that they are properly stabilized. If the bones
are not accurately aligned during healing, it may result in future
problems with wrist and elbow movement.
Most adult forearm fractures require surgery to make sure the bones are
stabilized and lined up for successful healing.
Tennis Elbow—Lateral Epicondylitis
Both tennis and golfer’s elbow are forms of tendinitis or swelling of
the tendons. Tennis Elbow results from inflammation of the tendon along
the outside of the elbow, and can affect you even if you have never set
foot on a tennis court.
Tennis elbow comes from any repetitive gripping activity that involves
using the thumb and first two fingers:
sports such as tennis, racquetball, squash, fencing and weight
Golfer’s elbow is an overuse injury and a relative of tennis elbow,
causing pain and inflammation in the tendon that connects the forearm to
the elbow along the inside of the elbow.
Golfer’s elbow is not just a golfer’s condition. It is caused by
activities that involve repetitive flexing, gripping or swinging and can
also affect people who garden, bowl, golf, play baseball, garden, paint
and do carpentry.
Both Tennis Elbow and Golfer’s Elbow are treated first non-surgically,
often with injections to reduce pain and inflammation. If this is not
effective, surgery to remove the section of tendon that is damaged and
repair the remaining tendon will be needed.
For more information, call 1.866.CALL.MLH.