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Specialist clinics Healthcare Innovations 27 Common shoulder problems
The shoulder is the most mobile joint in the body and is actually made up of three joints. The sternoclavicular and acromioclavicular joints are at either end of the clavicle and the ball-and-socket glenohumeral joint
T he glenohumeral joint, with
its large ball and relatively shallow socket, accounts for
most of the shoulder movement, but it’s very reliant on various soft-tissue structures (tendons and ligaments) to keep it in joint. As a result, the vast majority of shoulder problems are due to either injuries to the ligaments (dislocations) or wear and tear and injuries to the tendons (rotator cuff tendonitis and tears).
Shoulder dislocations Shoulder dislocations usually occur as a result of an accident or sporting injury in patients under the age of 30. Following a fi rst dislocation, having relocated the shoulder, treat- ment involves an initial period of rest followed by a course of physiotherapy. If the shoulder dislocates again, it’s highly likely that this will become a
recurrent problem, and referral to an orthopaedic surgeon for investigation with an MRI or CT scan and surgical stabilisation (usually by keyhole surgery) maybe required. Interestingly, the younger the age
at which a patient fi rst dislocates their shoulder, the higher the chance of recurrence. For younger patients, particularly if they’re involved in contact or professional sports, surgical stabilisation after their fi rst dislocation is sometimes considered.
Rotator cuff tendonitis/tears From about the age of 35, everybody’s rotator cuff tendons begin to undergo degenerative changes (wear and tear). As time goes by, the tendons become increasingly vulnerable to micro- tears leading to tendonitis, partial thickness and full thickness tears. T e initial symptoms can be pain
on certain movements, particularly when elevating the shoulder, but can progress to constant pain and ulti- mately weakness and an inability to move the shoulder. Initial treatment is with anti-in-
fl ammatory medications and physi- otherapy. If symptoms continue, and particularly if there’s concern that there’s a tear, referral to an ortho- paedic surgeon for investigation with an MRI or US scan is recom- mended. Further treatment may involve keyhole surgery to address any impingement or to repair the tendon.
Frozen shoulder Frozen shoulder is a bit of an enigma; while it can aff ect anybody, it tends to occur in people between the ages of 35 to 60 and in women more commonly than men. Although it can
Stabilisation
sometimes be sparked by an injury or a pre-existing shoulder problem, most of the time it occurs out of the blue. It usually starts insidiously with background pain, and initially it can often be very diffi cult to diff erentiate it from other common shoulder prob- lems. As it progresses, the pain can become constant and unrelenting and shoulder movements stiff en up.
While most frozen shoulders ulti- mately settle, this can take several years. However, there are a number of good treatments, including a capsular hydrodistension and, on occasion, keyhole surgery, which can success- fully treat a frozen shoulder. Early referral to an orthopaedic surgeon for assessment and potential treatment is recommended.
Rotator cuff
Shoulder anatomy
If you’d like to know more about common shoulder problems or any other shoulder problems, visit:
cambridgeshoulder.co.uk or the YouTube Channel Cambridge Shoulder
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