Rotator Cuff Tear
Rotator cuff tears are common in the adult population of people over 40. The rotator cuff is made up of four muscles and their tendons, which act to hold the upper arm (humerus) to the socket of the shoulder (glenoid fossa). The rotator cuff also provides mobility and strength to the shoulder joint. Two sac-like structures, called bursae, allow smooth gliding between the bone, muscle, and tendon. They also cushion and protect the rotator-cuff structures from the upper part of the scapula (the acromion).
Pain occuring in the front of the shoulder that radiates down the side of your arm. Gradual onset of pain is most common in the adult population. Activities involving reaching or lifting may bring about an onset of pain. At first the pain may be mild and relieved by over-the-counter medication such as aspirin or ibuprofen. Over time the pain may become noticeable at rest or with no activity at all and be accompanied by stiffness and loss of motion.
Trauma such as a lifting injury or fall can cause a tear in the rotator cuff that results in acute pain. When the tear occurs with an injury, there may be sudden acute pain, a snapping sensation and an immediate weakness of the arm.
The shoulder joint is your body’s most mobile joint. It can turn in many directions, but this advantage also makes your shoulder joint easy to dislocate. A partial dislocation (subluxation) means the head of the upper arm bone (humerus) is partially out of the socket (glenoid). A complete dislocation means it’s all the way out. Your shoulder joint can dislocate forward, backward or downward. A common type of shoulder dislocation is when your shoulder slips forward (anterior instability). This means your upper arm bone moved forward and down out of its joint. It may happen when you put your arm in a throwing position.
Symptoms to look for include swelling, numbness, weakness and bruising. Sometimes dislocation may tear ligaments or tendons in your shoulder. Once in awhile, the dislocation may damage your nerves.
Your doctor will examine your shoulder and may order an X-ray. It’s important for you to tell your doctor how it happened. Was it an injury? Have you ever dislocated your shoulder before? Your doctor will place the ball of the upper arm bone (humerus) back into the joint socket. This process is called closed reduction. Your severe pain stops almost immediately once your shoulder joint is back in place.
Burners and Stingers
Burners and stingers are a common injury in contact or collision sports. The injury is named for the “stinging” or “burning” pain that radiates (spreads) from the shoulder to the hand. This can feel like an electric shot or “lightening bolt” down the arm and can be accompanied by a warm sensation.This is a common injury in contact sports. In fact, up to 70 percent of all college football players report having experienced a burner or stinger during in their 4-year career. An orthopaedist makes the diagnosis based upon the history of injury and your symptoms. X-rays, magnetic resonance imaging (MRI) and other nerve studies are not usually needed.
More extensive work-up is required if you have:
- Weakness lasting more than several days
- Neck pain
- Symptoms in both arms
- History of recurrent stingers/burners
A broken collarbone (fractured clavicle) is a common injury among two very different groups of people: children and athletes. Many babies are born with collarbones that broke during the passage down the birth canal. A child’s collarbone can easily crack from a direct blow or fall because the collarbone doesn’t completely harden until a person is about 20 years old. An athlete who falls may break the collarbone because the force of the fall is transmitted from the elbow and shoulder to the collarbone.
The collarbone is considered part of the shoulder and helps connect the arm to the body. It lies above several important nerves and blood vessels. However, these vital structures are rarely injured when the collarbone breaks. The collarbone is a long bone, and most breaks occur in the middle section.
Signs of a break include:
- Sagging shoulder (down and forward).
- Inability to lift the arm because of pain.
- A grinding sensation if an attempt is made to raise the arm.
- A deformity or “bump” over the fracture site.
- Although a fragment of bone rarely breaks through the skin, it may push the skin into a “tent” formation.
Rupture of the Biceps Tendon
A pro football player attempts an arm tackle and hears a pop in his upper arm. A weightlifter doing curls suddenly feels his shoulder “bubble.” A woman rearranging the living room furniture gets a sharp pain in her shoulder. Each of these individuals just ruptured their biceps tendon.
Ruptures of the distal tendon near the elbow are rare. They usually occur when an unexpected force is applied to a bent arm. The proximal biceps tendons near the shoulder tear more easily. Tears can be either partial or complete. Among the elderly, biceps tendon ruptures near the shoulder are often associated with rotator cuff tears.
Signs and symptoms
- Sudden, sharp pain in the upper arm.
- Sometimes, an audible snap.
- A bulge in the upper arm above the elbow, and a dent closer to the shoulder.
- Bruising from the middle of the upper arm down toward the elbow.
- Pain or tenderness at the shoulder.
Your physician will examine your arm and ask you to bend the arm and tighten the biceps muscle. The doctor may apply pressure to the top of the arm to see if there is any pain. If you have a history of shoulder pain, your doctor may request an MRI or a special X-ray called an arthrogram to see if you have also torn the rotator cuff muscle.
Conservative treatment is usually all that is needed for tears in the proximal biceps tendons. Complete tears of the distal biceps tendon require surgery to reattach the tendon to the bone. Range of motion exercises can begin as early as two weeks after surgery, although forceful biceps activity is often restricted for four to six months. Partial tears of the distal biceps tendon may be treated either conservatively or surgically. You and your orthopaedic surgeon should discuss the options for your specific case.