image of shoulder pain

Shoulder Injury

The trained experts at iOrtho treat a variety of conditions involving problems with the shoulder, select a condition below to learn more.

Located on the front of your upper arms, your biceps are composed of two muscles — a “long head” muscle and a “short head” muscle — that work as one. Tendons keep the biceps attached to your arm bones. The proximal biceps tendon connects the shoulder joint to the biceps. The distal biceps tendon attaches the muscle to your ulna and radius (forearm bones). Inflammation or irritation of the bicep tendons is call bicep tendinitis.

Symptoms of Bicep Tendinitis

You may need to see a bicep tendinitis doctor if you experience a deep, throbbing pain in your shoulder joint that does not go away with home treatments. Bicep tendinitis pain often worsens if you move the shoulder, or you may hear a clicking noise and experience pain if you move your shoulder. Be aware that bicep tendinitis is often accompanied by a rotator cuff tear or superior labrum anterior to posterior lesions (SLAP), which necessitates more complex treatment methods that could involve arthroscopic surgery.

Causes of Bicep Tendinitis

Performing repetitive overhead motions, sports activities such as baseball, tennis or swimming and simple overuse/wear and tear are the primary causes of bicep tendonitis. Shoulder joint trauma or arthritis may also contribute to the development of bicep tendinitis.

How Does a Bicep Tendinitis Doctor Diagnose the Condition?

Your doctor may have you complete several tests to determine if you are suffering from bicep tendinitis. For example, Speed’s Test involves you holding your arm out, elbows slightly bent and palms up, while your doctor presses down on your arm. If you feel pain in a certain area of your shoulder during this test, this may indicate bicep tendinitis. Yergason’s Test has you bending your elbow about 90 degrees (right angle) while gripping your doctor’s hands. If you feel pain in a particular area of your shoulder while your doctor is pressing on your arm, you may be diagnosed with bicep tendinitis. Ultrasound and MRI are diagnostic imaging modalities that confirm a diagnosis of bicep tendinitis.

Tendons attach muscles to bones. Your biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. If you tear the biceps tendon at the shoulder, you may have pain,  lose some strength in your arm when you forcefully turn your arm from palm down to palm up and have a characteristic deformity of the muscle (popeye muscle) as a result of distal retraction.

Many people can still function with a biceps tendon tear, and only need simple treatments to relieve symptoms. If symptoms cannot be relieved by nonsurgical treatments, or if a patient requires complete recovery of strength, surgery to repair the torn tendon may be required.

Symptoms of Bicep Tear Includes:

    • Sudden and sharp pain 
    • Audible pop or snap
    • Cramping 
    • Bruising 
    • Pain or tenderness 
    • Weakness 
  • Difficulty turning the arm palm up or palm down
  • Deformity of the muscle 

Rotator cuff tears often cause pain and weakness, though they may not cause any symptoms at all. If pain does occur, lifting or lowering the arm can bring on the pain, though it can also occur at rest and at night, especially when sleeping on the injured shoulder. People with rotator cuff tears often experience weakness when they try to lift or rotate the arm. An ultrasound or MRI may be necessary to confirm the diagnosis and to plan rotator cuff tear treatment. The diagnosis of a shoulder rotator cuff injury is based on history and clinical exam. MRI is the definitive test which will demonstrate a tear. MRI examination can also show associated pathology including such things as impingement, labrum tearing, biceps tendon tearing, fatty infiltration of the rotator cuff muscles etc.

Rotator cuff tearing can be partial or complete. Partial thickness rotator cuff tearing can occur on the bursal surface, articular surface, or both.

Bursal sided tears are more often related to subacromial impingement by the direct influence of the external compression from the adjacent bone surfaces. The articular sided tears are more often related to repetitive stress and unrelated to impingement. The acronym for these tears is PASTA= partial articular sided tendon.

Full thickness tears are either non-retracted or retracted. Retracted tears can be mildly, moderately, or severely retracted. Tear patterns also include the shape of the tear and crescent tears, U shaped tears and longitudinal tears are examples of common tear patterns.

There are two categories of rotator cuff tears, acute and degenerative. An acute rotator cuff tear is caused by injury. For example, the injured person falls on an outstretched arm or tries to forcefully lift something well beyond their strength limitations. Degenerative rotator cuff tears are caused by long-standing wear and tear on the shoulder joint. They are most common in middle-aged individuals who spent a great deal of time performing the same arm motion repetitively, such as throwing a baseball, swinging a tennis racket, or rowing a boat. Bone spurs and blood supply abnormalities may also lead to degenerative rotator cuff tears.

Rotator Cuff Disease

Rotator cuff disease generally affects individuals over 40. Initially emerging from inflammation and/or bursitis of the shoulder, this disease eventually advances to tendons experiencing small tears and finally full thickness tears. Tendon degeneration is the usual cause of rotator cuff disease, but individuals may not realize the extent of the disease until debilitating symptoms begin occurring, such as an inability to raise their arms or perform certain movements. Rotator cuff disease may be accompanied by severe nighttime pain or frozen shoulder.

Treatment for Rotator Cuff Tears

Rotator cuff tear treatment may be surgical or nonsurgical. Indeed, many partial thickness rotator cuff tears may heal without surgery. Nevertheless, people who have chronic arm pain, weakness, or who are unable to lift their shoulder or arm should speak with a rotator cuff tear doctor to discuss treatment options.

Injuries to the tissue rim surrounding the shoulder socket can occur from acute trauma or repetitive shoulder motion. Examples of traumatic injury include:

  • Falling on an outstretched arm
  • A direct blow to the shoulder
  • A sudden pull, such as when trying to lift a heavy object
  • A violent overhead reach, such as when trying to stop a fall or slide

Throwing athletes or weightlifters can experience glenoid labrum tears as a result of repetitive shoulder motion.

Symptoms of a Labrum Tear

The symptoms of a tear in the shoulder socket rim are very similar to those of other shoulder injuries:

  • A sense of instability in the shoulder
  • Shoulder dislocations
  • Pain, usually with overhead activities
  • Catching, locking, popping, or grinding
  • Occasional night pain or pain with daily activities
  • Decreased range of motion
  • Loss of strength

A SLAP tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint.

Injuries to the superior labrum can be caused by acute trauma or by repetitive shoulder motion. An acute SLAP injury may result from:

  • Sudden and physically tolling accident
  • Fall onto an outstretched arm
  • Trying to catch a heavy object
  • Rapid or forceful movement of the arm when it is above the level of the shoulder
  • Shoulder dislocation
  • Individuals who participate in repetitive overhead sports, such as throwing athletes or weightlifters, can experience labrum tears as a result of repeated shoulder motion.

Many SLAP tears are the result of a wearing down of the labrum that occurs slowly over time and is often seen as a normal process of aging.

When something traumatic forces the humerus (top of the upper arm bone) out of the glenoid (your shoulder socket), your shoulder is considered dislocated. Heavy blows, falling hard on your shoulder or being forced to move your shoulder in unnatural ways often cause shoulder dislocations. Since your shoulder is your body’s most flexible and mobile joint, it is vulnerable to being dislocated. In fact, your shoulder is the most commonly dislocated joint in your body.

Dislocation can occur as a partial or complete dislocation and move downward, backward or forward. Your doctor may also find the ligaments keeping the shoulder stabile has been stretched and torn, another frequent complication seen in shoulder dislocations.

Symptoms of a Dislocated Shoulder

  • Your shoulder appears visibly deformed or your arm may hang incorrectly
  • Swelling and bruising is apparent around your shoulder
  • Intense, throbbing pain and muscle spasms cannot be relieved with NSAIDs or cold compresses
  • You can move your shoulder a little or not at all without experiencing pain and stiffness
  • You may feel tingling, weakness and numbness around the dislocated joint.
  • You may feel tingling and numbness in your neck and radiating down your arm

Until you are able to get to your shoulder dislocation doctor, keep your arm in a sling to prevent movement and minimize discomfort. A traumatically dislocated shoulder can usually be put back in place by a non-surgical reduction procedure implemented manually by your doctor. You may be directed to wear a shoulder sling for about a week to keep your shoulder immobilized until tissues heal from the stress of the dislocation. Rehabilitation exercise are useful to help your shoulder regain strength, mobility and stability. NSAIDs or prescription pain medications offer pain relief while your shoulder is recovering.

In complete dislocations for younger shoulders with characteristics findings of ligament failure (Bankart Tear) a surgical repair is often recommended to lower the risk of recurrence.

The shoulder joint can be replaced in much the same way that hips and knees are replaced with similarly good results. Typical indications for shoulder replacement are advanced arthritis and/or rotator cuff arthropathy. There are two broad categories of replacements; Anatomic and Reverse Arthroplasty
Anatomic Replacements are performed when the rotator cuff is intact and typically provides pain relief and restoration of function.
Reverse Arthroplasty is indicated when the rotator cuff is deficient with the glenohumeral joint is unstable and also provides pain relief and functional restoration of shoulder mechanics. Shoulder replacement can be performed as an outpatient, same-day surgery.  
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Shoulder Arthritis, Replacement, Rotator Cuff Injuries and More - iOrtho
Shoulder Arthritis, Replacement, Rotator Cuff Injuries and More - iOrtho