The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), collarbone (clavicle), and shoulder blade (scapula). The shoulder joint has the greatest range of motion of any joint in the body. The shoulder is one of the most commonly injured areas in the body. Shoulder injuries most commonly occur during sports, work-related activities, chores around the home, or after falls from a height. Symptoms may include pain, swelling, numbness, tingling, weakness, or stiffness. Pain after an injury is typically from a simple muscle strain or ligament sprain that heals fairly quickly with minimal treatment. There are, however, times when shoulder pain can result from significant structural damage that should not be ignored.

Patients do not always recall a specific injury, especially if symptoms started gradually or during routine activities. Overuse injuries can occur from excessive stress to the joint or through repetitive activities. Overuse injuries can include:

  • Inflammation of the sac of fluid that cushions and lubricates the joint area between one bone and another bone, tendon, or the skin (bursitis).
  • Inflammation of the strong, cord-like structures (tendons) that connect muscles to bones (tendinitis). Bicipital tendinitis is inflammation of one of the tendons that attach the muscle (biceps) on the front of the upper arm bone (humerus) to the shoulder joint. The inflammation usually occurs along the groove (bicipital groove) where the tendon passes over the humerus to attach just above the shoulder joint.
  • Muscle “pull” or strain.
  • Frozen shoulder (adhesive capsulitis), which is a condition that restricts shoulder movement. This condition is sometimes caused by injury, leading to lack of use due to pain, but also often arises spontaneously with no obvious preceding trigger.
  • Overhead arm movements, which can cause tendons to rub against part of the shoulder blade called the acromion. This scraping may lead to abrasion, inflammation or even tearing of the rotator cuff tendons (a condition called impingement syndrome).

At the Duval Orthopaedic Clinic our shoulder specialists are experts at evaluating and treating shoulder pain.

Frequently asked questions

If you have injured your shoulder or have chronic shoulder pain you should see a doctor, ideally an orthopaedic surgeon who is a shoulder specialist. Your doctor will start with a history and physical examination. X-rays are commonly obtained to evaluate for fractures or arthritis. Additional imaging may be ordered such as a magnetic resonance imaging (MRI) scan or an ultrasound. Early diagnosis and treatment is critical to prevent symptoms such as loss of motion and strength from occurring.

It is important to see a shoulder specialist to make sure there is not another problem that could be causing or adding to your symptoms. Surgery for biceps tendinitis is usually performed with key-hole incisions used to deliver a fiberoptic camera and miniature surgical instruments to the area of damage (arthroscopic surgery). This allows your doctor to assess the condition of the biceps tendon as well as other structures in the shoulder. There are two main surgical procedures that may be recommended: 1) biceps tenodesis or 2) biceps tenotomy.

Biceps tenodesis:
In some cases, the damaged portion of the upper biceps tendon is removed, and the remaining healthy tendon is reattached to the upper arm bone (humerus). This procedure is called a biceps tenodesis. Removing the painful part of the biceps helps to improve symptoms and restore normal function.

Biceps tenotomy:
In severe cases, the upper part of the biceps tendon may be so damaged that it is not possible to repair it. Your surgeon may decide to release the damaged biceps tendon from its attachment. This is called a biceps tenotomy. This option is the least invasive but may result in a "Popeye" bulge in the arm.

Rehabilitation:
After surgery, your doctor will prescribe a rehabilitation plan based on the procedure performed. A sling is usually worn for a few weeks to protect the repair. Your doctor may restrict certain activities to allow the repaired tendon to heal, but you will have immediate use of your hand for daily activities - writing, typing, eating, and bathing. Your doctor will soon start you on therapeutic exercises. Flexibility and strengthening exercises for your shoulder will be progressively added to your personalized rehabilitation plan.

Surgical outcome:
Eighty-five percent of patients report good to excellent results. Patients typically regain full range of motion and are able to move their arms without pain. A small percentage of patients report mild muscle cramping after surgery.

Most rotator cuff tears can be treated without surgery. Usually your doctor will write you a prescription for physiotherapy to work on strengthening the rotator cuff muscles and other muscles of the shoulder girdle. If the patient has significant pain, anti-inflammatory medications and sometimes steroid injections can be used to help and allow physiotherapy to be better tolerated.

For patients with larger tears where greater than 50% of the thickness of the rotator cuff tendon is torn on the MRI or ultrasound, surgery may be recommended. The goal of the surgery is to restore rotator cuff anatomy and allow the patient to regain full strength and motion. Surgery is often performed arthroscopically, avoiding any large incisions and is commonly done at an outpatient facility such as the Duval Orthopaedic Clinic.

The treatment of shoulder instability typically depends on the age and activity profile of the patient, as well as, the number of times the shoulder has dislocated. Younger patients, males, and involvement in collision/contact sports are all risk factors for repeated shoulder dislocations or subluxation episodes. For most patients after traumatic dislocation, non-operative treatment is initially recommended. This involves use of a sling with a short period of rest, followed by a course of physiotherapy and a gradual return to normal activities. Surgery is recommended in cases of repeated dislocation episodes, or if pain with use of the shoulder persists despite an adequate course of therapy exercises. The surgery is usually performed arthroscopically and may involve re-attachment of the torn labrum (called "Bankart repair") and/or tightening of stretched ligaments (called "capsulorraphy" or "capsular plication").