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The key to shoulder diagnosis can be narrowed down by range of motion tests and some orthopedic testing. The most movable joint in the body, the shoulder is also one of the most potentially unstable joints. To better understand shoulder problems and how they occur, it helps to begin with an explanation of the shoulder’s structure and how it functions. The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) (see illustration). In contrast to the hip joint, which more closely approximates a true ball-and-socket joint, the shoulder joint can be compared to a golf ball and tee, in which the ball can easily slip off the flat tee.
The shoulder is easily injured because the ball of the upper arm is larger than the shoulder socket that holds it. Although the shoulder is easily injured during sporting activities and manual labor, the primary source of shoulder problems appears to be the natural age-related degeneration of the surrounding soft tissues such as those found in the rotator cuff.
Shoulder pain may be localized or may be felt in areas around the shoulder or down the arm.
As with any medical issue, a shoulder problem is generally diagnosed using a three-part process. Other diagnostic tests, such as one that involves injecting an anesthetic into and around the shoulder joint, are discussed in detail in other parts of this publication. The symptoms of shoulder problems, as well as their diagnosis and treatment, vary widely, depending on the specific problem. After treatment and recovery, a previously dislocated shoulder may remain more susceptible to reinjury, especially in young, active individuals. A shoulder separation occurs where the collarbone (clavicle) meets the shoulder blade (scapula).
Bursitis, or inflammation of the bursa sacs that protect the shoulder, may accompany tendinitis and impingement syndrome. Generally speaking, individuals who are older and have had shoulder pain for a longer period of time can be treated with nonoperative measures even in the presence of a complete rotator cuff tear. Fracture of the neck of the humerus is usually treated with a sling or shoulder stabilizer. When nonoperative treatment of arthritis of the shoulder fails to relieve pain or improve function, or when there is severe wear and tear of the joint causing parts to loosen and move out of place, shoulder joint replacement (arthroplasty) may provide better results.
Exploring the role of possible biopsychosocial and genetic risk factors in which the development of chronic shoulder pain is likely to occur.
Developing and testing the effectiveness of biomechanically based rehabilitation strategies to improve upper extremity function and reduce pain in people with shoulder problems. Using animal models for better understanding of the healing response after surgery to repair shoulder injuries, and for helping to determine the most effective postoperative activity protocol.
Glenoid The dish-shaped part of the outer edge of the scapula into which the top end of the humerus fits to form the glenohumeral shoulder joint. If the capsule of the shoulder is damaged in any way, the resulting repair process can limit movement when the scars shorten. Because the bones provide little inherent stability to the shoulder joint, it is highly dependent on surrounding soft tissues such as capsule ligaments and the muscles surrounding the rotator cuff to hold the ball in place. Tendons are tough cords of tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder. The incidence of rotator cuff problems rises dramatically as a function of age and is generally seen among individuals who are more than 60 years old.
Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder. A diagnostic record that can be seen on an x ray after injection of a contrast fluid into the shoulder joint to outline structures such as the rotator cuff.

A noninvasive, patient-friendly procedure in which a small, hand-held scanner is placed on the skin of the shoulder. A noninvasive procedure in which a machine with a strong magnet passes a force through the body to produce a series of cross-sectional images of the shoulder. The following is important information to know about some of the most common shoulder problems. In a typical case of a dislocated shoulder, either a strong force pulls the shoulder outward (abduction) or extreme rotation of the joint pops the ball of the humerus out of the shoulder socket.
After this procedure, called arthroscopic surgery, the shoulder is generally stabilized for about 6 weeks. Shoulder pain or tenderness and, occasionally, a bump in the middle of the top of the shoulder (over the acromioclavicular or AC joint) are signs that a separation may have occurred. Repeated motion involving the arms, or the effects of the aging process on shoulder movement over many years, may also irritate and wear down the tendons, muscles, and surrounding structures. Typically, a person with a rotator cuff injury feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. Doctors usually recommend that patients with a rotator cuff injury rest the shoulder, apply heat or cold to the sore area, and take medicine to relieve pain and inflammation. With a frozen shoulder, the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm.
A doctor may suspect a frozen shoulder if a physical examination reveals limited shoulder movement. The break in a bone usually occurs as a result of an impact injury, such as a fall or blow to the shoulder. A shoulder fracture that occurs after a major injury is usually accompanied by severe pain. The usual signs of arthritis of the shoulder are pain, particularly over the acromioclavicular joint, and a decrease in shoulder motion.
In this operation, a surgeon replaces the shoulder joint with an artificial ball for the top of the humerus and a cap (glenoid) for the scapula. Department of Health and Human Services’ National Institutes of Health (NIH) to better understand shoulder problems and improve their treatment. The joint of the shoulder located between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle (collarbone).
A diagnostic test in which a contrast fluid is injected into the shoulder joint and an x ray is taken to view the fluid’s distribution in the joint.
The joint where the rounded upper portion of the humerus (upper arm bone) joins the glenoid (socket in the shoulder blade). Composed of tendons that work with associated muscles, this structure holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength to the shoulder joint.
Tough cords of connective tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder. They include sprains, strains, dislocations, separations, tendinitis, bursitis, torn rotator cuffs, frozen shoulder, fractures, and arthritis. The acromioclavicular (ah-KRO-me-o-klah-VIK-u-lahr or AC) joint is located between the acromion (ah-KRO-me-on, the part of the scapula that forms the highest point of the shoulder) and the clavicle. However, these other causes of shoulder pain are beyond the scope of this publication, which will focus on problems within the shoulder itself.
The arm is then stabilized for several weeks in a sling or a device called a shoulder immobilizer. A shoulder that dislocates severely or often, injuring surrounding tissues or nerves, usually requires surgical repair to tighten stretched ligaments or reattach torn ones.
Most often, the injury is caused by a blow to the shoulder or by falling on an outstretched hand.

Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement. Osteoarthritis of the shoulder is usually treated with nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen.
Passive shoulder exercises (where someone else moves the arm to rotate the shoulder joint) are started soon after surgery. Injections of corticosteroid drugs are sometimes used to treat inflammation in the shoulder. The shoulder is maintained by a series of muscles which enhance movement, and ligaments which keep excessive movement in check.
There are a series of bursas in that area as well, and inflammation of those can also add to the problem (bursitis). The glenohumeral joint, commonly called the shoulder joint, is a ball-and-socket-type joint that helps move the shoulder forward and backward and allows the arm to rotate in a circular fashion or hinge out and up away from the body. The shoulder, on the other hand, is relatively unstable but highly mobile, allowing an individual to place the hand in numerous positions. When a shoulder dislocates frequently, the condition is referred to as shoulder instability. Usually the doctor recommends resting the shoulder and applying ice three or four times a day.
After a period of rest, a therapist helps the patient perform exercises that put the shoulder through its range of motion. If tendinitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm), pain will occur in the front or side of the shoulder and may travel down to the elbow and forearm.
You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position. If surgery is not an immediate consideration, exercises are added to the treatment program to build flexibility and strength and restore the shoulder’s function.
After removing the strap and sling, the doctor will prescribe exercises to strengthen the shoulder and restore movement. The rotator cuff is a structure composed of tendons that work along with associated muscles to hold the ball at the top of the humerus in the glenoid socket and provide mobility and strength to the shoulder joint. There is also a lack of synovial fluid, which normally lubricates the gap between the arm bone and socket to help the shoulder joint move.
Analysis of synovial fluid from the shoulder joint may be helpful in diagnosing some kinds of arthritis. The goal is to restore the range of motion of the shoulder, strengthen the muscles, and prevent future dislocations. It is this restricted space between the capsule and ball of the humerus that distinguishes adhesive capsulitis from a less complicated painful, stiff shoulder. If these measures are unsuccessful, an intra-articular injection of steroids into the glenoid humeral joint can result in marked improvement of the frozen shoulder in a large percentage of cases. The patient also feels pain when lowering the arm to the side after the shoulder is moved backward and the arm is raised.
People with diabetes, stroke, lung disease, rheumatoid arthritis, and heart disease, or those who have been in an accident, are at a higher risk for frozen shoulder. In those rare people who do not improve from nonoperative measures, manipulation of the shoulder under general anesthesia and an arthroscopic procedure to cut the remaining adhesions can be highly effective in most cases.

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