Shoulder Conditions: Causes, Symptoms, and Treatments

The shoulder is one of the most complex and versatile joints in the human body, allowing for a wide range of movements. However, this very complexity makes it particularly vulnerable to various injuries and disorders. Understanding the most common conditions affecting this joint is essential for accurate diagnosis and effective treatment.

Anatomy and Function of the Shoulder

The shoulder joint is composed of several anatomical structures that work together to ensure both mobility and stability. These include:

• The humerus (upper arm bone)
• The scapula (shoulder blade)
• The clavicle (collarbone)
• The rotator cuff (a group of muscles and tendons)
• The glenoid labrum (a ring of cartilage)
• Ligaments and joint capsules

This intricate architecture allows for movements such as flexion, extension, abduction, adduction, and internal and external rotation. Given its involvement in many daily and athletic activities, the shoulder is subject to repetitive mechanical stress and potential trauma.

Common Shoulder Conditions

Dislocation

A shoulder dislocation occurs when the head of the humerus slips out of the glenoid cavity of the scapula. This traumatic event can cause significant damage to surrounding tissues, including tendons, ligaments, and in rare cases, nerves. Typical symptoms include:

• Sudden, intense pain
• Visible joint deformity
• Inability to move the arm
• Swelling and bruising

An acromioclavicular (AC) dislocation, involving the joint between the clavicle and the acromion of the scapula, is common after a direct fall onto the shoulder. Diagnosis is based on physical examination and X-rays. Treatment may range from manual realignment to surgery, depending on the severity and recurrence of the dislocation.

Acromioclavicular (AC) Joint Separation

Unlike a dislocation, an AC separation specifically affects the ligaments connecting the clavicle to the acromion. It typically presents with:

• Localized pain on the top of the shoulder
• Swelling and tenderness
• Limited arm movement, especially during lifting

Diagnosis is confirmed with weight-bearing X-rays, which can reveal any displacement of the clavicle. Most cases are treated conservatively with rest, ice, and physical therapy. In more severe cases, surgery may be needed to reconstruct the damaged ligaments.

Fractures

Shoulder fractures can involve the proximal humerus, clavicle, or scapula. These injuries are typically the result of high-impact trauma, such as car accidents or falls from a height. Common symptoms include:

• Intense, persistent pain
• Obvious deformity
• Significant swelling
• Inability to move the arm

Diagnosis is based on clinical evaluation and imaging. Treatment depends on the type and complexity of the fracture. While some fractures can be managed with immobilization and rehabilitation, others may require surgical intervention to realign and stabilize the bone fragments.

Rotator Cuff Injuries

The rotator cuff is a group of muscles and tendons that surrounds the shoulder joint, providing stability and enabling precise movement. Injuries to this structure are among the most common causes of shoulder pain, especially in adults and the elderly. They may result from acute trauma, repetitive strain, or age-related degeneration.

Common symptoms include:

• Pain, often worse at night
• Weakness during arm lifting or rotation
• A "clicking" or snapping sensation during certain movements
• Limited range of motion in daily activities

Diagnosis involves a clinical exam and imaging studies such as ultrasound or MRI. Treatment depends on the severity of the injury: mild cases are managed conservatively with physical therapy and anti-inflammatory medication, while more extensive tears may require surgical tendon repair.

Tendinopathies

Shoulder tendinopathies, such as biceps tendinitis or supraspinatus tendinosis, are inflammatory or degenerative conditions affecting the tendons. These may develop gradually due to repetitive microtrauma or occur suddenly after overexertion.

Typical symptoms include:

• Localized pain, possibly radiating down the arm
• Joint stiffness, especially in the morning
• Muscle weakness
• Functional limitations during specific movements

Diagnosis is based on patient history, physical examination, and imaging (usually ultrasound). Initial treatment includes relative rest, anti-inflammatory therapy, and physical rehabilitation. For persistent cases, injections or — more rarely — surgery may be considered.

Diagnostic Approach to Shoulder Conditions

Accurate diagnosis is crucial to determine the most appropriate treatment. The diagnostic process generally includes:

1. Detailed medical history: information about symptoms, onset, and triggering events
2. Physical examination: assessment of mobility, strength, stability, and pain points
3. Imaging tests:
• X-rays to detect fractures or bone abnormalities
• Ultrasound to visualize tendons, muscles, and bursae
• MRI for detailed images of all joint structures
• MR arthrography for evaluating labral tears

In some cases, diagnostic arthroscopy may be required for direct visualization of internal joint structures.

Treatment Options

Treatment for shoulder conditions depends on the specific diagnosis and severity. Therapeutic options include:

Conservative Management:

• Activity modification and rest
• Physical therapy: mobility, stretching, and strengthening exercises
• Manual therapy: massage and joint mobilization
• Modalities: ultrasound, laser therapy, TECAR
• Medications: anti-inflammatories, pain relievers
• Injections: corticosteroids, hyaluronic acid, or PRP (platelet-rich plasma)

Surgical Treatment:

• Arthroscopy: for rotator cuff repairs, labral injuries, or joint stabilization
• Open surgery: for complex fractures, joint replacements, or revision procedures

The choice between conservative and surgical treatment depends on factors such as the patient's age, activity level, response to prior treatment, and the extent of the injury.

Rehabilitation and Functional Recovery

Regardless of the chosen treatment, rehabilitation plays a key role in shoulder recovery. A personalized rehab program aims to:

• Reduce pain and inflammation
• Restore joint mobility
• Strengthen shoulder and scapular muscles
• Improve proprioception and neuromuscular control
• Prevent recurrence through patient education

The duration and intensity of rehabilitation vary depending on the condition and treatment, and can range from a few weeks to several months.

Prevention of Shoulder Injuries

Preventive strategies are based on several key principles:

1. Maintaining good posture in both daily and work activities
2. Regular stretching and strengthening exercises for the shoulder and back
3. Using correct techniques during sports or repetitive tasks
4. Avoiding overloading and allowing adequate rest periods
5. Paying attention to early signs of pain or discomfort and addressing them promptly

Conclusion

Shoulder disorders encompass a wide range of conditions that require a personalized diagnostic and therapeutic approach. The anatomical and functional complexity of the shoulder makes a thorough specialist evaluation essential to identify the underlying cause and determine the most appropriate treatment. Timely and targeted intervention, followed by a structured rehabilitation program, promotes optimal recovery and helps prevent long-term complications.

Need Help?

If you’re experiencing persistent symptoms or have recently sustained a shoulder injury, it’s always advisable to consult an orthopedic specialist for a thorough evaluation and a personalized treatment plan.

If needed, feel free to visit us at Ortopedia Zambelli, Via Taramelli 21/23 – Bergamo, or get in touch with us!

? We’re available at 035/212110, Monday to Saturday, from 9:00 to 12:30 and 15:00 to 19:00
? Or email us at: info@ortopediazambelli.it

We’re here to help!

All the news