Shoulder Pain - Shoulder Disorders - Injured Shoulder - Shoulder Conditions - Treatment Shoulder - Shoulder Surgery
Anatomy Shoulder Joint
The shoulder joint is the joint with the most extensive range of motion in the body. The tremendous mobility of this joint allows internal rotation, external rotation, and 360° circumduction. This is due to its construction: a ball-like joint head that moves in a flat joint capsule, the glenoid fossa or glenoid cavity. For the joint to remain stable, it is surrounded by a very complex, and thereby very sensitive, construction of joint capsules, tendons, ligaments, and synovial bursae. Especially the tendons starting at the shoulder, i.e. the rotary cuff, tend to be overloaded and often become inflamed or degenerate. If the joint is permanently overloaded, it is possible that a tendon rupture occurs.
What treatments are available for shoulder disorders?
As a first step, the causes of the problem must be analyzed. Once the cause is known, the principal rule is to treat the affected shoulder “with the mildest therapy possible” to affect a permanent cure.
An important cornerstone is here the "conservative therapy." It includes all forms of treatment aside from surgery. If a permanent cure is not possible with conservative treatment, the patient still does not have to permanently suffer from a shoulder condition. Often it is better to repair a joint injury through surgery, rather than to just treat the symptoms.
With today’s modern surgical techniques, such as arthroscopy, the treatment range has expanded considerably. In arthroscopic procedures, large incisions are no longer required. Instead, just a few millimeters incisions allow exploring the joint structure with a small camera. Simultaneously, the finest surgical instruments are inserted into the shoulder and the damages are repaired through the “keyhole.”
Such intervention causes little if any trauma to the patient and carries very low risks. In the hands of experts with experience in shoulder arthroscopy, many "hopeless" cases can be healed. The patient is again free of pain and has lastingly regained full mobility and function of the shoulder. Of course, this means a significant improvement of the quality of life for those affected.
The Most Common Disorders and Injuries of the Shoulder Joint
An impingement means a narrowing of the space between the shoulder acromion (hemispherical head) and humerus (upper arm bone): The tendon and the bursa running in this space are pinched because of the narrowness and lead to pain. Causes can be chronic congestion, e.g. permanent overhead activities of a craftsman or athlete or an anatomical variant, i.e. an individual, congenial increased curvature of the bony acromion.
The therapy aims to expand the space for tendon and bursa - whether through specific physiotherapy exercises, medications that reduce the swelling, or arthroscopic surgery. During arthroscopy, the chronically inflamed bursa under the acromion is removed, the bony constriction, and possibly the injured tendon is smoothed.
Torn Tendon (Rotary cuff tear)
Common cause of a torn tendon in the shoulder is a fall onto the shoulder or arm. But also an impingement syndrome can over time result in the tearing of the tendon or can even cause a complete tendon rupture through the ongoing friction of the rotator cuff under the acromion. In addition to chronic pain, an increasing loss of strength and function of the arm is characteristic of this disease.
If the tendon is torn, it should be clarified as soon as possible whether the conditions allows for suturing the tear. A rotary cuff tear does not heal by itself. The repair of the torn tendon should be repaired as soon as possible after the tear has occurred, since it increases over time, and the tendon deteriorates. Today shoulder specialists will generally repair a torn tendon arthroscopically.
Inflammation of the Bursa - Bursitis (Subacromial Bursitis)
The bursa is located under the acromion and allows on one hand optimum sliding of the tendon (rotator cuff) under the acromion. It also functions as a protection against too much pressure on the tendons. Overload, straining of the bursa, especially during overhead movement (e.g. painting, hanging up laundry, playing tennis, volleyball, etc.), can cause irritation or inflammation of the bursa.
The patient often feels pain after exercise, especially at night. Treatment consists of rest, cooling, anti-inflammatory ointments or possibly inflammatory medications or injections.
Calcification (Calcific Tendinitis)
Calcification in the shoulder is caused by deposits of calcium crystals in the rotary tendon. These deposits form more or less a large calcium deposit.
The reason for this calcification is either recurrent minor tendon injuries (for example, through impingement), but also local circulatory disorders of the tendon. Symptoms are often excruciating pain at night. In addition, the shoulder can hardly be strained in day-to-day activities.
If anti-inflammatory medications and physical therapy do not lead to satisfactory results, the calcification can be removed arthroscopically. A removal of the calcification can help the patient long-term to become pain free.
A recurrence of the calcification is generally not the case. Studies show that a shock wave treatment generally does not result in removal of a calcium deposit. Thus, arthroscopic treatment is the only causal therapy of shoulder calcification.
Frozen Shoulder (Capsulitis Adhesive)
The stiffness of a shoulder joint is a lengthy process. After a phase of "unexplained" shoulder pain, in the second phase the pain lessens, but an increasing stiffness develops in the shoulder joint, i.e., the arm does not move properly.
The cause of this disease is not known and consequently there are no preventive measures. In the first phase of the disease, the inflammatory process in the joint capsule can be treated with anti-inflammatory ointments, tablets, or an anti-inflammatory injection therapy. After a medicinal therapy, the frozen shoulder is mobilized again through specific physiotherapy.
Despite early conservative treatment often over many months, sometimes years, patients endure excruciating pain. Through an arthroscopic procedure in which the adhesions are released, the duration of shoulder stiffness can be significantly shortened.
Shoulder Instability (Shoulder Dislocation)
A shoulder dislocation is usually caused by an accident, such as a fall on the arm, can pull the humerus out of the socket. Often important structures such as stabilization ligaments and a stabilizing joint lip are injured as well. Often after such an incident, shoulder dislocation more frequently resulting in a chronically unstable shoulder.
Such an unstable shoulder should always be repaired arthroscopically. In an arthroscopy the torn ligaments and the joint lip are reattached. After the healing process, the shoulder will be fully functional again.
Glenoid wear and tear (Acromioclavicular Joint Osteoarthritis)
The acromioclavicular joint is the joint between the outer edge of the clavicle and the acromion. Wear and tear (osteoarthritis) of the joint occurs especially after recurrent minor injuries, for example, as a result of heavy physical work but also during intensive sport (strength training, contact sports).
Initially, the person feels pain depending on the load in the front upper part of the shoulder. Later, there is often nagging pain even when resting, especially at night when lying on the shoulder.
Treatments are ice packs, anti-inflammatory ointments and tablets, and injections with hyaluronic acid to improve the "lubrication" of the joint.
If the described conservative treatments do not lead to a satisfactory outcomes, e.g., permanent symptom-free function, the degenerating shoulder joint should be repaired in arthroscopic surgery. Through an arthroscopy, the mechanics of the acromioclavicular joint in the shoulder are improved and the shoulder is again free of pain and fully functional.
Functional Shoulder Pain
When speaking about "functional pain" we refer to pain that occurs when the interaction between muscles, tendons, ligaments, and joint capsule is disrupted. Thus, there is virtually no damage that should be repaired. Rather, the delicate balance between the joint structures should be improved.
The person affected by functional shoulder pain feels frequently a diffuse pain of varying intensity and localization. Treatment includes physiotherapy to improve the coordination of movement and muscular imbalances, circulatory supporting measures (electrotherapy, ice, etc.), changes of techniques during exercise, strengthening of the shoulder girdle muscles.
Experts: Shoulder Pain / Shoulder Disorders / Shoulder Injuries
For an effective treatment of shoulder disorders and shoulder injuries, the experts for shoulder disorders and injuries at the Klinik am Ring are particularly well-qualified. Stefan Preis, M.D. and Jörg Schroeder, M.D., senior physicians at the Practice and Department of Orthopedics and Sports Traumatology at the Klinik am Ring in Cologne, specialize together with their team in the treatment of knee and shoulder disorders. In 2004, they founded the WEST GERMAN SHOULDER KNEE & CENTER, Cologne. The team, consisting of eight specialists, treats more than 10,000 patients per year. They perform more than 2,500 surgeries per year, of which 1200 are arthroscopic surgeries of the shoulder.