Shoulder Joint

Sometimes we might feel as if we have the weight of the world on our shoulders. But there is a lot that can weigh on our shoulders in a physical sense, too.

The shoulder is a highly complex mechanism for enabling movement that can quickly and easily be put out of line – either from frequently working at shoulder height, receiving a blow to the shoulder, poor posture, a pulled muscle and so on.

Read on to learn more about the shoulders and the most common problems and diseases. You can also find the right contact person to assist with your enquiry.

Anatomy
  • Bones

  • 1Acromion
  • 2Acromioclavicular joint
  • 3Coracoid
  • 4Humeral head (caput humeri)
  • 5Shoulder joint (glenohumeral joint)
  • 6Upper arm bone (humerus)
  • 7Collarbone (clavicle)
  • 8Shoulder blade (scapula)
  • Muscles

  • 9Biceps (biceps brachii)
  • 10Rotator cuff, consisting of:
    • Supraspinatus (M. supraspinatus)
    • Infraspinatus (M. infraspinatus)
    • Teres minor (M. Teres minor)
    • Subscapularis (M. scapular)
  • 11Teres major (M. Teres major)
  • 12Deltoid (deltoideus)
  • 13Trapezoid (trapezius)
  • Tendons, ligaments, soft tissues

  • 14Long biceps tendon (caput longum)
  • 15Bursa
  • 16Supraspinatus tendon
  • 17Ligaments (coracoclavicular ligament)
  • 18Joint capsule (articular capsule)
shoulder Acromion Acromioclavicular joint Coracoid Humeral head (caput humeri) Shoulder joint (glenohumeral joint) Upper arm bone (humerus) Collarbone (clavicle) Shoulder blade (scapula) Muscles Biceps (biceps brachii) Rotator cuff Teres major (M. Teres major) Deltoid (deltoideus) Trapezoid (trapezius) Tendons, ligaments, soft tissues Long biceps tendon (caput longum) Bursa Supraspinatus tendon Ligaments (coracoclavicular ligament) Joint capsule (articular capsule)
Common problems and diseases
  • Osteoarthritis of the shoulder
  • Shoulder tendon tear / rotator cuff rupture
  • Calcific shoulder tendonitis
  • Frozen shoulder
  • Dislocated shoulder and shoulder instability
  • Impingement syndrome
  • Injury to the acromioclavicular joint
  • Broken collarbone
  • Tension and strains

Osteoarthritis of the shoulder

Osteoarthritis of the shoulder is chronic wear and tear in the shoulder joint. Cartilage and bones between the scapular and the collarbone rub against each other, which can be painful and limit your range of movement. If this causes inflammation, swelling and a build-up of heat in the joint, it may be a sign of osteoarthritis of the shoulder.

Treatment

Osteoarthritis cannot be cured. However, if it is detected early and treatment is started in good time (physiotherapy and anti-inflammatory drugs), the symptoms can be alleviated and further wear and tear prevented.

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TIP

Do not favour the shoulder too much. When you move, the joint receives nutrients which limit cartilage degeneration.

Shoulder tendon tear / rotator cuff rupture

The rotator cuff is a group of four muscles which link the upper arm with the shoulder blade. It centres the humerus in the flat socket of the scapula and stabilises the joint, which enables movement of the upper arm. An accident or wear on the tendon can cause a rotator cuff tear. When this occurs, there is usually a tear in the cap where all four muscles come together and sit on the upper arm. Contact with the bone is lost, which means the muscles can no longer perform their role correctly. The shoulder and the arm can no longer be moved, or only with pain.

Treatment

The treatment method is extremely patient-specific. Depending on the profession, age or type of sport, small tears can be treated with physiotherapy and pain-relieving medication.

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TIP

Move yes, strain no. Lifting, carrying, supporting your weight and driving are taboo in the first few weeks.

Calcific shoulder tendonitis

Calcific shoulder tendonitis is caused by a build-up of calcium salts under the scapular on the tendon of the rotator cuff. The cause is unknown; however, such calcification usually occurs in people between the ages of 30 and 50. The pain increases when the body triggers an inflammatory reaction in the bursa against the fibro cartilage tissue on which the calcium salts collect and harden.

Treatment

Temporary immobilisation of the shoulder with cooling can alleviate pain in the event of inflammation. Shockwave therapy selectively triggers biological healing processes which can disintegrate the calcium deposits. Physiotherapy prevents tension caused by poor posture as a result of pain.

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TIP

A stiff shoulder due to a relieving posture can be counteracted with stretches and circular movements.

Frozen shoulder

Frozen shoulder and shoulder stiffness cause the joint lining and capsule to become inflamed. In the process, the capsule initially thickens and then shrinks back later. If the patient has no other issues with their shoulder, the cause of this stiffness usually remains unclear. It begins with pain and difficulty lifting and rotating the arm outwards. It can take up to several years for the patient to progress through the inflammatory, stiffening and thawing phases.

Treatment

In the first phase, the inflammation in the joint must be treated with anti-inflammatory medication (cortisone, if necessary). In the second phase, the stiffening phase, the movement should be improved with special exercises so that the stiffness can release in the third phase – the thawing phase.

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TIP

Patience and positive thinking are required: The healing process takes between 1.5 years and 3 years; those affected are spared any long-term damage. A frozen shoulder usually heals completely.

Dislocated shoulder and shoulder instability

When a dislocated shoulder occurs, the humerus pops out of the socket. This injury usually occurs as a result of an accident or weakness in the capsule ligament apparatus. It is one of the most common types of dislocations as the shoulder joint is very mobile. If a patient suffers frequent (close) dislocations, this can cause shoulder instability with resulting soft tissue injuries, overstretching of the joint capsule or a tear in the labrum.

Treatment

As long as there is no fracture in one the neighbouring bones, the joint should be immediately reset so that ligaments and tendons do not suffer any long-term damage. After immobilising the joint for several days, follow-up treatment to stabilise the joint can be started. This will also treat any painful dysfunction caused by the injury. If a ligament tear occurs at the same time as the dislocation, surgery may prevent chronic instability.

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TIP

Gentle mobilisation exercises at home can release painful muscle blockages in the shoulder and promote healing in the injured ligaments.

Impingement syndrome

Impingement syndrome reduces the distance between the humerus and the scapular. Soft tissue such as the tendons and the bursa in between is so incarcerated that this can trigger inflammation of the bursa or even tears in the ligaments. Impingement syndrome causes pain to radiate out as far as the elbows when you lift your arm over your head.

Treatment

Depending on the severity of the pain, a cortisone injection can provide relief. In the acute phase, the arm is immobilised and rested so that the Impingement syndrome can then be treated afterwards in intensive physiotherapy with targeted exercises. Depending on how widely impinged the joint is, surgery may be required.

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TIP

Do not underestimate pain: Please seek medical advice right from the time that you first experience pain in the shoulder. This can counteract any further constriction and prevent the shoulder issue from becoming chronic.

Injury to the acromioclavicular joint

The scapular and the collarbone make up the acromioclavicular joint, which is surrounded by a stabilising network of ligaments that can tear in the event of a fall. The collarbone is then no longer correctly fixed in the scapular, which causes the joint to become unstable and can restrict the function of the arm.

Treatment

The affected shoulder should initially be immobilised so that swelling and internal bleeding can subside. Only then can the severity of the injury be determined and a decision made as to whether the ligaments must be surgically joined together or left to grow back together naturally with a bandage.

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TIP

If a visible “hump” forms in the middle of the shoulder, this is an indication of injury to the acromioclavicular joint.

Broken collarbone

The collarbone is a long, thin bone which breaks quickly due to its structure and location – particularly in the event of a fall. A collarbone fracture usually causes clear elevation in the shoulder as the muscles pull the broken pieces up and forwards. Extensive bruising and pain when moving are further indicators of a broken collarbone.

Treatment

Immobilisation with a bandage heals the break in around four weeks. Depending on the position and the state of the fragments, surgery with a stabilising metal plate or nails is required so that the individual connective bones between the shoulder and trunk grow back together correctly and the patient does not suffer any permanent complaints.

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TIP

After six weeks, daily exercise can be managed again with the affected arm. The arm should be rested for a period of approx.12 weeks before undertaking intensive exercise such as mountain biking.

Tension and strains

Tension or strains in the shoulder usually affect the muscles of the rotator cuff and the trapezoid. Tension often occurs due to stress or poor posture in which the muscle is maintained in a state of permanent tension and is not correctly supplied with blood as a result; this means it is no longer adequately supplied with oxygen, which causes painful hardening. On the other hand, strains are inflammatory reactions in the muscle which occur as a result of extremely intense or sudden strain.

Treatment

Tension can be effectively treated with massage as well as with mobilisation exercises and those which promote blood flow. It is also important that the causes of the tension are found and avoided. A strain heals in one or two weeks by itself. Anti-inflammatory ointments can be applied to combat the pain; a break from training is also a good idea for the shoulder.

bulb

TIP

To heat or cool? If there is tension in the shoulder, warmth can improve the blood supply to the muscles, which will then help them to relax. On the other hand, a strain should be cooled as this will help to alleviate any inflammation.

Osteoarthritis of the shoulder

Osteoarthritis of the shoulder is chronic wear and tear in the shoulder joint. Cartilage and bones between the scapular and the collarbone rub against each other, which can be painful and limit your range of movement. If this causes inflammation, swelling and a build-up of heat in the joint, it may be a sign of osteoarthritis of the shoulder.

Treatment

Osteoarthritis cannot be cured. However, if it is detected early and treatment is started in good time (physiotherapy and anti-inflammatory drugs), the symptoms can be alleviated and further wear and tear prevented.

bulb

TIP

Do not favour the shoulder too much. When you move, the joint receives nutrients which limit cartilage degeneration.

Shoulder tendon tear / rotator cuff rupture

The rotator cuff is a group of four muscles which link the upper arm with the shoulder blade. It centres the humerus in the flat socket of the scapula and stabilises the joint, which enables movement of the upper arm. An accident or wear on the tendon can cause a rotator cuff tear. When this occurs, there is usually a tear in the cap where all four muscles come together and sit on the upper arm. Contact with the bone is lost, which means the muscles can no longer perform their role correctly. The shoulder and the arm can no longer be moved, or only with pain.

Treatment

The treatment method is extremely patient-specific. Depending on the profession, age or type of sport, small tears can be treated with physiotherapy and pain-relieving medication.

bulb

TIP

Move yes, strain no. Lifting, carrying, supporting your weight and driving are taboo in the first few weeks.

Calcific shoulder tendonitis

Calcific shoulder tendonitis is caused by a build-up of calcium salts under the scapular on the tendon of the rotator cuff. The cause is unknown; however, such calcification usually occurs in people between the ages of 30 and 50. The pain increases when the body triggers an inflammatory reaction in the bursa against the fibro cartilage tissue on which the calcium salts collect and harden.

Treatment

Temporary immobilisation of the shoulder with cooling can alleviate pain in the event of inflammation. Shockwave therapy selectively triggers biological healing processes which can disintegrate the calcium deposits. Physiotherapy prevents tension caused by poor posture as a result of pain.

bulb

TIP

A stiff shoulder due to a relieving posture can be counteracted with stretches and circular movements.

Frozen shoulder

Frozen shoulder and shoulder stiffness cause the joint lining and capsule to become inflamed. In the process, the capsule initially thickens and then shrinks back later. If the patient has no other issues with their shoulder, the cause of this stiffness usually remains unclear. It begins with pain and difficulty lifting and rotating the arm outwards. It can take up to several years for the patient to progress through the inflammatory, stiffening and thawing phases.

Treatment

In the first phase, the inflammation in the joint must be treated with anti-inflammatory medication (cortisone, if necessary). In the second phase, the stiffening phase, the movement should be improved with special exercises so that the stiffness can release in the third phase – the thawing phase.

bulb

TIP

Patience and positive thinking are required: The healing process takes between 1.5 years and 3 years; those affected are spared any long-term damage. A frozen shoulder usually heals completely.

Dislocated shoulder and shoulder instability

When a dislocated shoulder occurs, the humerus pops out of the socket. This injury usually occurs as a result of an accident or weakness in the capsule ligament apparatus. It is one of the most common types of dislocations as the shoulder joint is very mobile. If a patient suffers frequent (close) dislocations, this can cause shoulder instability with resulting soft tissue injuries, overstretching of the joint capsule or a tear in the labrum.

Treatment

As long as there is no fracture in one the neighbouring bones, the joint should be immediately reset so that ligaments and tendons do not suffer any long-term damage. After immobilising the joint for several days, follow-up treatment to stabilise the joint can be started. This will also treat any painful dysfunction caused by the injury. If a ligament tear occurs at the same time as the dislocation, surgery may prevent chronic instability.

bulb

TIP

Gentle mobilisation exercises at home can release painful muscle blockages in the shoulder and promote healing in the injured ligaments.

Impingement syndrome

Impingement syndrome reduces the distance between the humerus and the scapular. Soft tissue such as the tendons and the bursa in between is so incarcerated that this can trigger inflammation of the bursa or even tears in the ligaments. Impingement syndrome causes pain to radiate out as far as the elbows when you lift your arm over your head.

Treatment

Depending on the severity of the pain, a cortisone injection can provide relief. In the acute phase, the arm is immobilised and rested so that the Impingement syndrome can then be treated afterwards in intensive physiotherapy with targeted exercises. Depending on how widely impinged the joint is, surgery may be required.

bulb

TIP

Do not underestimate pain: Please seek medical advice right from the time that you first experience pain in the shoulder. This can counteract any further constriction and prevent the shoulder issue from becoming chronic.

Injury to the acromioclavicular joint

The scapular and the collarbone make up the acromioclavicular joint, which is surrounded by a stabilising network of ligaments that can tear in the event of a fall. The collarbone is then no longer correctly fixed in the scapular, which causes the joint to become unstable and can restrict the function of the arm.

Treatment

The affected shoulder should initially be immobilised so that swelling and internal bleeding can subside. Only then can the severity of the injury be determined and a decision made as to whether the ligaments must be surgically joined together or left to grow back together naturally with a bandage.

bulb

TIP

If a visible “hump” forms in the middle of the shoulder, this is an indication of injury to the acromioclavicular joint.

Broken collarbone

The collarbone is a long, thin bone which breaks quickly due to its structure and location – particularly in the event of a fall. A collarbone fracture usually causes clear elevation in the shoulder as the muscles pull the broken pieces up and forwards. Extensive bruising and pain when moving are further indicators of a broken collarbone.

Treatment

Immobilisation with a bandage heals the break in around four weeks. Depending on the position and the state of the fragments, surgery with a stabilising metal plate or nails is required so that the individual connective bones between the shoulder and trunk grow back together correctly and the patient does not suffer any permanent complaints.

bulb

TIP

After six weeks, daily exercise can be managed again with the affected arm. The arm should be rested for a period of approx.12 weeks before undertaking intensive exercise such as mountain biking.

Tension and strains

Tension or strains in the shoulder usually affect the muscles of the rotator cuff and the trapezoid. Tension often occurs due to stress or poor posture in which the muscle is maintained in a state of permanent tension and is not correctly supplied with blood as a result; this means it is no longer adequately supplied with oxygen, which causes painful hardening. On the other hand, strains are inflammatory reactions in the muscle which occur as a result of extremely intense or sudden strain.

Treatment

Tension can be effectively treated with massage as well as with mobilisation exercises and those which promote blood flow. It is also important that the causes of the tension are found and avoided. A strain heals in one or two weeks by itself. Anti-inflammatory ointments can be applied to combat the pain; a break from training is also a good idea for the shoulder.

bulb

TIP

To heat or cool? If there is tension in the shoulder, warmth can improve the blood supply to the muscles, which will then help them to relax. On the other hand, a strain should be cooled as this will help to alleviate any inflammation.

Treatments


1) Total and reverse shoulder replacement:

A shoulder prosthesis is an artificial shoulder joint. It is implanted in severe osteoarthritis (degeneration) of the shoulder joint, in humeral head fractures and in non-repairable rotator cuff tears. However, a shoulder prosthesis is not implanted in osteoarthritis of the shoulder joint before other treatment options have proved unsuccessful.

The shoulder joint is essentially a ball-and-socket joint. It consists of the head of the humerus (humeral head) and the shoulder socket. These bone components of the joint are not able to stabilise the shoulder unaided. The shoulder joint is stabilised with the aid of a group of muscles and tendons, the rotator cuff.

A shoulder prosthesis is most commonly implanted in age-related degeneration (osteoarthritis) of the shoulder. If, despite every effort, it is no longer possible to provide adequate relief for the symptoms and pain, then an artificial shoulder joint is often the only remaining treatment option. A shoulder prosthesis may also be implanted in comminuted fractures of the joint head and non-repairable injury to the rotator cuff.

2) Arthroscopic rotator cuff surgery and SLAP repair

The rotator cuff is a group of tendons and muscles in shoulder that provides support to the shoulder joint and helps in lifting and rotating the arm. Due to injury or trauma the rotator cuff tendon can be torn or damaged or get pinched by the bones around them causing pain, inflammation and difficulty in movement. In such cases, surgery is performed and most of these surgeries are done arthroscopically which a minimally invasive procedure. This technique allows little trauma to surrounding tissue, relatively fast recovery and less scarring.

The term SLAP is an acronym for ‘Superior Labrum Anterior and Posterior’. The labrum is a ring of cartilage that supports the ball and socket of the shoulder joint.  A SLAP tear happens at to the bicep tendon that is attached to the labrum. This is common in high performing athletes with symptoms such as catching, locking, loss of strength and a dead arm feeling. In case conservative options are not effective, arthroscopic surgery is performed.

3) Arthroscopic / open acromio- clavicular joint (ACJ) resection, repair and reconstruction:

The acromioclavicular joint (ACJ) is one of the three joints in the shoulder which sits at the top of the shoulder that connects the clavicle (collarbone) to the scapula (shoulder joint). The joint is stabilised by three ligaments. Injury to the ACJ is commonly known as separate shoulder, which is different from a dislocated shoulder, and is often caused by physical contact sports like football/soccer, rugby and wrestling.

The dislocation of the AC joint is visible with an apparent bump at the end of collarbone (clavicle).  When ligaments are completely torn they are regarded as grade III injuries which requires AC joint reconstruction surgery.  The surgery may be performed either traditionally by opening the site or arthroscopically depending on the severity of the injury and patient’s overall condition. 

4)  Arthroscopic shoulder stabilising surgery:

Arthroscopic shoulder stabilising surgery is performed to treat chronic instability in the shoulder joint which occurs when the head of upper arm bone (humerus) dislocates from its socket (glenoid). This instability usually results from  sudden injury or overuse of the joint.  The repeated dislocation may lead to arthritis. The instability surgery depends on the different causes of the repeated dislocation such as labrum tear, or rotator cuff or ligament tear in the front of the shoulder. All surgeries aim to tighten the loose ligaments in the shoulder.

5)Arthroscopic subacromial decompression and biceps tenodesis:

A subacromial decompression is a surgery performed for patients with shoulder impingement. Impingement is one of the most common causes of pain in the shoulder. It results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is raised to the shoulder height. The pain may be due to a “bursitis” or inflammation of the bursa overlying the rotator cuff or a “tendonitis” of the cuff itself. In some cases, a partial tear of the rotator cuff may cause impingement pain.

However, if after a course of conservative treatment consisting of anti-inflammatory medication and physical therapy, your symptoms do not improve, arthroscopic subacromial decompression may be recommended by your surgeon. It is performed under local or general anaesthesia to create more room for the rotator cuff tendons. Subacromial decompression, also known as acromioplasty, can be performed with an arthroscope or with an open technique (larger incision). 

During the procedure the front (anterior) edge of the acromion (bony prominence at the top of the shoulder blade) is removed along with some of the bursal tissue and the last four or five millimetres of the clavicle to increase subacromial space for the rotator cuff tendons. After treating the problem, the incisions (portals) are closed with sutures.