Dislocation:

• A shoulder dislocation occurs when the head of the humerus becomes dislodged from the glenoid fossa of the scapula. A dislocation means 100% of the joint surfaces have lost contact.  A subluxation is like a dislocation but there is still contact between the two joint surfaces.  Once a dislocation occurs the shoulder will be loose, which could lead to chronic dislocations.

• This most often occurs when the arm is abducted and externally rotated in combination with an external force being applied, such as a fall or collision.  Dislocation can also occur with a direct blow to the posterior shoulder, pushing the humeral head anteriorly.

• Symptoms can include severe pain, and difficultly moving the arm. The shoulder will generally be positioned in slight abduction and external rotation, with the forearm being supported by a sling.  There may also be a noticeable fullness in the anterior shoulder.

SLAP (Superior Labrum from Anterior to Posterior) Lesion:

• Around the glenoid fossa of the scapula, or socket of the shoulder, is a piece of cartilage, called the labrum, which help provide extra stability to the shoulder joint.  In a SLAP lesion this cartilage is torn across the top part of the cartilage, starting in the front and going to the back.

• This injury is commonly caused by trauma, such as a fall or bracing for an accident, or repetitive overhead activities.

• Symptoms often include an ache within the shoulder, popping or clicking, and pain with specific movements.  

Rotator Cuff Tear:

• The rotator cuff is a group of 4 muscles and their tendons that have converge around the shoulder, providing extra stability to the joint.  When these tendons and muscles are stressed, they can either partially or completely tear.

• Most tears develop gradually, but can also occur abruptly. The most common causes of a rotator cuff tear are overuse injury, irritation to the tendons, or trauma.

• Symptoms can change depending on the acutely of the injury.  An acute rotator cuff tear can present with pain, instability, weakness, and possible inability to lift the arm.  Chronic rotator cuff tears can present with limited range of motion, pain, weakness, and adhesive capsulitis.

• Severe rotator cuff tears will require surgery to repair. General anesthesia is given before surgery. There are a few different surgical techniques ranging from an arthroscopic procedure, requiring only a few little holes, to opening the shoulder, which requires a 2-3 inch incision.  These surgical techniques are used to remove debris, make more room for the tendons, and/or sewing the tendon back together. After surgery a sling is required.  Pain, weakness, and limited motion are to be expected.  Strengthening exercises generally do not begin until 6-8 weeks after surgery.

Impingement:

• Impingement is the compression of structures, such as the rotator cuff tendons, in the anterior aspect of the shoulder between the humeral head and the coracoacromial arch.  There are four grades of impingement that are dependent on the underlying causes.

• Impingement can be primary, which is caused by a mechanical impingement.  This could be causes by a rotator cuff pathology from muscle imbalances, repetitive micro trauma, or degeneration of a tendon (tendonosis).  Secondary impingement means that the underlying cause of the impingement is from other indirect factors such as instability of the scapula or glenohumeral joint.

• The typical symptoms of impingement syndrome include pain, weakness, and difficulty reaching up or behind the back.

Adhesive Capsulitis (Frozen Shoulder):

• The joint involved with adhesive capsulitis is the joint that is made between the head of humerus and the glenoid fossa of the scapula. Around this joint there is a capsule, which is connective tissue, along with other ligaments, all of which help provide stability to the joint.  There are three phases of adhesive capsulitis.  Phase I is the painful/freezing phase, which last 10-36 weeks.  Phase II is the stiff phase, which can last 4-12 months.  Phase III is the recovery phase, which can last 2 months to 2 years.

• The most common cause of adhesive capsulitis is idiopathic, meaning it can have no apparent cause. However it can be caused by not using the shoulder joint normally, such as after an injury.

• The Symptoms include pain, stiffness, and limited range of active and passive motion. During phase I, severe pain can be present, especially at night.  The pain may also radiate down the arm.  During phase II, the pain will decrease, but severe restrictions in movement will be seen.  During phase III, there will be a slow recovery of the lost movement.

Bicipital Tendinitis:

• Bicipital tendinitis is inflammation of the bicep brachii muscles.  The two tendons that make up the biceps are found in the anterior portion of the upper arm and shoulder.  The most problematic area of the biceps tendon is in the intertubercular sulcus, or groove on the front of the humerus, where it courses up towards the shoulder joint.

• Common symptoms of bicipital tendonitis include shoulder pain that be travel down the front of the arm, tenderness over the biceps tendon, and decrease shoulder movement.

• Common causes include overuse, inflammatory diseases, injuries, or infection.  The bicep muscle acts to elevate the shoulder and bend the elbow. It’s the repetitive imbalances within the shoulder above horizontal that can cause bicipital tendinitis.