Shoulder Pain – Everything You Need To Know – Dr. Nabil Ebraheim
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Dr. Ebraheim’s educational animated video describes conditions associated with neck and shoulder pain
Shoulder pain
Shoulder pain is most commonly associated with injury to the muscles, tendons, and ligaments within the shoulder. However, this pain can also originate from the area of the cervical spine and radiate into the arm. There are 2 main joints within the shoulder, the acromioclavicular joint (AC joint) and glenohumeral humeral joint is the shoulder joint. The acromion and the clavicle combined to form the AC joint. The glenohumeral joint is a ball-and-socket joint which involves articulation between the head of the humerus and the glenoid fossa of the scapula. There are 4 major muscles at the shoulder joint that are responsible for movement of the shoulder.
These are the 4 muscles:
• Subscapularis
• Superaspinatus
• Infraspinatus
• Teres minor
In addition to the 4 muscles, the biceps is an important shoulder and elbow muscle. The for shoulder muscles can be in front, or in back of the shoulder. The subscapularis muscle is present in front of the shoulder. Here you can see the relationship between the subscapularis muscle and the 2 heads of the bicep muscle. The supraspinatus is a relatively small but important muscle that runs from the top portion of the scapula and inserts into the top of the humeral head. And from the back position or the posterior position, the muscles of the shoulder joint include the infraspinatus and teres minor muscles. These muscles of the shoulder combined to form a thick cuff that is important in stabilizing the shoulder as well as elevating and rotating the arm. Common causes of shoulder pain includes impingement. 50% of all patients to go to the doctor for shoulder pain will have an impingement syndrome. With rotator cuff tendonitis, raising the arm is painful. Elevation of the arm causes squeezing of the bursa located above the supraspinatus tendon and below the acromion. Bursitis is a frequent cause of shoulder pain and usually occurs in conjunction with an impingement syndrome. Irritation of this bursa will often cause pain due to overuse. Tears of the rotator cuff is a common cause of pain associated with the shoulder. Most tears occur in the supraspinatus muscles and the tear can be either partial or complete, with complete tears of the tendon usually requiring surgery. With tears of the rotator cuff, the patient is unable to raise the arm. Biceps tendonitis is a condition that affects the area where the biceps muscle meets the front of the shoulder. The pain is in front of the shoulder. Tendonitis of the biceps usually develops as a result of rotator cuff tendonitis. The labrum is a cuff of tissue surrounding the rim of the glenoid which helps to keep the head of the humerus in place within the shoulder joint. Tears of that glenoid labrum is often associated with significant shoulder pathology.
Two of the most common labral injuries are:
• SLAP tear
• Bankart lesion
A SLAP tear is different from a Bankart lesion. The SLAP tear is not common and is difficult to diagnose. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum. The pain associated with a SLAP tear is deep within the shoulder or in the back of the shoulder. The patient complains of catching, popping, or clicking sensations. Pain with throwing a ball and pain with overhead activities. The O’Brien’s test is the most commonly used test for the diagnosis of a SLAP tear. MRI arthrogram is usually helpful.
Bankart lesion occurs as a result of dislocation of the shoulder. When an individual sustains a shoulder dislocation, that ultimately tears the labrum. The AC joint is located at the top of the shoulder, where the acromion of the scapula and the clavicle joint together. This joint can be affected by inflammation, arthritis, or osteolysis or injury. Osteolysis of the distal end of the clavicle can be seen, especially weightlifters.
Another common cause of shoulder pain is arthritis of the shoulder. The patient will have global pain with decreased painful range of motion that is restricted. X-ray will show the arthritis.
The treatment of shoulder pain depends entirely on the cause of the problem. If you are not sure about the cause of your shoulder pain, or if you do not know the specific treatment recommendation for your condition, then you should seek medical attention.
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