The shoulder is a complex joint connecting the arm to the rest of the body and it is the joint that has the greatest range of motion.  

In addition to the shoulder’s flexibility and range of motion, it is both capable of lifting heavy loads and quick, snapping motions like throwing a basketball or a football. However, due to the flexibility of the joint, it is also prone to injury when we fall, throw something a little too hard or repeat the same movement too many times. Here is how the shoulder works, plus some common shoulder injuries that Sauk Prairie Healthcare ’s Sports Medicine doctors treat on a regular basis. 

Shoulder Anatomy

The humerus (upper arm bone) connects  with one end of the scapula (shoulder blade bone) to form a ball-and-socket joint, which enables the shoulder to move the arm through a wide range of motion.

Part of the shoulder blade, called the glenoid, forms the shallow cup of the shoulder socket. The acromion is another part of the scapula that forms the roof of the ball and socket joint of the shoulder. Another shoulder bone is the clavicle (collarbone) which connects to the scapula at the acromion.  

The scapula (socket) and humerus (ball) are connected to each other with the capsular ligaments. Cushioning the end of the ball and surface of the socket is a smooth hard cartilage called hyaline cartilage. On the outer edge or rim of the “socket” or glenoid bone there is a soft rubbery cartilage called a labrum which provides additional strength and stability to the shoulder. 

In addition to the capsular ligaments, there are four major muscles that attach to the scapula and reach out to hold the ball in the socket. The muscles are attached to the humerus bone by rope-like tendons. These four muscles and tendons that hold the scapula to the humerus are called the rotator cuff. These muscles are essential to moving the shoulder joint.  

Outside the joint and sitting between the rotator cuff tendons are a number of fluid-filled sacs called bursae. Each bursa helps protect the joint from friction between muscle layers during movement. 

Rotator Cuff Tear

About two million Americans visit the doctor each year because of rotator cuff injuries, many of which result from sports or work injuries, such as painters, carpenters, construction workers and baseball players. 

The four rotator cuff muscles are all anchored to the shoulder blade, and the tendons extend out to wrap around or create a “cuff” around the “ball” or humeral head of the shoulder joint. The rotator cuff muscles and tendons allow for lifting and rotation of the shoulder. Injuries often begin with thickening and fraying of the tendon, and over time can result in a rotator cuff tear

Rotator cuff tears come in two forms: an acute tear or a degenerative tear. An acute tear is the result of an injury, like falling onto an outstretched arm or lifting something that is too heavy with a jerking motion. Rotator cuff tears also happen with other injuries such as a broken collarbone or shoulder dislocation. 

A degenerative tear happens over time, and is mainly the result of aging and repetitive stress. 

Rotator cuff tears can range in severity from small partial thickness tears to a rupture where the entire tendon attachment is torn. 

Symptoms of a rotator cuff tear include: 

  • Pain when at rest, particularly making it difficult to sleep on the injured shoulder
  • Pain when lifting and lowering the arm in particular directions
  • Pain with overhead and reaching activities
  • Weakness lifting or rotating the arm
  • Painful snapping and crepitus, or crackling sensation that occurs during certain movements

At your appointment, your Sports Medicine doctor will ask about your symptoms and when you first experienced them. Be sure to mention any activities you think may have made your shoulder injury worse. Your doctor will examine your shoulder to check its strength, range of motion and stability. Some rotator cuff tears can be detected by physical examination. If a rotator cuff tear is suspected, your doctor may perform a musculoskeletal ultrasound examination of your shoulder. The doctor performing the ultrasound examination will then be able to show you if there is a rotator cuff tear with a high degree of accuracy. A musculoskeletal ultrasound is as accurate as an MRI at detecting rotator cuff tears. Your doctor may also order X-rays or an MRI if they suspect either the bones or something deeper in the shoulder is injured. 

Some rotator cuff tears, especially large tears or ruptures that happened suddenly, need surgery right away. If this type of tear is detected, you may be immediately referred to an Orthopedic surgeon to have it fixed.

Other rotator cuff tears, especially those that are small or developed gradually, may not require surgery at all and all you need is non-surgical treatments. Sports Medicine doctors and physical therapists often incorporate stretching and strength training into treatment. Strengthening muscles in the shoulder help keep the joint stable, while stretching can reduce soreness, increase range of motion, and prevent further injury.

AC Separation

Acromioclavicular joint injuries, or AC injuries, make up close to half of the shoulder injuries suffered by athletes in contact sports. Though they are called “shoulder separations,” a majority are sprains in which the ligaments holding the joint together are stretched or partially torn. AC separation is often caused by a sudden blow to the outer point of the shoulder while the arm is in a lowered position, parallel to the rest of the body. 

The AC ligament is responsible for a majority of the strength of that portion of the shoulder, while the coracoclavicular (CC) ligaments are responsible for vertical stability of the joint. 

The seriousness of the separation is by grades one to six. People who suffer grade one or two separations may find it painful, but often improve on their own. More serious injuries can involve persistent pain and limited use of the joint.  

Symptoms of a more serious AC injury can include: 

  • An obvious deformity over the joint, usually a very prominent bump or swelling. 
  • Supporting the elbow of the injured arm with the opposite hand
  • Pain in the shoulder with affected breathing, coughing and sneezing.

Often treatment is limited to immobilizing the shoulder with a sling for comfort for up to few weeks, combined with range of motion exercises. More extreme cases require surgical treatment options such as CC ligament reconstruction.

Shoulder Labral Tear

The labrum is a soft rubbery cartilage that forms a gasket around the rim of the glenoid or socket of the shoulder joint. One of the biceps tendons attaches to the top edge of the labrum and is a common place for tears to occur. A SLAP tear is one type of labral tear involving an injury to the top part of the cartilage that protects the socket of the shoulder joint. SLAP is short for Superior Labrum Anterior and Posterior. It is also common for the tendon connecting the bicep to the shoulder to be damaged in a SLAP tear injury. 

A SLAP tear can be caused by traumatic incident like a motor vehicle accident, falling onto an outstretched arm or catching a heavy object, but it can also happen in repetitive over-head sports like basketball, baseball, volleyball or some track and field events.  

SLAP tear symptoms include: 

  • A popping, locking or grinding sensation
  • Pain with movement
  • Decreased shoulder strength
  • Decreased range of motion

At your appointment, your Sports Medicine doctor will ask about your symptoms and when you first experienced them. Be sure to mention any activities or sports you think may have made your shoulder injury worse. Your doctor will examine your shoulder to check its strength, range of motion and stability. The doctor will then perform specific tests to rule out any other injuries. Your doctor may also order X-rays or an MRI specific to labral tears, which sometimes include an injection of contrasting dye into the shoulder. An MRI can be used to determine if the labrum is torn or if there is a different nearby injury like tendon damage.

There are several types of SLAP tear with different treatments, but your doctor will usually start with non-surgical options. SLAP tear treatments include: 

  • Rest
  • Non-steroidal anti-inflammatory medications like ibuprofen or naproxen
  • Physical therapy to improve your range of motion and strengthen your shoulder
  • Occasionally cortisone injection to relieve pain and assist physical or occupational therapy

If your pain does not subside after several months of rest and non-surgical treatment, your Sports Medicine doctor may refer you to an Orthopedic surgeon . The Orthopedic surgeon may then review options, with possible recommendations including arthroscopic and open surgical procedures.

Following surgery, once the pain and swelling has improved, the next step is to resume a physical therapy program to regain your range of motion, and to prevent stiffness. In most cases, SLAP tear recovery treatments allow athletes that use their arm for throwing to return to play at least three or five months after surgery. 

Dislocated Shoulder

The shoulder is relatively easy to dislocate because it can move in so many directions and is looser than most other joints. It can dislocate in any direction, but most commonly in the forward direction. A shoulder dislocation can result in injury to labrums, tendons or nerves.  

There are two types of shoulder dislocation: 

  • Partial shoulder dislocation, also called subluxation, means the top of the humerus or “the ball” has only partially slipped out of the socket.
  • Complete shoulder dislocation occurs when the head of the humerus is all the way out of the socket.

No matter what type, shoulder dislocations cause unsteadiness and pain in the shoulder. Other symptoms of a dislocated shoulder include:

  • Deformity
  • Swelling
  • Numbness
  • Shoulder weakness

In rare cases, a dislocated shoulder causes muscle spasms, which can make the pain even worse.

During your appointment, your Sports Medicine doctor will examine your injured shoulder. You should let your doctor know how you hurt your shoulder and if it has happened before.

Usually, your Sports Medicine doctor can set your shoulder back into place right in the office using a procedure called a closed reduction. A closed reduction is done by placing the head of the humerus back into its socket. After the shoulder is back in place, your pain will improve immediately. A reduction can also be performed in the emergency room or by your athletic trainer.

Depending on the injury’s severity, your doctor may immobilize your shoulder in a shoulder sling and ask you to start treatment by resting and icing your shoulder for a few days. After the pain and swelling has gone down, your doctor may refer you to a physical therapist, because in most cases people will develop tightness and weakness after a shoulder dislocation. A physical therapist can teach you shoulder exercises to strengthen the muscles and regain full range of motion. This may also help reduce your risk of dislocating your shoulder again later.

If you dislocate your shoulder repeatedly, you may have chronic shoulder instability.

Multidirectional instability is a condition in which repetitive strain on the shoulder can cause a loose joint and persistent pain. A common source of this kind of injury is repetitive overhead activity such as in volleyball, swimming and gymnastics. Symptoms can begin to surface during high-demand situations and over time begin to appear more regularly.

Some common chronic shoulder instability symptoms include:

  • Recurrent shoulder dislocations or partial dislocation episodes
  • Pain caused by repetitive shoulder movement
  • Persistent feeling of looseness in the shoulder

When seeing your Sports Medicine doctor about your shoulder instability, tell him or her about your medical history, especially if you have dislocated your shoulder before. The doctor may also perform specific tests to see how unstable your shoulder is or if the ligaments in your shoulder are loose.

Multidirectional shoulder instability without trauma, a fall, or acute injury can usually be diagnosed without imaging and you may be first referred for physical therapy. If the doctor feels imaging is necessary, they will usually start out with X-rays and or an ultrasound image of you shoulder. If there is a history of trauma or if the doctor discovers something on the physical exam that raises concern of a possible injury deep in the shoulder joint, an MRI might be ordered. 

Chronic shoulder instability is usually treated with non-surgical methods first, but it can take several months to tell how effective they are. Some recurrent shoulder dislocation treatment options include:

  • Modified activities or rest away from sports to avoid worsening symptoms
  • Non-steroidal anti-inflammatory medication to relieve pain and swelling
  • Physical therapy to strengthen the shoulder muscles

If you are young and have a traumatic shoulder dislocation, you should see an Orthopedic Surgeon who may talk to you about surgery as possibly the best option. Even though your Sports Medicine doctor may start by using non-surgical treatments, shoulder instability surgery may be needed to repair the ligaments so they can hold the shoulder more securely in place.

Arthroscopic surgery for chronic shoulder instability is relatively minimally invasive, but some patients may need open surgery. No matter which type of surgery your Orthopedic surgeon recommends, expect a period of rehab to follow your surgery. You will start some physical therapy right away, but you will need to wear a sling for several weeks.

Shoulder Tendonitis

Tendonitis is a condition that can affect tendons in various locations of the body. Many forms of the condition have their own name based on their frequent appearance among athletes in specific sports, eg: jumper’s knee, tennis elbow or golfer’s elbow.  

In the shoulder, rotator cuff tendonitis is a very common issue, particularly among swimmers, athletes in throwing sports, older adults and those who perform repetitive overhead and reaching work. 

The four rotator cuff muscles are all anchored to the shoulder blade and the tendons extend to wrap around or creates a “cuff” around the “ball” or humeral head of the shoulder joint. The rotator cuff muscles and tendons allow for lifting and rotation of the shoulder. Tendonitis or inflammation of the rotator cuff tendons can occur from suddenly doing a repetitive activity that you are not used to, such as painting rooms over the weekend or it can happen from years of work that requires repetitive movements such as factory line work. 

Some symptoms of tendonitis include: 

  • Minor pain with activity and rest
  • Dull ache 
  • Pain radiating from the shoulder to the side of the arm and even down to the elbow 
  • Sudden pain with lifting and reaching 
  • Pain with lying or sleeping on the affected shoulder
  • Pain with lowering the shoulder or reaching across or behind the torso 

Over time the condition may progress to include pain at night, and loss of strength and motion. 

Potential tendonitis sufferers are advised to see a Sports Medicine doctor if moving that arm in that joint becomes difficult or if the pain reaches a point of disrupting sleep or keeping them from their usual activities. 

At your appointment, your Sports Medicine doctor will ask about your symptoms and when you first experienced them. Be sure to mention any activities you think may have made your shoulder injury worse. Your doctor will examine your shoulder to check its strength, range of motion and stability. Rotator cuff tendonitis can by diagnosed by the story you tell and physical examination, however, if a rotator cuff tear is suspected, your doctor may perform a musculoskeletal ultrasound examination of your shoulder. The ultrasound is very good at showing rotator cuff tendonitis, but can also pick up more serious tears of the rotator cuff. A musculoskeletal ultrasound is as accurate as an MRI at detecting rotator cuff tears. Your doctor may also order X-rays or an MRI if they suspect either the bones or something deeper in the shoulder is injured.

Treatment ranges from rest and ice, to including physical therapy, oral or topical anti-inflammatory, and sometimes cortisone injections into the bursa that sits on top of the rotator cuff tendons. Rotator cuff tendonitis can be caused by the rubbing between the rotator cuff and the bones of the shoulder joint. This condition is called impingement syndrome and an MRI may be required to confirm the diagnosis. Surgery is often needed to fix impingement syndrome. 

Shoulder Bursitis

Shoulder bursitis, or subacromial bursitis, occurs when the fluid-filled bursae cushioning the shoulder joint become inflamed and swollen. Bursitis can happen in almost any joint, but it’s particularly common in joints that experience regular pressure, like the shoulders, hips and knees.  

You may hear about shoulder bursitis but it is commonly mistaken for rotator cuff tendonitis which is far more common. Shoulder bursitis is often due to rotator cuff tendonitis that has not been treated or gotten worse. 

Pain is one of the main symptoms of shoulder bursitis, and sometimes it may be bad enough to wake you up at night. Other shoulder bursitis symptoms include: 

  • Swelling 
  • Redness 
  • Tenderness and warmth to the touch, especially on the upper arm 
  • Reduced mobility 

During the appointment with your Sports Medicine doctor, he or she will examine your shoulder, see if it is tender, and test your range of motion and strength. If necessary, the doctor may also order an X-ray or perform a musculoskeletal ultrasound to rule out other causes of shoulder pain. You may also need a blood test if your doctor suspects an infection or an autoimmune condition is the cause your symptoms. 

One of the most important shoulder bursitis treatments is rest. Avoiding activities that make your pain worse will help your shoulder heal. Other treatments include: 

  • Ice to reduce swelling 
  • Over-the-counter pain relievers 
  • Prescription medications 

Because rotator cuff tendonitis is almost always the cause of subacromial bursitis, your doctor will likely refer you to a physical therapist. The physical therapist can show you exercises to treat rotator cuff tendonitis that will help with the bursitis and help your shoulder return to its full range of motion and prevent stiffness. 

Shoulder bursitis surgery is rare, however, if your shoulder doesn’t respond to other non-invasive treatments, your Sports Medicine doctor may recommend a consultation with an Orthopedic surgeon.

Shoulder Osteoarthritis

Shoulder osteoarthritis, also referred to as degenerative joint disease, is caused by a natural breakdown of cartilage in the shoulder joint, resulting in greater friction, increased pain, and decreased mobility. As the condition progresses, night pain becomes more common, interfering with sleep. 

Osteoarthritis of the shoulder is not as common as in the knee or hip, but it affects roughly one-third of adults over the age of 60, and affects more women than men. The prevalence of the condition has increased as the overall population ages. 

Osteoarthritis can affect the two joints that make up the shoulder. The glenohumeral joint is the “ball-and-socket” joint of the shoulder and when it is affected by arthritis, there is often a deep aching feeling in the shoulder. Sometimes it’s in the back of the shoulder, but the pain could also radiate to the side or the front of the shoulder as well. Acromioclavicular, or AC joint arthritis, is more common where the collarbone meets the shoulder. Arthritis in the AC joint often begins to appear as a pain at the top of the shoulder. 

Osteoarthritis symptoms include:  

  • Swelling
  • Limited motion and stiffness
  • A deep aching sensation
  • Sudden sharp pains with certain movements of the shoulder
  • Crapitus, or the sensation of hearing or feeling grinding or clicking in the joint 

There isn’t a way to reverse the damage of arthritis, but there are ways to alleviate symptoms and slow its progress in further damaging the joint. 

Following an initial examination, one of the more likely recommendations is a combination of modified activity, rest, acetaminophen (Tylenol), topical and oral anti-inflammatories and ice. The situation may also be improved by physical therapy, strength training and aerobic exercise. If you are having a painful flare-up that is not improving with rest and anti-inflammatories, your sports medicine doctor may recommend a cortisone injection for your shoulder.  

Cortisone injections into the shoulder joints are given by sports medicine doctors using musculoskeletal ultrasound guidance. Ultrasound guidance is used to make sure the needle is in the right place in the joint. Cortisone injections are considered temporary relief, but in some cases it is effective in improving long-term pain in combination with rest and physical therapy. 

Acetaminophen is often recommended as a first step in pain relief. Glucosamine and chondroitin have also been used to improve joint health, though there is less evidence of reliable effectiveness. Non-steroidal anti-inflammatory drugs may also be used to reduce inflammation in the joint. 

Surgical options are also available including cartilage resurfacing, an arthroscopic procedure in which a thin tube is used to insert a tiny camera to guide small surgical tools into the joint, and in more serious cases, arthroplasty, or complete shoulder replacement. 

How Sauk Prairie Healthcare Treats Shoulder Sports Injuries

At Sauk Prairie Healthcare, we strive to treat every person’s shoulder injury as a unique situation to make sure they can return to the activities they enjoy without pain slowing them down.  

Our Sports Medicine doctors in Sauk Prairie, Lodi and Spring Green prioritize conservative treatments for all kinds of sports injuries, including shoulder injuries. For injuries requiring surgery, our Orthopedic surgeons will help you understand your choices in treatment and give you the information you need to be prepared for surgery, taking precautions to minimize any risk and put you in the best position for a quick recovery. 

Our team also includes physical therapists and certified athletic trainers to help you through the rehab process. 

Your Sauk Prairie Healthcare team will follow up with you through every step after your injury, from the first appointment until you have recovered and can safely return to a fully active lifestyle. 

Our Sports Medicine Physicians:
Masaru Furukawa, MD, MS
David Krey, DO
Mark Timmerman, MD

To schedule an appointment with a Sports Medicine physician, call 608-643-7677.

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