Shoulder & Elbow

The shoulder is the only joint in the body that can accomplish a 360 degree rotation, although this level of mobility translates into a lesser degree of stability than other joints. The primary function of the shoulder is to support, or anchor, the different positions of the hand and arm. 

The bony structures of the shoulder include the scapula, humerus, and clavicle, which together create two separate joints -- the glenohumeral joint and the acromioclavicular joint. Some of the muscles and tendons that support the shoulder joint are referred to as the rotator cuff. 

The elbow joint connects the bone of the upper arm, the humerus, with the two bones of the lower arm, the radius and the ulna. Within the joint structure are three smaller joints, created by the communication of the three separate bones. The humerus-ulna joint and the humerus-radius joint contribute to the hinge-like motion of the arm. The radius-ulna joint and the humerus-radius joint permit rotation of the forearm and the palm-up, palm-down positioning of the hand.

Common Problems of the Shoulder and Elbow

• Shoulder Impingement Syndrome
• Dislocation
• Shoulder Instability
• Arthritis
• Frozen Shoulder
• Rotator Cuff Injury
• Elbow Fractures
• Bursitis
• Tennis Elbow/Golfer's Elbow

Shoulder Impingement Syndrome

One of the most common shoulder problems is called shoulder impingement syndrome. This occurs when the roof of the shoulder rubs on the rotator cuff muscles, which are important for shoulder movement. Frequently overhead activities and reaching behind, such as putting an arm in a coat, are quite painful. Another common symptom is difficulty sleeping because of pain from pressure on the shoulder. Symptoms usually occur in people in their 40s and usually come on fairly gradually over several months, but they also can occur suddenly.

Avoiding activities which require reaching with the elbow away from the body may be one of the first steps in treatment. Reaching overhead or out away from the body tends to be painful. An exercise program that helps maintain the range of motion in the shoulder and also increases the strength of the rotator cuff muscle should be started. Anti-inflammatory medicines frequently help decrease pain and inflammation. If symptoms continue for more than a month, a physician should be consulted. An injection of cortisone may help alleviate the discomfort. If symptoms persist, the "bone spur" may need to be removed surgically. In some cases, the rotator cuff may actually be torn and must be repaired surgically. Click here to learn more about Impingement Syndrome.

Dislocation

When the shoulder is dislocated, the head of the upper arm bone or humerus pops out of the shoulder socket. This can result from a fall on an outstretched hand, a blow to the shoulder, or extreme rotation of the arm. A dislocation is very painful, and the shoulder itself appears out of position. The condition is sometimes accompanied by a fracture, typically of the humerus. 

Treatment of the dislocation includes manipulating the upper arm bone back into the socket and immobilization of the shoulder with a sling or shoulder immobilizer, followed by rehabilitation. Depending on the severity of the injury to muscles and other structures of the shoulder, surgery may be necessary, followed by rehabilitation.

Shoulder Instability

Once the shoulder has been dislocated, it may pop out of place over and over again. This tends to occur most commonly in younger people. 

If the shoulder remains unstable the initial treatment is an aggressive rehabilitation program is recommended. If the shoulder continues to pop out of the socket following rehabilitation, surgery may be necessary tore pair the ligaments and capsule around the shoulder joint.

Arthritis

Arthritis of the shoulder occurs much less often than arthritis of the knee and hip, however it can be quite disabling. Shoulder problems caused by arthritis include pain and limited movement. 

The initial treatment for arthritis of the shoulder is a gentle strengthening program and nonsteroidal anti-inflammatory medicines to help with pain and inflammation. If symptoms continue after these and other pain relieving measures are used, shoulder replacement may be considered to help alleviate pain and restore function to the arm. Shoulder replacements are not as common as hip or knee replacements, but the shoulder replacement tends to last a little longer than hip or knee replacements.

Frozen Shoulder

Frozen shoulder is a condition where movement of the shoulder is seriously limited because of inflammation in the shoulder joint lining. Lack of use, particularly following an injury, is one of the factors that contributes to frozen shoulder. People with diabetes also seem to have a higher incidence of frozen shoulder. However, many times a frozen shoulder occurs for no apparent reason. 

Treatment may include the application of heat and cold and the use of nonsteroidal anti-inflammatory medicine or other pain medication. Injections of steroids may also be helpful. Movement may be restored with exercise or manipulation by a physician.

Elbow Fractures

A common injury to the elbow is a fracture resulting from a traumatic blow. For example, a fall onto an outstretched wrist can result in elbow fracture. When the elbow fractures, there is a great deal of pain, swelling and tenderness. Attempts at moving are quite painful. 

If a fracture is suspected, the injury needs to be evaluated by a doctor immediately. Surgery is often required if the fracture is displaced. 

Bursitis

Bursitis is an inflammation of the fluid-filled sac or bursa that cushions the joint. Bursitis in the shoulder is called "subdeltoid bursitis," and it can lead to frozen shoulder if the irritation continues and is left untreated. 

The treatment for bursitis is most often rest. Ice and possibly steroid injections may help with the pain. If the bursitis is recurring, it maybe treated surgically.

Tennis Elbow/Golfer's Elbow

The most common problem of the elbow is "tennis elbow,"  which is an inflammation of muscles on the outside of the elbow. These muscles attach above the elbow and course down the forearm. Their function is to lift the wrist. If tendinitis occurs on the inside of the elbow, it is called golfer's elbow. It is most frequently caused by overuse, although it can result from a traumatic blow. Symptoms include tenderness directly over the affected muscles and frequently the pain radiates down into the forearm, particularly with use of the hand and wrist. Usually, symptoms come on gradually but they can appear rather suddenly, particularly after an activity that involves repetitive motion such as planting a garden, or a great deal of writing or typing. 

Rest is important to allow the muscles to recover. If activities are painful, they need to be altered, or stopped until the elbow has had a chance to heal. Heat, followed by a stretching and strengthening program, and then ice massage is quite helpful. A tennis elbow strap is also helpful to alleviate some of the pressure from the muscle attachment. Nonsteroidal anti-inflammatory medicines decrease the pain and inflammation. If symptoms persist beyond two to four weeks, a physician should be consulted. Steroid injections may be used and sometimes even a cast is necessary to alleviate the symptoms.