The shoulder is composed of three bones joined together: the shoulder blade (scapula), the upper arm bone (humerus) and the collar bone (clavicle). The shoulder is a ball socket joint comprised of three joints working in conjunction. The primary joint, which attaches the humerus to the scapula, is the glenohumeral joint. The acromioclavicular and sternoclavicular joints make up the other connecting joints of the shoulder. These joints and bones receive stability from surrounding muscles and tendons which make up the rotator cuff and attach the humerus bone to the scapula. The most common causes of pain and discomfort in the shoulder are trauma, arthritis, instability, and inflammation of the tendons and bursa.

Bursitis: Excessive use of the shoulder joint may result in damage to the small fluid filled sacs called bursa. These provide cushioning for the joint, however may become inflamed under chronic stress. This is nearly always associated with tendinitis.

Tendinitis: The tendon is the long cord connecting muscle to bone. Tendinitis presents in one of two ways: acute, or chronic. Injury due to excessive lifting or throwing may result in acute tendinitis, while arthritis and degenerative disease may cause chronic tendinitis. Tearing of the tendons due to injury may also cause tendon pain.

Trauma: Fracturing of any of the bones making up the shoulder (clavicle, humerus and scapula) is considered shoulder trauma. Dislocation of any of the shoulder joints additionally qualifies as trauma. Injury to the shoulder is extremely common and can generally be attributed to high impact events such as automobile accidents, falls, and sports related injuries. Treatment is often possible without surgery; however, this is dependent on the severity of the injury.

Instability: Dislocation of the humerus bone from the socket can be partial or complete. Partial dislocation, or subluxation, as well as complete dislocation, may result in loosening of the stabilizing muscles and tendons which secure the bones and joint. This eventually causes repeated dislocations and perpetuates arthritis. In the event of repeated dislocations, surgery is necessary.

Arthritis: Pain and stiffness of the shoulder joint may be arthritic. Osteoarthritis is the gradual degeneration of the smooth articular cartilage which cushions the bones and joint. It typically presents in adults 50 years or older. Rheumatoid arthritis is the inflammation and wear down of the lubrication of the bone, called synovium. Post- traumatic arthritis results following an injury. While arthritis is not curable, there are a number of treatments, therapies and surgical solutions which can help alleviate pain and restore mobility to the joint.

Rotator Cuff Tears: The shoulder bones (humerus, clavicle and scapula) are held together by a group of four muscles joined together as tendons called the rotator cuff. This tissue covers the head of the humerus bone and provides stability to the shoulder joint. When this group of tendons is torn away from the bone, it results in pain, swelling, and immobility. Rotator cuff injuries are common, affecting over 2 million people annually. Tears can be partial, full, acute, or degenerative. The type and severity of the tear is the deciding factor in surgical intervention. Approximately 80% of cases are healed using physical therapy, steroid injections, activity modification, and non-steroid anti-inflammatory medications.



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