Shoulder disorders are usually characterized by pain, muscle weakness and loss of motion in the affected shoulder joint. Shoulder disorders are often associated with shoulder lifting pain and nighttime pain, and often even waking up from sleep with pain. Therefore, it has a great impact on the patient’s daily work life.
There are many shoulder disorders. Besides adhesive capsulitis (frozen shoulder), there are also other disorders such as acromioclavicular impingement syndrome (rotator cuff traumatic tendonitis), rotator cuff tear, glenoid labral injury, calcific tendonitis, suprascapular nerve impingement, quadrilateral foramen syndrome, recurrent shoulder dislocation, shoulder laxity, etc. It is necessary to differentiate from other causes of shoulder pain, such as Cervical spine disorders (disc herniation, cervical spondylosis), thoracic spine disorders (tumor, upper lobe pneumonia) and abdominal disorders (diaphragm irritation, gallbladder dysfunction).
Shoulder disorders caused by sports trauma are more common in young and middle-aged people. According to the statistics of more than 200 cases of shoulder sports trauma in the outpatient clinic of the Third Hospital of Peking University, rotator cuff injury accounts for 60%, biceps long head tendon tenosynovitis accounts for 18%, bursitis 4.3%, glenohumeral dislocation, subluxation, acromioclavicular joint sprain and dislocation accounts for 9.4%, clavicle fracture accounts for 4.3%, and others 4.3%.
I. Adhesive capsulitis.
It is also known as frozen shoulder, which is usually called “frozen shoulder”, and is more common in people aged 40-70. The main symptoms are pain in the shoulder joint, limited movement, dull pain, knife-like pain, especially at night, and even waking up in pain, radiating to the forearm or hand, neck and back, and aggravated by movement. The upper arm cannot be abducted, and there is a significant restriction of internal and external rotation. The deltoid muscle becomes atrophied after a long time. Patients are unable to lift their arms, wash their faces or comb their hair.
The overall incidence of frozen shoulder is about 2%, but it is much more likely to be complicated by the following types of diseases, including diabetes, cervical spine disease, hyperthyroidism, thoracic pathology, and trauma. The disease generally occurs regardless of the cause, as long as the shoulder joint does not move or moves little.
The main conservative treatments for frozen shoulder include non-steroidal anti-inflammatory drugs, physical therapy, and intra-articular injections of corticosteroids. If conservative treatment does not work well and external rotation is in neutral position or worse with severe stiffness, surgical treatment should be considered. Minimally invasive adhesion release with shoulder arthroscopy is usually used, and postoperative rehabilitation functional training is continued until the shoulder function is completely restored.
Rotator cuff tears
The rotator cuff consists of the tendons of four muscles, namely the subscapularis, supraspinatus, infraspinatus and teres minor. Rotator cuff tears are a common cause of shoulder pain and dysfunction. Common symptoms include shoulder pain, weakness and limitation of motion. The main manifestation is progressive shoulder pain and weakness, usually accompanied by a loss of active mobility. Pain is often present at night and radiates to the deltoid stop area. Passive shoulder mobility is initially fully preserved until the development of adhesive capsulitis, when it is affected. In most cases, the cause is degenerative changes of this tendon followed by rupture due to less severe sprains, strains, and contusions.
The disruption of rotator cuff integrity can be classified in different ways, including acute and chronic, partial and total, traumatic and degenerative, and it is important to develop an appropriate treatment plan according to the different types: conservative treatment with physiotherapy and functional exercises, and large rotator cuff tears requiring surgery to repair them.
Rotator cuff impingement syndrome
It is also known as rotator cuff traumatic tendinitis, secondary to subacromial bursitis. The main symptom is shoulder pain, followed by limitation of shoulder movement, muscle spasm and muscle atrophy. The abduction of the shoulder joint is limited or accompanied by a painful arc. The exit x-ray may reveal a “hook-shaped” enlargement of the acromion. Surgery to remove the enlarged part of the acromion and the thickened bursa may yield good results.
Calcific tendonitis
This disease is an inflammation caused by the deposition of calcium salts in the degenerated tendons of the rotator cuff. It is divided into two types: acute and chronic. It is characterized by a sudden onset of acute pain in the shoulder joint, redness, swelling and heat in the shoulder joint, and fear of shoulder joint activity in any direction. The site is mostly in the tendon of the supraspinatus muscle. Local injection of drugs or arthroscopic cleaning of the calcified foci can achieve good treatment results.
V. Glenoid labrum injury
The glenoid labrum of the shoulder joint is a cartilage-like structure attached to the edge of the shoulder glenoid, which can deepen the glenoid and increase the stability of the glenohumeral joint. Glenoid labrum injuries are often caused by trauma or repeated strains on the shoulder joint. Glenoid labrum injuries often cause instability, pain, dislocation or interlocking of the joint. Overhead movements of the shoulder joint, such as throwing, can induce increased pain and are often accompanied by intra-articular popping or interlocking. Shoulder glenoid labral injuries can be divided into four types, and different treatments can be used depending on the severity of the lesion, mainly arthroscopic lesion cleaning or suture reconstruction.
VI. Tenosynovitis of the long head of the biceps tendon
This disease is mostly seen in javelin, grenade, hoop, bar, volleyball players. Mostly due to the shoulder joint over the range of shoulder rotation activities, so that the tendon of the long head of the biceps muscle, constantly in the inter-nodal groove in the transverse or longitudinal sliding, repeated wear and tear caused by injury. When re-injured or in chronic cases, the discomfort is present at the time of injury, followed by increased pain and spreading to the subdeltoid muscle. The pain is equivalent to severe pain at the long head of the biceps tendon, with significant restriction of joint movement and pain when lifting objects. In cases of injury due to chronic strain, the history of injury is mostly unclear, with complaints of pain only in the deltoid region and limited pressure pain in the inter-nodal groove. Conservative treatment includes non-steroidal anti-inflammatory drugs, physical therapy, and intra-articular corticosteroid injections.
VII. Recurrent shoulder dislocation
The shoulder joint is one of the most unstable joints in the body, and shoulder dislocations account for about 50% of all joint dislocations. Age at the time of first dislocation is an important factor in recurrence of dislocation. The younger the age, the more likely the dislocation will recur.
Because of the tendency to combine glenoid labral injury (Bankart injury) and insertional fracture of the humeral head (Hill-Sachs injury) with shoulder dislocation, it further aggravates the joint instability and creates a vicious circle. For those with recurrent episodes that affect daily life, surgical repair of the injured glenoid labrum can prevent recurrent dislocation of the shoulder joint.
VIII. Suprascapular nerve impingement
The suprascapular nerve emanates from the arm from the nerve trunk, crosses the trapezius muscle to reach the upper edge of the scapular gland, then crosses the suprascapular notch and sends out branches to innervate the supraspinatus and infraspinatus muscles. The majority of suprascapular nerve entrapment occurs at the suprascapular notch, where a lipoma or cyst can compress the suprascapular nerve and cause atrophy of the infraspinatus muscle.
The main manifestations are shoulder discomfort, weakness in snapping the ball when playing volleyball, and inability to keep the forearm in the correct position when shooting a basketball, which can easily deflect. For those who are diagnosed, early surgery to remove the lesion and release the nerve compression can lead to recovery.