Shoulder in brief
The shoulder complex is made up of three bones (the scapula, the humerus, the clavicle) interconnected through muscles, tendons and ligaments.
The clavicle connects the shoulder to the chest keeping it away from the trunk and it is connected to the large, flat and triangular scapula through the acromioclavicular joint. The acromion extends from the scapula to form a sort of roof.
The short head of biceps originates from the coracoid process of the scapula. The humeral head, the glenoid cavity with the glenohumeral ligaments form the glenohumeral joint, the most mobile in the body. In conclusion, the shoulder is the result of coordinated movements of several joints: the glenohumeral, the scapulothoracic, the acromioclavicular and the pseudo subacromial.
A bursa lies between the acromion and the cuff cushioning tendons and the overlying bone. This small sac can become easily inflamed.
Why does the shoulder wear out?
Many particular and repetitive shoulder movements and aging are the cause of the most common shoulder problems. Whenever the arm is abducted in any direction, the shoulder rotator cuff and the bursa are compressed. Over time too much friction can lead to wear out tendons and bursa. Excessive muscle stress , air conditioning and no warm-up exercises before starting gymnastics can inflame these structures (impingement). Inflammation of the bursa is defined bursitis, inflammation of the rotator cuff or biceps tendon is referred to as tendinitis.
Rotator tendon degeneration may lead to an ulceration and eventually a lesion. In the latter case a clicking sound can be heard sometimes in the shoulder.
However, there is an individual constitutional and genetical predisposition to tendon degenerative processes.
Which is the role of the specialist?
Your specialist will ask you detailed information on your shoulder pain: when and how has it appeared? Gradually or suddenly?
During the visit the physician will verify the pain intensity and radiation, range of motion and will perform some tests to detect the validity of the single muscles.
Possible calcium deposits can be detected with radiographic tests requiring particular projections in the case of shoulder. Echography and MRI prove to be very useful diagnostically.
In the most complex cases arthroscopy turns out to be diagnostically and therapeutically useful and allows rapid recovery with minimal esthetic impairment.
It is important not to get used to the prolonged "disuse" (prolonged bracing immobilization), ask your physician for an advice so to diagnose the problem correctly and rapidly.
Tiring or painful activities should be avoided and job or sports related movements should be modified.
Once diagnosed the problem and prescribed the appropriate therapy the patient has to rely on a rehabilitation expert and follow the rehabilitation program regularly. In particular the postoperative recovery is crucial to a complete healing. Remember you must follow your physician’s exercises accurately to regain normal movements.
Location of the most frequent extra articular disorders