The shoulder has the largest range of motion of any joint in the body. Everything from scratching your back to lifting a book requires your shoulder. Because of this, the shoulder is often subject to overuse, traumatic injury, and/or natural body changes, leading to pain and tissue damage.
Causes of shoulder pain:
- Arthritis
- Bone spurs
- Fractures
- Instability
- Weakness
- Inflammation
- Infection, tumors, or nerve problems (less common)
Suffering from shoulder pain? Contact us to learn about treatment options.
How Your Shoulder Works
The shoulder consists of three bones, the joints between them, and the muscles that generate strength and motion.
Shoulder bones are:
• The shoulder blade (scapula);
• The collarbone (clavicle); and
• The upper arm bone (humerus).
The shoulder blade and the collarbone come together on top of the shoulder to form the acromioclavicular (AC) joint.
The upper arm bone is shaped like a ball to fit into a socket on the shoulder blade. This is called the glenohumeral joint. The socket is shallow to allow a wide range of arm motion. Inside the socket is a flexible rim of soft tissue called the labrum, which helps increase shoulder stability.
Four muscles surround the shoulder joint to help rotate the arm and provide additional stability. These muscles form the rotator cuff.
Many other muscles help move the shoulder, such as the pectoralis muscles (pecs) on the chest and the latissimus dorsi (lats) on the back.
For the shoulder to function properly, bones, joints and muscles must work in unison.
Shoulder Surgery
Some shoulder conditions may require surgery, especially if conservative treatment options haven’t been successful. For example, a rotator-cuff tear often requires torn tendons to be surgically reattached to the bone. Shoulder dislocations may also require surgery to repair the socket and prevent future dislocations.
Most shoulder surgeries can be done arthroscopically, using instruments inserted through two to five small incisions. This type of surgery causes less harm to healthy tissues and greatly reduces recovery time.
Arthroscopic surgery can treat:
- Impingement
- Cartilage damage
- Rotator-cuff tears
- Labral tears
- Biceps tendonitis
- Arthritis
- And more
Often, arthroscopic shoulder surgery can address multiple conditions at one time.
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After Shoulder Surgery
After surgery, your surgeon will explain what they found and any limitations you’ll have using your arm.
The degree of your injury and the amount of repair determines what type of sling you’re placed in after surgery. You may be put in a simple shoulder sling and can move your shoulder as pain allows. For larger repairs, you’ll be placed in a shoulder immobilizer sling which supports your arm at your side.
If you’re in an immobilizer shoulder sling, you’re often unable to move your surgical arm other than in small circles for six weeks. After that, you typically begin physical therapy to expand range of motion, and eventually progress to strengthening exercises.
Conditions Where Surgery May be Necessary
The rotator cuff passes through a small space near the top of the shoulder. Scar tissue or bone spurs can press into that space and cause pinching, or impingement. If the pinching isn’t alleviated, it can lead to rotator-cuff tears.
It’s like wearing a hole in the knee of your jeans. If you keep rubbing the same spot, the fabric will thin and eventually the fibers will break and create a hole. Rotator-cuff tendons can catch and rub on bone spurs, leading first to pain and weakness and progressing to tendon tears.
Patients with shoulder impingement often can’t alleviate their pain without surgery. During an arthroscopic decompression, your surgeon removes bone spurs and scar tissue, creating more space for your rotator cuff. After a simple decompression, you’ll go home in a shoulder sling and can use your arm as tolerated.
Initial recovery for a decompression is relatively short; however, the surface that the spur was removed from can be sore for a few months following surgery, as it takes time for your body to develop new hard covering on the bone. This procedure is typically very helpful, and the bone spurs rarely return.
The upper arm bone is ball-shaped to fit neatly into a socket created by the shoulder blade. These bony surfaces are covered by hard cartilage which should ideally be smooth. A hard-cartilage defect or flap can cause your shoulder to have a painful catch or click, limiting shoulder motion.
A hard-cartilage defect can damage healthy shoulder tissue. Relatively small defects can sometimes be polished and smoothed out with gentle motion exercises. Severe hard-cartilage damage may require surgery.
Arthroscopic shoulder chondroplasty can smooth out damaged hard cartilage. With this procedure, a surgical instrument removes the fraying or flapped hard cartilage and smooths down remaining tissue.
After chondroplasty, you are often placed in a shoulder sling and can move your shoulder as you feel up to it. Your surgeon will detail your post-surgery restrictions.
The rotator cuff is comprised of four muscles surrounding the shoulder joint that help rotate the arm and provide stability, strength, and power. The tendons of these muscles can be pinched or torn through daily use, a fall, or an injury, causing pain and arm weakness. Over time, the rotator cuff can fray, partially or completely tearing the tendons.
Most rotator-cuff tears can be fixed arthroscopically or via a mini-open procedure, where an incision is expanded to three to five centimeters to better visualize tissues without the arthroscope.
If your rotator cuff is completely torn and pulled away, your surgeon will use anchors placed into your bone to reattach the torn tendon. The anchors have sutures attached that let the surgeon sew the tendon tightly to the bone. The number of anchors and sutures depends on the severity and number of tendon tears.
Your tendons need time to heal after a large rotator-cuff repair, so you’re usually placed in an immobilizer shoulder sling for up to six weeks. This prevents you from putting too much tension on the repair before the tendon heals to the bone, which could cause a re-tear.
If you have only minor rotator-cuff fraying or your tendons aren’t completely torn, your surgeon may simply debride (clean up) the damaged area. In this case, you’ll likely be placed in a simple shoulder sling and can return to daily activities as tolerated.
It can take from two weeks to two months before you return to daily activities following a rotator-cuff repair, and six months to a year until your shoulder feels completely normal again.
The labrum is a flexible rim of soft tissue that sits between the ball and socket and helps increase the shoulder’s stability while allowing a wide range of motion.
When the ball comes out of the socket, the resulting shoulder dislocation can injure the labrum, causing pain, popping, and a feeling of instability. The labrum can fray or completely tear, causing a tissue flap to catch within the shoulder joint.
This condition can be treated arthroscopically. Minor labrum fraying can be cleaned up and smoothed. For a completely torn labrum, your surgeon will often use anchors made of a bone-like substance to sew your labrum to the bone. Over time, your body turns the anchor into bone.
If you’ve dislocated your shoulder multiple times, you may have damaged the tissue surrounding the joint. Your surgeon can tighten this tissue and restabilize your shoulder.
The number of anchors and type of sling you’re placed in after surgery depends on the size and severity of your injury. For small labrum repairs, you’ll be placed in a simple shoulder sling and can lift light objects like a pencil, toothbrush, or fork. For larger repairs, you’ll likely be placed in a shoulder immobilizer sling for six weeks after surgery.
The bicep runs from the elbow to the front of the shoulder. The long head of the biceps attaches to the labrum, a flexible rim of soft tissue that cushions the upper arm bone and shoulder blade. The short head of the biceps tendon attaches to a bony bump on the front of the shoulder blade called the coracoid process.
When the biceps’ long head becomes irritated and inflamed, the resulting tendonitis can be very painful or even tear the tendon at its attachment. If the pain is hard to control with oral anti-inflammatories, cortisone injections, or physical therapy, surgery may be necessary.
Your surgeon can use an arthroscope to release the long head of the biceps tendon from its attachment on the labrum. Since the short head of the biceps tendon is still attached to the shoulder blade, you will not lose strength or power in your arm. This can provide substantial relief for tendonitis patients.
The portion of the biceps tendon that was released can either be left unattached (tenotomy), causing a slight bulge in the biceps muscle, or re-attached to a lower area of the upper arm bone (tenodesis).
After this procedure, you’re often placed in a simple shoulder sling and can lift light objects like a pencil, toothbrush, or fork. Your surgeon will detail post-surgery restrictions.
At the very top of your shoulder the collarbone joins your shoulder blade, creating the acromioclavicular (AC) joint. When the shoulder blade is pulled away from the collarbone, the injury is called a separation. Over time, your AC joint can develop wear-and-tear damage or arthritis, pinching the soft tissue.
Oral anti-inflammatories or cortisone injections sometimes help the pain, but if they don’t provide lasting relief, surgery is an option.
Your surgeon uses an arthroscope to see the AC joint and clear away soft tissues. Using a bone-shaving tool, your surgeon removes about a half-inch off the end of the collarbone, providing more space within the AC joint and relieving pain.
If this is the only procedure you have, you can go home in a simple shoulder sling and use your arm as you’re able.
The surface the bone was taken from can be sore for a few months following surgery, as it takes time for your body to develop a new hard covering on the bone. This procedure is typically very helpful, and the problem almost never returns.