Shoulder

What is the shoulder?

The shoulder is the part of the body that serves as the link between the arm and the body. It is formed by the junction of the ends of three bones: the clavicle, the scapula (shoulder blade) and the humerus, along with muscles, ligaments and tendons. The main shoulder joint joins the head of the humerus and the scapula or shoulder blade and is called the scapulohumeral joint and has two articular surfaces (one corresponds to the head of the humerus and the other to the glenoid cavity of the scapula). Thus, the head of the arm bone fits into a rounded cavity of the scapula. Both surfaces are covered with cartilage to allow smooth and painless movement. In addition, a set of muscles and tendons attach to the bone surfaces and make joint mobility possible. Among them, the rotator cuff is very important, formed by four muscles that give mobility and stability to the shoulder. The shoulder is the joint with the greatest range of motion in the entire body.

The shoulder is the joint with the greatest range of motion, but it can also suffer many injuries.

Function of the shoulder

Actually the shoulder is formed by a set of joints that combine with the tendons and muscles and allow a wide range of movements in the arm and that allow us from scratching our back, to swimming, writing, using the cutlery or playing certain sports that require the use of the arms (basketball, handball, tennis, paddle tennis, etc.).

Pathologies that can affect the shoulder

Most shoulder pathologies fall into 4 categories:

• Inflammation of the tendon (bursitis or tendonitis), or tendon tear.
• Instability
• Osteoarthritis
• Fracture of a bone

Less common are tumors, infections and nerve-related problems.

Thus, the main pathologies suffered by the shoulders are:

• Bursitis: small fluid-filled sacs located in joints throughout the body and the shoulder as well. Sometimes overuse of the shoulder leads to inflammation or swelling of the bursa located between the rotator cuff and the shoulder blade. This becomes inflamed and painful.
• Tendonitis: The tendon is a kind of cord that connects the muscle and bone. Most tendonitis results from wear and tear of the tendon. It can be acute or chronic, when it is produced by some degenerative disease. The most commonly affected are the four rotator cuff tendons and one of the biceps tendons.
• Tendon tears: may be the result of acute injury or degenerative changes due to aging, prolonged overuse, wear and tear or sudden injury. They can be partial or completely rupture the tendon. Rotator cuff and biceps tendon injuries are the most common.
• Compression: occurs when the upper part of the shoulder blade presses on the underlying soft tissues as the arm is lifted away from the body. As the arm is lifted, the part of the shoulder blade compresses the rotator cuff tendons and bursa. This causes pain and can lead to tendonitis or bursitis. If compression is allowed to continue, it can lead to a rotator cuff tear.
• Instability: occurs when the head of the arm bone is forced out of the shoulder socket. It can occur from a sudden injury or overuse. A shoulder dislocation can be partial or complete.
• Osteoarthritis: usually from wear and tear. Symptoms (inflammation, pain and stiffness) usually begin in middle age and the pain worsens over time. It may be related to sports injuries, occupational injuries or wear and tear.
• Fracture: is the breakage of a bone. They usually involve the clavicle (neck bone), humerus (arm bone) and scapula (shoulder blade). In older patients they are usually fall injuries. In younger people they are often caused by an injury related to traffic accidents or contact sports injuries. Fractures cause a lot of pain and inflammation.

Treatments for shoulder pathologies

The main treatment for shoulder injuries usually involves rest, a change in activities, and physical therapy (physiotherapy) to improve shoulder strength and flexibility. Overexertion or activities to which the patient is not accustomed should also be avoided. In addition to the above, the specialist in Traumatology can indicate some medication to reduce inflammation and pain, always following the indications of the specialist to be effective. Finally, surgery may be necessary to resolve some injuries. However, most shoulder injuries will respond to simple treatments (change of activities, rest, moderate physical exercise or medication). If surgery is necessary, the most common are arthroscopy, to repair torn tissues, or traditional open procedures, if the reconstruction is major.

Specialist who treats shoulder pathologies

The specialist in charge of treating and studying shoulder pathologies is the traumatologist. In addition, there are many specialists who have specific training that allows them to be experts in the approach to specific shoulder pathologies.