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Anatomy of the shoulder joint.

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MRI of subacromial impingement 

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X-Ray of acromioclavicular (AC) separation 

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Humerus fracture

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Shoulder anatomy with articular cartilage (white)

General Issues of the shoulder joint

 

The glenohumeral joint, commonly known as the shoulder joint, is a complex joint which provides a lot of the motion necessary for everyday tasks.  Even small issues can cause noticeable symptoms including pain and decreased motion.  There is a lot of overlap with the cervical spine (neck) which means Dr. Urband will spend time during your visit making sure the correct issue is being addressed.

Impingement

Impingement occurs when there is excessive friction between tissues. In the shoulder, it often happens when the space between the shoulder blade and a group of tendons called the rotator cuff decreases, leading to excessive rubbing. Shoulder impingement is often a result of overuse, which can occur in overhead sports like volleyball and tennis or in occupations like construction. Common symptoms of this condition include weakness, and stiffness at the shoulder joint.

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AC Separation

An Acromioclavicular (AC) joint injury is a traumatic injury to the shoulder that occurs when the ligaments connecting the acromion(shoulder blade)  and clavicle (collarbone) are injured. A strong force from impact can tear these ligaments, causing the acromion and clavicle to separate. AC separation commonly occurs in athletes and males, and includes symptoms like weakness, bruising and swelling, limited range of motion, and a bump at the top of the shoulder. Recovery for AC separation depends largely on the classification of injury and how many ligaments are intact. Overall, the AC joint is a complex joint that can be injured in many different ways and severities, and there are a variety of treatments to account for this. 

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Fracture

Fractures of the shoulder joint involves breaking one of the three bones of the shoulder: the clavicle, humerus, or scapula. The symptoms of a shoulder fracture include pain while moving the arm, swelling, bruising, limited range of motion, and “grinding” feeling when moving. Additionally, a bump on the shoulder is characteristic of a fractured clavicle. Most fractures can be treated non surgically with rest and immobilization, while surgery is needed for more serious injuries.

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Cartilage Tear

The articular cartilage is a type of connective tissue that facilitates movement and makes it easier for bones to slide past each other at the joint. It can be injured from acute trauma, wear and tear, or preexisting conditions like osteochondritis. Common symptoms of this condition include pain with lifting the arm over the head, weakness, decreased range of motion, night pain, and a “clicking” or “grinding” sensation at the shoulder joint. 

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Bursitis

Bursitis is the inflammation of the bursa, which are fluid filled sacs that reduce friction and cushion the tissues within a joint. The bursa of the shoulder are called the subacromial bursa, and they cushion the area between the rotator cuff and the acromion (shoulder blade). Individuals that do a lot of repetitive overhead motion are at risk for bursitis, as well as older people. Illnesses like diabetes, rheumatoid arthritis, kidney disease, and thyroid diseases are also associated with bursitis. Common symptoms of this condition include pain with movement, stiffness, and swelling of the shoulder joint, you may have this condition. 

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Tendonitis

Shoulder tendonitis is a condition where the tendons of the shoulder are inflamed, causing pain,  stiffness, and swelling. Anything that causes the tendons of the shoulder to be pinched by surrounding structures can lead to this condition, from years of overhead activity to acute injuries. The symptoms of this shoulder tendonitis are quite similar to bursitis, another inflammatory condition of the shoulder joint. You may also experience a limited range of motion, tenderness, and night pains with this condition. 

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Bone Spurs

Osteophytes, also called bone spurs, are smooth, bony projections from bone that form near joints. They often develop over time with the onset of joint damage and arthritis, and result in pain and other symptoms when they impinge on other tissues of the body. 

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Instability

Shoulder instability can range from small micromotions or subluxations to complete dislocations. There are a variety of contributing factors, and instability can have acute causes such as trauma or chronic causes such as recurrent smaller subluxations or dislocations, or tissue laxity and hypermobility which can sometimes be caused by genetics. Dr. Urband will consider all of these factors in his treatment of your condition.

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Rotator Cuff Injuries

The rotator cuff is a group of muscles and tendons in the shoulder that are important for stability and strength during motions. Issues can arise anywhere from the nerve connection and signal to the muscle to the insertion of the tendon to bone. So, "rotator cuff injury" is inclusive of a wide variety of issues.

Frozen Shoulder

Also called adhesive capsulitis, frozen shoulder is a condition which limits range of motion of the joint. In a frozen shoulder, the connective tissue around the shoulder becomes thickened and inflamed, leading to pain, stiffness, leading to a limited range of motion.

To a degree, it can be caused by inactivity after surgery;  thus, maintaining your range of motion after surgery can help to prevent this condition.

Sports Injuries
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Bursitis

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Volleyball (overhead sport)

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Shoulder pain

 
 
 
 
 
Instability

Shoulder instability can range from small micromotions or subluxations to complete dislocations. There are a variety of contributing factors, and instability can have acute causes such as trauma or chronic causes such as recurrent smaller subluxations or dislocations, or tissue laxity and hypermobility which can sometimes be caused by genetics. Dr. Urband will consider all of these factors in his treatment of your condition. 

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Rotator Cuff Injuries

The rotator cuff is a group of muscles and tendons in the shoulder that are important for stability and strength during motions. Issues can arise anywhere from the nerve connection and signal to the muscle to the insertion of the tendon to bone. So, "rotator cuff injury" is inclusive of a wide variety of issues.

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Frozen Shoulder

Also called adhesive capsulitis, frozen shoulder is a condition which limits range of motion of the joint. In a frozen shoulder, the connective tissue around the shoulder becomes thickened and inflamed, leading to pain, stiffness, leading to a limited range of motion.

To a degree, it can be caused by inactivity after surgery;  thus, maintaining your range of motion after surgery can help to prevent this condition.

Read more 

Sports Injuries

Many common shoulder injuries are a result of sports. Repetitive overhead motions can put athletes at risk for a variety of conditions, including SLAP tears, shoulder instability, and rotator cuff tears. Dr. Urband will discuss prevention and treatment options with his patients to keep athletes on the field.

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Arthritis

Arthritis means inflammation (itis) of the joint (arthro). It occurs when the cartilage that cushions the ends of bones breaks down. There are over a hundred types of arthritis that can affect any joint in the body, but the three most common types are osteoarthritis, rheumatoid arthritis, and post traumatic arthritis.

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Bone Bruises

Bone bruises happen when an injury causes blood to build up in the bone, causing pain, swelling, bruising, and color change. They can be caused by any kind of injury or arthritis. Individuals that do physically demanding sports or activities or high risk activities are at risk for bone bruises. X-rays are used to rule out the possibility of bone fractures, while MRIs are used to confirm the diagnosis. Rest, icing the bruise, and over the counter pain medications can help relieve pain, while more severe injuries can be treated with a sling or immobilizer. However, you should start a range of motion exercises 7-10 days after immobilization to prevent joint stiffness. Diet modifications like consuming increased amounts of Calcium, Vitamin D, and protein rich food can also help prevent future injuries.

Treatment

Icing, resting, and taking over the counter pain medications can help reduce inflammation and pain in a variety of conditions. Dr. Urband will recommend a variety of conservatives treatments inducing physical therapy with you to best help treat your condition before discussing surgical options.

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Images

Shoulder

Bursitis

1. OpenStax College. “Shoulder Joint”. Wikimedia Commons, 19 May 2013, https://commons.wikimedia.org/wiki/File:914_Shoulder_Joint.jpg.

2. RSatUSZ. “Subacromial Impingement with Supraspinatus Rupture”. Wikimedia Commons, 1 February 2017, https://commons.wikimedia.org/wiki/File:Subacromial_Impingement_with_Supraspinatus_Rupture.jpg.

3. Cox, Jay F. “AC Separation XRAY (enhanced)”. Wikimedia Commons, 11 November 2006, https://commons.wikimedia.org/wiki/File:AC_Separation_XRAY_(enhanced).png.

4. Nevit Dilmen. "Humerus fracture 1300272". Wikimedia Commons, September 30, 2010, https://commons.wikimedia.org/wiki/File:Humerus_fracture_1300272.JPG.

5. Young Lae, Moon M.D. "Shoulder muscle - force couple of rotator cuff.gif". Wikimedia Commons, October 2, 2012, https://commons.wikimedia.org/wiki/File:Shoulder_muscle_-_force_couple_of_rotator_cuff.gif

6. Lengerke. “Phs-calc”. Wikimedia Commons, 29 June 2010, https://commons.wikimedia.org/wiki/File:Phs-calc.jpg.

7. Biser Todorov. “Bulgaria-serbia volley 2012”. Wikimedia Commons, 30 July 2011, https://commons.wikimedia.org/wiki/File:Bulgaria-serbia_volley_2012.jpg.

8. 2. Hellerhoff. "Dislocated shoulder in X-ray". Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Dislocated_shoulder_X-ray_10.png.

9. Nucleus Communications www.nucleusinc.com. “Rotator cuff tear”. Wikimedia Commons, 3 December 2018, https://commons.wikimedia.org/wiki/File:Rotator_cuff_tear.jpg.

10. RSatUSZ. "MRI. Thickened joint capsule, specially at the inferior recess. Could be a sign for a frozen shoulder..jpg". Wikimedia Commons, October 1, 2011, https://commons.wikimedia.org/wiki/File:MRI._Thickened_joint_capsule,_specially_at_the_inferior_recess._Could_be_a_sign_for_a_frozen_shoulder..jpg.

11. Edwin Martinez. “Serena Williams”. Wikimedia Commons, 29 August 2013, https://commons.wikimedia.org/wiki/File:Serena_Williams_(9630796711).jpg.

12. Michele N Edison, Anthony Caram, Miguel A Flores, Kurt Scherer. “X-ray of rheumatoid arthritis of the shoulder”. Wikimedia Commons,  1 August 2016, https://commons.wikimedia.org/wiki/File:X-ray_of_rheumatoid_arthritis_of_the_shoulder.jpg.

13. ParentingPatch. "Equate Ibuprofen Pills and Bottle". Wikimedia Commons, January 31, 2013, https://commons.wikimedia.org/wiki/File:Equate_Ibuprofen_Pills_and_Bottle.JPG.

Sources

See page for each individual condition

4. This is an X-Ray showing bursitis of the shoulder joint

5. Overhead athletes like volleyball players are at risk for shoulder injuries, especially overuse injuries.

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Shoulder dislocation

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Rotator cuff tear

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MRI showing thickened joint capsule, which could signify adhesive capsulitis

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Shoulder Treatment

Shoulder exercises 

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Ibuprofen: an over the counter pain medication