AC Separation
An acromioclavicular joint separation, or AC separation, is a common injury among athletes that have contact, such as football, or cyclists that fall over the handlebars. The shoulder separation happens when the tip of the shoulder endures a direct and forceful blow. The result of a shoulder separation is the clavicle separating from the scapula, which can include injury to the muscles, tendons and ligaments. Typically an AC separation does not require surgery. Although there is great discomfort with an AC separation, including instability and pain with pressure, it will usually heal on its own within 12 weeks. There are six categories of shoulder separation:
- Grade I - slight displacement of the joint. The acromioclavicular ligament may be stretched or partially torn. This is the most common type of injury to the AC joint.
- Grade II - partial dislocation of the joint in which there may be some displacement that may not be obvious during a physical examination. The acromioclavicular ligament is completely torn, while the coracoclavicular ligaments remain intact.
- Grade III - complete separation of the joint. The acromioclavicular ligament, the coracoclavicular ligaments, and the capsule surrounding the joint are torn. Usually, the displacement is obvious on clinical exam. Without any ligament support, the shoulder falls under the weight of the arm and the clavicle is pushed up, causing a bump on the shoulder.
- Grades IV through VI are rare, typically an injury from a car accident, and surgery is required for these.
Frozen Shoulder
Frozen shoulder is a term for stiffness and pain in the shoulder joint that gradually develops and worsens over time. The exact cause of a frozen shoulder has not yet been determined although it is more prevalent in patients that have had some form of arm injury in which the shoulder was immobile for a long period of time or a pre-existing disease, such as diabetes. A frozen shoulder has three stages:
- Freezing stage - pain is experienced when the shoulder has any sort of movement and your range of motion begins to decrease
- Frozen stage - the pain begins to decrease although the shoulder becomes more stiff, resulting in difficulty of performing daily activities
- Thawing stage - the pain continues to decrease and your range of motion begins to slowly increase until you have close to the normal range of motion
The process of a frozen shoulder can be a long one, up to three years for the three stages, although there are some non-surgical treatments available. A few of the non-surgical treatments include physical therapy, cortisone injections or anti-inflammatory medications. If the non-surgical treatments are not reducing the pain, your doctor may recommend surgical treatments in which manually stretch the scar tissue in the shoulder or cut through the portions of the joint that are causing the pain. One of the best prevention methods is to regularly perform exercises that maintain the shoulder range of motion.
Rotator Cuff Tear
Shoulder pain is common among all ages, with a large number of injuries 
classified as impingement syndrome or rotator cuff tears. Shoulder impingement syndrome occurs when the tendons of the rotator cuff are compressed as the shoulder is moving. This results in damage to the tendons and the bursa, a sac on top of your shoulder that allows the tendons to move freely, and pain is experience when the arm is raised away from the body. Impingement can develop over time with repetitive motions or as a result of an injury. There are three categories of impingement:
- Grade I - marked by inflammation of the bursa and tendons
- Grade II - progressive thickening and scarring of the bursa
- Grade III - rotator cuff degeneration and tears are evident
A rotator cuff tear causes weakness in your shoulder and pain that can hinder daily activities such as brushing your hair or reaching above your head. If the tendons in the shoulder are injured, this will cause the bursa to also become inflamed. If there is a tear in a rotator cuff tendon, the tendon will break away from the head of the humerus. A tear is typically a result of a certain movement, such as lifting a heavy object, or it can be caused by degeneration. The two types of tears are partial and full, partial means that the tendon is damaged but full is when the tendon is completely separated from the bone. If a tear occurs from an incident, you will typically feel sudden and intense pain, and possibly hear a popping of the tendon. If the tear develops over time, you will notice weakness in your shoulder and an increase of pain. Depending on the severity of the tear, it may be recommended that you rest your shoulder, use anti-inflammatory medications, have a cortisone shot or begin physical therapy. Surgical procedures may be recommended if you have experienced the symptoms for longer than six months or if the tear is too large to heal on its own.
Shoulder Dislocation
Shoulder instability, or dislocation is a term used when the joint is loose and can potentially slip out of the socket. There are two types of instability, traumatic onset which is related to a sudden injury and atraumatic onset which is not related to a sudden injury. Knowing the difference between the two is very beneficial when determining the correct treatment. A patient that has experienced an injury to the shoulder that then causes repeated dislocations is and example of traumatic onset, while atraumatic onset is described as a shoulder with general looseness that leads to the shoulder being unstable.
Once the joint slips out of the socket it is considered dislocated. Typically an injury to the shoulder resulting in it becoming dislocated is the reason the shoulder becomes unstable. Although the shoulder is put back into place after being dislocated, the cartilage surrounding the socket has been stretched out or torn resulting in the joint becoming less secure. Shoulder instability can lead to the shoulder repeatedly becoming dislocated when performing daily activities. This injury is very common in pitchers, swimmers and volleyball players.
Shoulder Labral Tears
The labrum is a piece of cartilage is located on the socket side of the shoulder that stabilizes the joint while acting as a bumper to restrain the humerus from excessive movement. The labrum also holds the humerus securely to the glenoid.
Injuries of the labrum are typically caused by falling with an outstretched arm, a direct hit to the shoulder, extreme overhead reach as if trying to catch a ball while sliding on the ground. It is very common for athletes that throw a ball or weight lifters to experience a tear of the labrum due to the repetitive motion of the shoulder.
The symptoms of a labrum tear include instability, shoulder dislocation, pain throughout the day or night, catching or popping when moving the shoulder, decrease of range of motion or loss of strength. To rule out other injuries as the cause to your pain, your doctor will oftentimes order an X-ray of the shoulder.
Glenohumeral (Shoulder) Arthritis
Wear and tear of the shoulder leads to damage to the cartilage and over time becomes arthritis of the shoulder, or glenohumeral arthritis. As the cartilage layer is destroyed over the years of continuous use, there becomes a bone-on-bone environment in which bone spurs are created from the friction. This causes pain and decreases the range of motion. In addition to the normal wear and tear, other factors can increase the chances of developing shoulder arthritis including, trauma, infection, chronic inflammation, osteonecrosis, chronic rotator cuff tears or post-surgical changes within the shoulder. Your doctor will most likely order X-rays to determine the exact injury and the type of arthritis. Treatment for shoulder arthritis can be non-surgical or surgical depending on the severity.
Total Shoulder Replacement
Shoulder replacements on the shoulder are not as common as knee and hip replacements, but they are equally successful in alleviating the patient’s pain. If non-surgical treatments, such as physical therapy or medications, are not efficient in reducing the pain in the shoulder, shoulder replacement surgery is a great alternative. As with other replacement surgeries, the damaged parts of the shoulder are removed and replaced with prosthetic components. Individuals that best benefit from shoulder replacement surgery suffer from severe shoulder pain that interferes with their daily activities, pain while the shoulder is resting, weakness of shoulder and lack of range of motion.
To further educate yourself on hip procedures, read below or visit the patient education section.
