Kyung Hee University Hospital
2020.07.22.
6 Major Shoulder Disorders: Characteristics & Treatment
The most common disorder affecting the shoulder joint is rotator cuff tear, which is typically a degenerative disease that occurs with aging.
Among the four tendons that make up the rotator cuff (supraspinatus, infraspinatus, subscapularis, and teres minor), the supraspinatus tendon is the most commonly damaged and torn. A tear does not always cause pain, but it may also be accompanied by muscle weakness.
① Rotator Cuff Tear: The "Frozen" Shoulder
The most common shoulder disorder is rotator cuff tear, which is primarily a degenerative disease that occurs with aging.
The rotator cuff consists of four tendons: the supraspinatus, infraspinatus, subscapularis, and teres minor. The supraspinatus tendon is most commonly damaged and torn. A tear does not always result in pain, but it may lead to muscle weakness in addition to pain.
For partial tears, conservative treatment is pursued, and the condition is monitored with ultrasound or MRI scans every 6 months to 1 year. However, patients who experience severe pain may require arthroscopic rotator cuff repair.
In cases of full-thickness tears due to degenerative changes, conservative treatments such as medication, injections, and stretching are attempted for 3 to 6 months. If the pain does not improve or the tear worsens, surgical intervention may be considered.
② Shoulder Joint Dislocation Caused by External Trauma
The shoulder joint is shaped like a golf ball resting on a tee, allowing for a wide range of motion, but this large range of motion also makes it relatively unstable compared to other joints.
Shoulder dislocations are most commonly caused by direct external trauma. When a dislocation first occurs, it can typically be treated conservatively by strengthening the surrounding muscles. However, in cases of recurrent dislocations, the tear of the anterior labrum is often present, and arthroscopic labral repair may be necessary.
In more severe cases, where dislocation causes significant bone loss from the glenoid (the socket of the shoulder joint), a bone graft from another area, such as the coracoid process, may be used to fill in the defect and restore stability to the joint.
③ SLAP Lesion (Superior Labrum Anterior and Posterior Tear) Caused by Excessive Shoulder Exercise
The SLAP lesion, or superior labrum anterior and posterior tear, which Major League Baseball player Ryu Hyun-jin suffered from, can occur due to excessive shoulder exercise or injury. It typically occurs in athletes, such as baseball pitchers, when the shoulder is stressed during the throwing motion or if the arm is suddenly pulled.
Pain is felt when applying force to the shoulder or when the arm is extended backward. However, it is often difficult to distinguish from other shoulder conditions, so a specialist’s evaluation is necessary. To alleviate symptoms, steroid injections may be administered into the joint capsule, but if pain persists, arthroscopic labral repair is performed.
④ Frozen Shoulder (Adhesive Capsulitis): A Condition Affecting Various Age Groups
Frozen shoulder, commonly known as adhesive capsulitis, is a condition where the shoulder becomes painful and its range of motion is severely restricted, even without any injury. While it is often associated with individuals in their 50s, the term "frozen shoulder" is becoming less appropriate as it is now seen in a wider range of age groups.
Frozen shoulder occurs when inflammation develops in the joint capsule, which connects the upper arm to the shoulder and allows for smooth movement. This inflammation leads to adhesions, where tissues become stuck together. As a result, patients often experience pain at night and may be unable to lie on the affected shoulder.
Most cases can be effectively treated with non-surgical methods, including medication, steroid injections, and rehabilitation therapy. However, in rare cases where recovery does not occur, arthroscopic surgery may be required to release the adhesions in the joint capsule.
⑤ Calcific Tendonitis: Pain Caused by Calcium Deposits
Calcific tendonitis occurs when calcium deposits, resembling small stones, accumulate around the rotator cuff tendons that surround the shoulder joint, leading to pain.
Acute calcific tendonitis causes severe pain, while chronic cases lead to larger calcium deposits that exert pressure on the tendons and surrounding tissues, resulting in persistent, dull pain. This can gradually reduce the range of motion in the joint, often confusing the condition with symptoms of frozen shoulder.
The exact cause of calcific tendonitis remains unclear. Treatment generally involves the use of pain relievers and anti-inflammatory medications to reduce inflammation caused by the calcium deposits or steroid injections.
In addition, extracorporeal shockwave therapy can be used to increase blood circulation and eliminate the cause of the deposits. Ultrasound-guided needling can also be used to stimulate the calcium deposits, speeding up their absorption. If the calcium deposits are large enough to cause significant pressure and pain, arthroscopic procedures, such as decompression and calcium removal, may be performed.
⑥ Shoulder Impingement Syndrome: The "Clicking" Shoulder
Shoulder impingement syndrome occurs when the rotator cuff, which surrounds the head of the humerus, rubs against the acromion (the bony prominence on the shoulder blade) above it, causing inflammation.
Pain typically arises when lifting the shoulder within a certain range, and sometimes a "clicking" or "popping" sound can be heard when the shoulder is moved.
Most cases are treated conservatively with pain-relieving and anti-inflammatory medications. However, if the pain is severe and interferes with daily activities, arthroscopic surgery may be performed to remove the inflamed bursa causing the pain, followed by acromioplasty to reshape the acromion and relieve the pressure on the rotator cuff.
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