Overview of Comprehensive Shoulder Evaluation Strategies
Shoulder issues are some of the most common conditions diagnosed and treated by healthcare professionals, including general doctors, sports medicine specialists, and orthopedic doctors. This simplified review talks about key points and helpful techniques for understanding complicated shoulder problems.
Anatomy and Physiology of Comprehensive Shoulder Evaluation Strategies
The shoulder is made up of the scapula (shoulder blade) and clavicle (collarbone), which link to the chest wall, and the upper arm bone, or humerus, which joins with the scapula. The part of the humerus that connects with the scapula forms the “ball and socket” shoulder joint. This joint can move in many different directions and allows you to move your arm in a full circle.
The shoulder’s movements are made possible by the coordinated movement of four different joints: the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic joints. These joints are kept stable by a combination of static stabilizers, like the glenohumeral joint and surrounding ligaments, and dynamic stabilizers, like the muscles in the rotator cuff and around the shoulder blade.
The rotator cuff is made up of four muscles which help move and stabilize the shoulder. The supraspinatus initiates shoulder movement, particularly the first 15 degrees when lifting your arm sideways. The infraspinatus, teres minor, and subscapularis muscles also help move the shoulder and keep it stable, with the subscapularis helping with inward rotation of the shoulder.
The biceps muscle in your upper arm is not part of the shoulder, but it does connect to it. It has two main parts – a long head and a short head. The long head connects to a part of the shoulder blade and then runs down the front of the upper arm in a groove. The tendon from the long head of the biceps joins with the tendon from the short head to form a common tendon that attaches to the radius bone in the forearm. The biceps muscle helps to bend the elbow and rotate the forearm, and it can also help lift the arm when it’s turned outwards.
The biceps muscle sits in a landmark called the biceps groove between two juttings out from the humerus bone called tuberosities. It’s still not fully understood what role, if any, the running of the biceps in this groove plays in stabilizing the shoulder.
Why do People Need Comprehensive Shoulder Evaluation Strategies
If you’re experiencing any sort of discomfort or pain in your shoulder, around the shoulder blade, neck, or an unspecified upper extremity issue, you should consider getting a detailed evaluation of your shoulder. It’s essential to figure out the exact cause so that your doctor can provide the most effective treatment.
How is Comprehensive Shoulder Evaluation Strategies performed
When a patient comes in with shoulder pain or dysfunction, whether it’s sudden or has been ongoing for a while, it’s important for doctors to get a detailed understanding of their history and symptoms. If the patient already has an injury or fracture in the upper arm, this doesn’t mean the shoulder should be ignored – it’s necessary to check it to avoid overlooking any issues. There are many potential reasons someone might experience shoulder pain, which could involve multiple areas in and around the shoulder itself.
For patients whose symptoms might indicate instability of the long head of the biceps tendon (LHBT), doctors also need to look at any other shoulder injuries or conditions. Understanding exactly what caused the injury can help doctors figure out the source of the problem. For instance, issues with the acromioclavicular (AC) joint often happen after an injury, like a collision during a sport, or a fall directly onto the shoulder.
Here are some symptoms patients might experience if they have common shoulder issues:
LHBT Tendinopathy:
- Pain in the front of the shoulder that comes on gradually, and may get worse suddenly or over time.
- This pain might get worse when doing activities that involve raising the arms above the head.
- The pain may be noticeable even when the patient is resting or at night.
- Patients may either currently participate in sports that involve a lot of overhead movement or have a history of doing so.
- They may be manual laborers or have a history of doing physical labor.
LHBT Instability:
- Patients might experience a painful “clicking” or “popping” sound when moving the shoulder in certain ways.
- Pain is often felt in the front of the shoulder and may radiate down the arm over the biceps muscle.
Rotator Cuff Syndrome:
- Pain in the shoulder that appears gradually without a clear injury, and gets worse when doing activities that involve raising the arms overhead.
- This pain is often worse at night.
Superior Labrum Anterior-posterior (SLAP) Lesions:
- Pain deep in the shoulder that came on suddenly.
- Having a “jerking” force applied to the shoulder that was followed by the onset of pain.
- A history of shoulder instability or sports participation, especially those involving overhead movements.
- They may also do heavy physical labor.
Shoulder Instability:
- First-time patients: These patients often have a recent history of intense trauma or collision that caused the shoulder to dislocate. Doctors will ask about how the injury happened and what sports or activities the patient was doing at the time.
- Chronic cases: These patients often come in once the limited range of motion in their shoulder starts to impact their lives. Doctors will ask for a detailed history of when the instability first started.
For both first-time and chronic patients, doctors will also ask for relevant details such as sports participation, their profession, which hand they primarily use, if they’ve had any previous injuries or surgeries in the shoulder or neck, and any other relevant surgical history.
After the patient’s history has been reviewed, doctors will conduct a physical examination. This involves checking if there are also any issues with the neck, as issues can sometimes happen at the same time. They’ll observe the patient’s posture, muscle symmetry, and neck flexibility. They’ll also perform some special tests to check for nerve damage and ensure the patient’s blood flow is normal.
The doctor will also examine the patient’s sense of touch in case there are underlying issues with the shoulder or neck. They need to conduct this examination on both sides to get an accurate understanding of what’s causing the symptoms.
In addition to checking for sensory issues, the doctor will also assess the motor function of the elbow and wrist to rule out the possibility of injuries to the brachial plexus (network of nerves that send signals from your spine to your shoulder, arm and hand.) They’ll also check the pulses at the wrist to make sure blood flow is not compromised.
What Else Should I Know About Comprehensive Shoulder Evaluation Strategies?
Rotator cuff syndrome (RCS) covers a range of issues that can affect your shoulder, from minor sprains and inflammation of the tendons in your rotator cuff, to more severe conditions where these tendons wear away over time.
Shoulder injuries, particularly in the rotator cuff, are common and often lead to shoulder pain. These injuries tend to happen when the tendons in your shoulder are subjected to repetitive strain or pressure. This can occur due to poor sports technique, bad posture, inadequate training, and the failure of the padding in your shoulder (known as the subacromial bursa) to properly protect the tendons. Over time, this can lead to a series of injuries, starting from inflammation, hardening of the tissues, thinning, and eventually tearing of the tendons.
Rotator cuff (RC) Tendonitis/Tendinosis are conditions that occur when there is a strain or stress on these shoulder tendons. This can be due to repetitive motions or because of underlying physical risk factors.
The term shoulder impingement is used to describe the pain and discomfort felt while moving your arm overhead. It can originate from inside or outside your shoulder:
- Internal impingement often affects athletes who use overhead throwing motions like baseball pitchers or javelin throwers. The pain happens when the ball of the shoulder (rotator cuff) rubs against the top edge of the shoulder blade (glenoid rim and labrum) in a specific position.
- External impingement can happen when the outer area of your shoulder (acromion) puts pressure on the inner components, leading to inflammation and damage to the rotator cuff tendons.
Swimmer’s shoulder is a term referring to several shoulder problems that swimmers may face due to the repetitive nature of their sport. These can include tendonitis, injuries to the shoulder lining (labrum), imbalance of the shoulder muscles, or nerve issues from nerve squeezing.
Inflammatory conditions, such as tendinitis or tendinopathy, usually occur because of existing or previous shoulder problems. One of these conditions, called biceps tendinitis, is an inflammatory issue with the tendon of the biceps muscle as it passes through a groove in the upper arm bone (the humerus). Over time, constant inflammation can lead to the degradation of the tendon.
Traumatic damages and tendon tears can occur due to injury, instability, or indirect trauma such as a penetrating injury, or fractures at the upper arm bone.
Biceps instability refers to a condition where the long head of the biceps muscle can become misaligned or dislocated due to overuse or trauma. In most cases, damage or injury to the components that stabilize the tendon can result in instability in the biceps.
Lastly, shoulder instability happens when the joint of the shoulder becomes loose and can’t maintain its structure. This is often seen in people who participate in physical activities and can cause the shoulder to dislocate or partially dislocate a lot. Most of these dislocations occur in the forward direction.