Some common pathologies of shoulder

The shoulder is a combination of four joints that along with tendons and muscles allows a wide range of movement in the arm — from scratching your back to throwing the perfect pitch.

Mobility has its price, however. It may lead to problems of instability of the joint or impingement or tear of the soft tissues in your shoulder resulting in pain, explains Dr Chidananda P. Shivashankar, Specialist Orthopedic, Zulekha Hospital, Dubai. The pain may be temporary or it may continue requiring medical attention.

Some of the common pathologies of shoulder include rotator cuff tear, impingement syndrome, shoulder instability and frozen shoulder.

Rotator cuff is a confluence of four tendons which provide stability and mobility to the shoulder. Owing to its position below the bone, it is vulnerable to get damaged/torn, leading to pain and/or inability to lift or rotate the arm.

The pain is common at night and often radiates down the arm. This damage can be caused by a single injury or over a period of time. Treatment includes drug therapy, physiotherapy and steroid injections. A keyhole surgery can solve the problem and help recover early. An open surgery is indicated in some cases.

Impingement syndrome occurs due to pinching and inflammation of part of the rotator cuff in the space below the Acromion (subacromial) causing pain in certain movements and positions of the shoulder. The causes include fluid cushion inflammation, bony growth or a calcific deposit in the tendon. Treatment involves physiotherapy and medicines.

Main joint of the shoulder (Glenohumeral joint) is a ball and socket joint. The socket is like a flat saucer while the ball is a hemisphere. Shoulder instability occurs when the ball is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse and it is more commonly seen between the age group of 20 to 40 years.

Once the ligaments and tendons (the stabilising structures) around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations cause pain and unsteadiness when you raise your arm or move it away from your body. Depending on the age, extent and cause of instability, the condition may need surgical stabilisation to prevent arthritis and pain.

Frozen shoulder is an extremely painful condition in which shoulder becomes partially or completely immovable. Cause is largely unknown but it starts with pain, moves on to stiffness and finally reaches a stage of resolution when pain becomes less and most of the movement returns. Treatment is usually with anti-inflammatory medications, physiotherapy and joint injections. Resistant cases may need surgery.

Keyhole surgery involves two to three 5mm wounds, use of telescopic camera and specific instruments. Majority of the shoulder problems can be managed by this method.

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