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Shoulder Anatomy
Shoulder Anatomy
http://www.arthritis.org/about-arthritis/where-it-hurts/shoulder-pain/
Shoulder Anatomy
An inside look at the structure of the shoulder :: The shoulder is made up of three
bones: the scapula (shoulder blade), clavicle (collarbone) and humerus (upper arm
bone). Two joints in the shoulder allow it to move: the acromioclavicular joint, where the
highest point of the scapula (acromion) meets the clavicle, and the glenohumeral joint.
The glenohumeral joint is the one most people think of as the shoulder joint. It is formed
where a ball (head) at the top of the humerus fits into a shallow cuplike socket
(glenoid) in the scapula, allowing a wide range of movement. The surfaces of the bones
where the ball and socket meet are covered with smooth, elastic cartilage that absorbs
shock and allows the joint to move easily.
Because the socket of the shoulder is shallow, the joint relies on surrounding soft tissues
to support it and hold the components in place. Many of these soft tissues surround the
joint to form a protective capsule, which is lined with a thin membrane called
the synovium. The synovium produces a fluid (synovial fluid) to cushion and lubricate
the joint.
Joint inflammation and other problems that may be to blame for shoulder pain
Many forms of arthritis and related conditions that affect the joints, muscles and/or
bones can cause problems like pain, stiffness and swelling in the shoulders. Here are
some diseases that can affect the shoulders.
Osteoarthritis. The most common form of arthritis, osteoarthritis is a chronic
condition characterized by the breakdown of the cartilage that cushions the ends of
the bones where they meet to form joints. This breakdown causes the bones to rub
against each other, causing stiffness, pain and loss of movement in the joint. Bony
projections, or spurs, can develop around the joint. In the shoulder, osteoarthritis
often occurs after an injury.
Rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disease of
the joints that occurs when the body’s immune system – which normally protects us
from infection – mistakenly attacks the synovium, the thin membrane that lines the
joints. The result can be joint damage, pain, swelling, inflammation, loss of function
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and disability. The joint involvement of rheumatoid arthritis is symmetrical. That
means if one shoulder is affected the other likely will be too.
Gout. Gout is a form of arthritis that occurs when excess uric acid, a bodily waste
product circulating in the bloodstream, is deposited as needle-shaped monosodium
urate crystals in tissues of the body, including the joints. For many people, the first
symptom of gout is excruciating pain and swelling in the big toe – often following a
trauma, such as an illness or injury. Subsequent attacks may occur off and on in other
joints, typically the feet, ankles, hands, wrists, elbows and knees. Shoulder
involvement is less common, but can occur.
Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs
following an infection of the genital, urinary or gastrointestinal system. Features of
reactive arthritis include inflammation and swelling of the joints, eyes and structures
within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or
bladder. Although the ankles, knees and joints of the feet often are the first joints
affected by reactive arthritis, it also can affect the shoulder.
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affects both children and adults. In addition to the symptoms of polymyositis,
including pain and weakness of the muscles around the shoulders and pelvis,
symptoms of dermatomyositis also include a patchy skin rash, purplish discoloration
of the eyelids, swelling around the eyes, changes around the nail beds and calcium
deposits in the shoulders, pelvis, hips, calves and thighs, which may limit motion.
Lyme disease. Lyme disease is an infectious disease spread by the bite of deer
ticks infected with the bacteriaBorrelia burgdorferi. The first symptoms are often a
bulls-eye-shaped rash and flu-like symptoms. If not treated early, the disease
symptoms may progress to involvement of the heart, nervous system and joints,
including the shoulder.
Shoulder Injuries
Learn about some common and some not-so-common shoulder injuries.
The shoulder is the most movable joint of the body. It also is one of the most unstable
joints. As a result, it is the site of many problems and injuries. The following are some of
the most common shoulder injuries:
Dislocated shoulder. The shoulder is one of the most frequently dislocated joints.
Pulling the shoulder backward or rotating it too far can cause the ball of the upper
arm bone (humerus) to pop out of the socket (glenoid). Shoulder instability is a
condition in which the shoulder dislocates frequently. Sometimes the ball of the
upper arm bone is only partially out of the socket. This is called a partial location or
subluxation.
Glenoid labrum tear. Also called shoulder joint tear, this is an injury to the
cartilage that surrounds the rim of the shoulder socket. This injury often results from
repetitive motion or trauma from a fall, pull or blow to the shoulder. Symptoms
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include pain, loss of strength, decreased range of motion and catching, locking or
popping of the shoulder.
Torn rotator cuff. Overuse, aging, a fall or other type of trauma can strain the
rotator cuff tendons, which can cause them to become inflamed, leading to a tear.
The rotator cuff is a network of muscles and tendons that cover the top of the upper
arm bone (humerus) to hold it place and enable the arm to rotate. If you experience a
rotator cuff injury you may experience pain over the deltoid muscle at the top and
outer side of the shoulder, especially when you raise or extend your arm out from
your body. Your shoulder may feel weak and you may hear a click or pop when you
try to move your shoulder.
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Do any of your family members have arthritis or other shoulder problems?
Do you have other medical problems that could be causing your symptoms?
During the physical exam your doctor will look at and touch your shoulders and any
other joints you may be experiencing problems with. Your doctor will be looking for
areas that have tenderness, pain or swelling, as well as indications that the joint may be
damaged. Depending on the findings of the history and exam, your doctor may order
lab tests and imaging tests to help make or confirm a diagnosis.
Imaging Tests
Noninvasive tests that help your doctor see inside your shoulders.
Imaging tests can allow your doctor to see the structures inside your shoulders. The
most common imaging tests to diagnose shoulder problems are:
X-ray (radiography). A standard X-ray is a simple test in which an X-ray beam (a form of
electromagnetic radiation) is passed through the shoulder to create a two-dimensional
picture of the bones that form the joint. Your doctor can use X-rays to view:
joint space. Narrowing of the space between the bones, which are normally
covered by cartilage, can be a sign of arthritis and its severity.
bone spurs. Bony overgrowths at the joint are a sign of osteoarthritis.
fractures. Broken bones will show up on X-rays, however, small cracks in the
bone may not.
In some cases a contrast dye is injected into the shoulder to enable the doctor to better
see the joint on X-ray. This is called arthrography.
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Often a sample of blood or joint fluid can help you doctor confirm a diagnosis. For
example, a blood test showing high blood levels of rheumatoid factor – an antibody that
acts against the blood component gamma globulin – or an antibody called anti-cyclic
citrullinated peptide antibody (anti-CCP) may suggest rheumatoid arthritis. High levels
of antinuclear antibodies (ANAs), abnormal antibodies directed against the cells' nuclei,
could suggest lupus or another inflammatory disease. High erythrocyte sediment rate
(ESR, or sed rate), along with muscle pain in the shoulders, could help confirm a
diagnosis of polymyositis or polymyalgia rheumatica.
Tests of fluid drawn with a needle from the joint may reveal crystals of uric acid,
confirming a diagnosis of gout; calcium pyrophosphate dehydrate, confirming
pseudogout; or a bacterium, suggesting that joint inflammation is caused by an
infection.
If your doctor suspects your pain may be caused by disease of the heart, liver,
gallbladder or other organ or area of the body, different types of blood tests may aid in
the diagnosis of those problems.
Within 48 hours of the injury, you should also begin self-care measures. Use the acronym
RICE to help remember these treatments:
Rest -Take a break from activity. Avoid using your injured shoulder ankle.
Ice - Lace an ice pack on your shoulder for 15 to 20 minutes at a time to reduce pain
and swelling.
Compression: Compress the shoulder with an elastic bandage to help stabilize the
shoulder and reduce swelling.
Elevation: As much as possible, keep your shoulder elevated higher than your heart.
Use pillows to prop up your shoulder when you lie down.
Whether you have an acute injury or chronic arthritis, medications don't always relieve
pain completely. At times when you need extra help with pain relief, recovery or help
with daily activities, here are some techniques and devices worth trying.
Hot and cold: While cold is helpful for reducing inflammation from a new shoulder
injury, it also can be helpful for chronic pain or for the pain and inflammation of an
arthritis flare. For aching shoulders without acute inflammation, heat may provide relief.
Physical therapy: In the early stages of arthritis, physical therapy may be helpful for
strengthening the shoulder muscles and maintaining joint range of motion. Your doctor
may also prescribe physical therapy for some shoulder injuries or to help in recovering
from shoulder surgery.
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Slings: For certain shoulder fractures, including most fractures of the scapula,
nonsurgical treatment using a sling to immobilize the joint is an effective treatment. The
shoulder may be stiff when your doctor first removes the sling. An exercise or physical
therapy program will be necessary to regain full motion of the shoulder after
immobilization.
Assistive devices: When your shoulders are stiff or painful it can be hard to perform
daily tasks, such as bathing, getting dressed, driving or reaching for items in your
kitchen cabinets. Many devices are available to make these activities easier, including
reachers, zipper pulls, long-handled brushes or sponges and specially designed adaptive
clothing. You can buy many assistive devices through medical supply stores and
specialized mail-order catalogs. Talk to your doctor and physical and/or occupational
therapist about using these assistive devices.
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