Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move.

Frozen shoulder occurs in about 2% of the general population. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men.

Anatomy

Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of the upper arm bone fits into a shallow socket in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint.

To help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint. 

Description

In frozen shoulder, the shoulder capsule thickens and becomes tight. Stiff bands of tissue — called adhesions — develop. In many cases, there is less synovial fluid in the joint.

The hallmark sign of this condition is being unable to move your shoulder - either on your own or with the help of someone else. It develops in three stages:

• Freezing: In the "freezing" stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.
• Frozen: Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the "frozen" stage, daily activities may be very difficult.
• Thawing: Shoulder motion slowly improves during the "thawing" stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.

Patient Education Sheets

For additional information about this condition, we have included this complete patient eduction sheet as a pdf to view, download and print:

The rotator cuff is a group of four muscles and their tendons that wrap around to form a "cuff" over the upper end of the arm at the shoulder. The rotator cuff helps guide the shoulder through many motions by allowing lift and rotation to the arm while stabilizing the ball of the shoulder within the socket. The space over the top of the rotator cuff is occupied by a bursa which is a fluid sac between the tendon and the acromion bone. Bursitis, a common condition, is inflammation of this fluid sac and occurs with repetitive overhead activity or overuse of the arm. The term impingement refers to pinching of the rotator cuff tendons and bursa against the acromion bone above it.

A Bankart lesion of the shoulder is a tear of the labrum that causes instability and recurrent dislocations of the shoulder joint. This type of injury often occurs when the shoulder pops out of joint, thereby tearing the labrum. This is quite common in younger patients.

Clavicle fractures occur most frequently after a direct fall on the shoulder. They are especially common in young males. Dirt biking accidents are a frequent mechanism. They present with pain and swelling over the clavicle. In general, greater than 2 cm of shortening or 100% displacement increases the chances of non-union, decreased shoulder strength, decreased endurance, and altered scapular mechanics with pain. Many clavicle fractures can be treated without surgery; however, patients with greater than 2 cm of shortening or greater than 100% displacement typically have better short term outcomes with surgical fixation. 

Clavicle radiographs demonstrating a multi-fragmented right clavicle fracture (left image), treated with open reduction and internal fixation (right image)

Distal clavicle or "AC" (acromioclavicular) arthritis results in pain over the shoulder, especially right on top of the shoulder with overhead and cross body maneuvers. Sometimes pain from AC arthritis can be present in addition to rotator cuff pain or a completely separate issue. Pain from the AC joint is usually quite distinct from rotator cuff pain but they can be confused. Arthritis of the AC joint is initially treated with physical therapy, NSAIDs, and cortisone injections. When these measures fail to help, a limited distal clavicle resection surgery can be performed to open up the space between the clavicle and acromion. This can be performed arthroscopically and requires only a few days of immobilization afterwards.

Shoulder radiographs demonstrating "AC" arthritis.

Arthroscopic images before and after distal clavicle resection, demonstrating an increased space between the distal arthritic clavicle and the acromion.

Similar to the hip, the shoulder joint is a ball-and-socket joint. The ball of the upper arm bone is held in place within the socket of the shoulder blade. However, the shoulder socket itself is extremely shallow and unstable. The bones of the shoulder are not held in place adequately, thereby requiring extra support. To help compensate for this instability, the shoulder joint has a cuff of cartilage (labrum) that forms a cup for the end of the arm bone to move within. The labrum wraps around the shallow shoulder socket, thus making the socket deeper. In addition, the bicep muscle tendons of the upper arm attach to the shoulder just above the labrum. This arrangement makes the shoulder much more stable and allows for a very wide range of movements.

A shoulder or arm injury may cause a labrum tear, but the labrum itself may simply become brittle with age and may fray and tear as part of the aging process.

Proximal humerus fractures can involve four sections of the proximal humerus – the shaft, the ball, the lesser tuberosity, and greater tuberosity. Treatment options include non-operative treatment, surgical fixation, and replacement. The vast majority can be successfully treated without surgery. Depending on age, fragment displacement and angulation, some patients have better outcomes with surgical repair or replacement.

Shoulder radiographs demonstrating a complex proximal humerus fracture on the left, treated with a reverse shoulder arthroplasty on the right.

Shoulder radiographs demonstrating a valgus impacted proximal humerus fracture (left image), treated with open reduction internal fixation (right image).

A rotator cuff tear is a common cause of pain and disability among adults. Each year, over a million people in the United States go to their doctors because of a rotator cuff problem. A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed may become painful and difficult to do.

Anatomy

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade.

Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a network of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.

Description

When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.

There are different types of tears:

• Partial Tear: This type of tear damages the tendon, but does not completely sever it.
• Full-Thickness Tear: This type of tear is also called a complete tear. In most cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon.

Patient Education Sheets

For additional information about this condition, we have included this complete patient eduction sheet as a pdf to view, download and print:

Learn about treatment options for this condition:

Shoulder dislocations can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket.

Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Chronic shoulder instability is the persistent inability of these tissues to keep the arm centered in the shoulder socket.

Severe injury, or trauma, is often the cause of an initial shoulder dislocation. When the head of the humerus dislocates, the socket bone (glenoid) and the ligaments in the front of the shoulder are often injured. The torn ligament in the front of the shoulder is commonly called a Bankart lesion. A severe first dislocation can lead to continued dislocations, giving out, or a feeling of instability.

Patient Education Sheets

For additional information about this condition, we have included this complete patient eduction sheet as a pdf to view, download and print:

Learn about treatment options for this condition:

One of the most common physical complaints is shoulder pain. Your shoulder is made up of several joints combined with tendons and muscles that allow a great range of motion in your arm. Because so many different structures make up the shoulder, it is vulnerable to many different problems. The rotator cuff is a frequent source of pain in the shoulder.

Anatomy

Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

Your arm is kept in your shoulder socket by your rotator cuff. These muscles and tendons form a covering around the head of your upper arm bone and attach it to your shoulder blade.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm.

Cause

• Overuse, strenuous shoulder activities
• Young athletes
• Minor injury
• Idiopathic (unknown reason)

Symptoms

Rotator cuff pain commonly causes local swelling and tenderness in the front or side of the shoulder. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position. You may have sudden pain with lifting and reaching movements.

Patient Education Sheets

For additional information about this condition, we have included this complete patient eduction sheet as a pdf to view, download and print:

A direct fall on the shoulder can cause a "shoulder separation" or acromioclavicular (AC) joint sprain. This injury is usually sports related. Some separations happen in car accidents or falls. This is not the same as a shoulder dislocation, which occurs at the large joint where the arm attaches to the shoulder, although the two may appear to be the same.

The shoulder separation, or acromioclavicular (AC) dislocation, is an injury to the junction between the collarbone and the shoulder. It is usually a soft-tissue or ligament injury but may include a fracture (broken bone).

High grade sprains can result in elevation of the distal end of the clavicle resulting in a bump or prominence. These are usually treated without surgery. If significant displacement or pain persists after non-operative treatment, surgical repair can be performed. Acute injuries can be treated with plating or other fixation methods, whereas chronic tears require ligament reconstruction.

Shoulder radiographs demonstrating a "shoulder separation" or acromioclavicular sprain ("AC sprain"), with the clavicle end elevated away from the acromion (left image), and repair with open reduction internal fixation (right image).

Learn about treatment options for this condition:

The sternoclavicular (SC) joint is the pivot on which the shoulder girdle moves on the trunk. It is located at the junction of the collar bone and the breast bone. Dislocation of this joint most often results from a fall onto the shoulder.

The type of treatment your physician prescribes will depend entirely on the type of injury to your joint.

Anterior or forward dislocations are the most common and can sometimes occur with minimal trauma in patients with generalized looseness in their joints. Posterior dislocation of the sternoclavicular joint is less common than the anterior type but is potentially much more serious. Damage to important structures located behind the sternoclavicular joint (arteries, veins, nerves, esophagus, trachea) can cause difficulty breathing and swallowing, poor circulation to the arm and hand, and nerve damage.

The labrum is a fibrous bumper that helps to stabilize the shoulder joint. It provides an attachment site for a variety of other shoulder structures including the capsule, ligaments and biceps tendon. When the superior labrum is detached or torn at the site of the biceps tendon insertion, it is termed a superior labrum anterior to posterior tear (SLAP). A variety of injuries may cause damage to the superior part of the labrum where the biceps tendon inserts. The most common type of injuries are repetitive over arm motion such as throwing a ball, falling on an outstretched arm or lifting a heavy object.

Overhead athletes or patients involved in repetitive overhead work can damage the superior labrum. This often generates a deep or posterior pain in the shoulder joint accompanied by a clicking, catching or popping sensation. There may be weakness with overhead activity. The throwing athlete often notices diminished velocity and control with throwing a ball. A thorough evaluation by your sports medicine physician is most appropriate to confirm this diagnosis. X-rays may be obtained in order to rule out any type of bony damage. An MRI may also be obtained in order to determine the degree of superior labral injury, as well as the existence of any injury in the adjacent capsule, ligaments or biceps tendon.

Learn about treatment options for this condition: