Shoulder - Conditions

Hunter Sports & Joint Replacement


The shoulder is a complex joint with a high range of motion and very little inherent stability. The shoulder relies on a combination of dynamic and static stabilises to allow the shoulder to move freely with 6 degrees of freedom.

The shoulder also a relies on a balanced interplay between large muscles like the deltoid and smaller muscles like the rotator cuff to perform these complex movements. If Any one of the components from the joint to the ligaments to the muscles fails then the shoulder can cause considerable pain and dysfunction.

The challenge is to identify which components are causing the problem and device appropriate treatments to address the problem.

Subcoracoid Impingement

Subscapularis impingement is defined as impingement between the coracoid and lesser tuberosity.

Outlet (subacromial) Impingement

Outlet impingement is the first stage of rotator cuff disease which is a continuum progressing from partial to full-thickness to massive rotator cuff tears, and finally to rotator cuff tear arthropathy.

Calcific Tendonitis

Calcification and tendon degeneration near the rotator cuff insertion.

Rotator Cuff Tears

Tear in the rotator cuff tendons. Rotator cuff tears may involve individual tendons or a combination of tendons.

Rotator Cuff Arthropathy

Shoulder arthritis in setting of rotator cuff dysfunction is defined as a combination of massive chronic rotator cuff tear, glenohumeral cartilage destruction, subchondral osteoporosis, humeral head collapse.

Proximal Biceps Tendonitis

Well recognized as a pain generator in the shoulder. Often associated with other primary shoulder pathology subacromial impingement, stenosis of bicipital groove, rotator cuff tears and especially subscapularis pathology. The Pathoanatomy is more consistent with “tendinosis” than true inflammation.

Biceps Subluxation

Bicep tendon sometimes considered the 5th tendon of the rotator cuff involved in movement such as shoulder flexion and abduction. Most commonly associated with subscapularis tears, coracohumeral ligament tear, transverse humeral ligament tear.

Acromio-Clavicular Injuries (AC Separation)

Common injury making up 9% of shoulder girdle injuries. More common in males.

Distal Clavicle Osteolysis

Loss of bone in the lateral clavicle, Caused by repetitive micro-fracture in distal clavicle which leads to osteopenia.

AC Arthritis

AC joint arthritis is caused by transmission of large loads through a small contact area. More common with age but can occur by second decade of life.

Risk factors;
Prior AC separations, commonly associated with individuals who engage in constant heavy overhead activities, especially in weight-lifters and overhead throwing athletes.

Traumatic Anterior Shoulder Instability (TUBS)

Traumatic Anterior Shoulder Instability (TUBS)
TUBS (Traumatic Unilateral dislocations with a Bankart lesion requiring Surgery);

  • is one of most common shoulder injuries
  • has a 1.7% annual rate in general population
  • has a high recurrence rate that correlates with age at dislocation
  • effects up to 80-90% in teenagers

Posterior Dislocation

Posterior shoulder dislocations are less common than anterior dislocations, but more commonly missed. 50% of traumatic posterior dislocations seen in the emergency department are undiagnosed. 2% to 5% of all unstable shoulders.

Risk factors;
Bone abnormality, glenoid retroversion or hypoplasia is a less common cause of instability, ligamentous laxity.

Multidirectional Shoulder Instability (MDI)

Also referred to as AMBRI;

  • Atraumatic
  • Multidirectional
  • Bilateral (frequently)
  • Rehabilitation (often responds to)
  • Inferior capsular shift (best alternative to nonop)

Peaks in second and third decades of life.

Underlying mechanism includes;
Microtrauma from overuse:

  • seen with overhead throwing, volleyball players , swimmers, gymnasts

Generalized ligamentous laxity:

  • associated with connective tissue disorders: Ehlers-Danlos and Marfan's

Luxatio Erecta (Inferior Glenohumeral Joint Dislocation)

Term for inferior dislocation of the glenohumeral joint. Very rare, only 0.5% of all shoulder dislocations.

SLAP Lesion

Superior Labrum from Anterior to Posterior tears. May occur as isolated lesion or be associated with;

  • internal impingement
  • rotator cuff tears (usually articular sided)
  • instability (may be subtle

Internal Impingement

Internal impingement refers to pathology on undersurface of rotator cuff.
In contrast to subacromial or “external” impingement which occurs on bursal side of rotator cuff) Internal impingement covers a spectrum of injuries including;

  • fraying of posterior rotator cuff
  • posterior and superior labral lesions
  • hypertrophy and scarring of posterior capsule glenoid (Bennett lesion)
  • cartilage damage at posterior glenoid

Major cause of shoulder pain in throwing athletes.

Glenohumeral Internal Rotation Deficit (GIRD)

A condition resulting in the loss of internal rotation of the glenohumeral joint as compared to the contralateral side.
Occurs primarily in overhead athletes.
Often seen in baseball pitchers.

Little Leaguer's Shoulder

A condition resulting in the loss of internal rotation of the glenohumeral joint as compared to the contralateral side.
Occurs primarily in overhead athletes.
Often seen in baseball pitchers.

Posterior Labral Tear

Commonly referred to as a reverse Bankart lesion.
May occur in all athletes due to trauma.
Most commonly occur in;

  • football linemen (blocking)
  • weightlifters (bench press)

Glenohumeral Arthritis

Glenohumeral Arthritis
Glenohumeral degenerative joint disease has many causes including osteoarthritis, rheumatoid arthritis which is the most prevalent form of inflammatory process affecting the shoulder with >90% developing shoulder symptoms. Connective tissue diseases, spondyloarthropathies. It is commonly associated with rotator cuff tears. 25%-50% have full thickness tears. It is more common in the elderly, but may be associated with throwing athletes at younger age.

Adhesive Capsulitis (Frozen Shoulder)

Defined as pain and loss of motion in shoulder with no other cause. It is associated with;

  • diabetes (both types)
  • thyroid disorders (autoimmune etiology)
  • previous surgery (lung and breast)
  • prolonged immobilization
  • extended hospitalization

Avascular Necrosis of the Shoulder

A condition caused by interruption of blood supply to humeral head. Causes include;

  • Alcohol, AIDS
  • Steroids (most common), Sickle, SLE
  • Erlenmeyer flask (Gaucher's)
  • Pancreatitis
  • Trauma
  • Idiopathic/ Infection
  • Caisson's (the bends)

Scapulothoracic Crepitus

Scapulothoracic crepitus, or snapping scapula syndrome, manifests as pain at the scapulothoracic junction with overhead activity.

Suprascapular Neuropathy

Can be caused by;
suprascapular notch entrapment;

  • weakness of both supraspinatus and infraspinatus

spinoglenoid notch entrapment;

  • weakness of infraspinatus only

Scapular Winging

Two types based on direction of top-medial corner of scapula;
medial winging:

  • serratus anterior (long thoracic nerve)

lateral winging:

  • trapezius (CN XI - spinal accessory nerve)

Brachial Neuritis

(Parsonage-Turner Syndrome) Clinical definition.
Brachial neuritis.
More formally called neuralgic amyotrophy (AKA Parsonage-Turner syndrome).

Risk factors;
Viral infection, immunizations, medications, extreme stresses, autoimmune diseases.

Thoracic Outlet Syndrome

A neurovascular compressive neuropathy with either a neurogenic or vascular etiology. occurs in females > males.

Quadrilateral Space Syndrome

Axillary nerve and posterior humeral circumflex artery compression in the quadrilateral (quadrangular) space. Rare and often misdiagnosed as subacromial impingement.

Scapulothoracic Dyskinesis

Axillary nerve and posterior humeral circumflex artery compression in the quadrilateral (quadrangular) space. Rare and often misdiagnosed as subacromial impingement.

Pectoralis Major Rupture

Exclusively seen in males, often occurs in weightlifters and most commonly occurs as a tendinous avulsion.

Deltoid Rupture

Deltoid ruptures are usually strains or partial tears.
Complete ruptures are rare.

Risk factors;
Repeated corticosteroid injections about the shoulder, rotator cuff tear, trauma.

Triceps Rupture

Usually males.
Age 30-50 most common.
Commonly seen in;

  • competitive weightlifting
  • body building
  • football players

Latissimus Dorsi Rupture

Rare condition but has been reported as a cause of pain in the thrower's shoulder.

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