Things can go wrong with the shoulder in numerous ways.

As it is the most mobile joint of all, things can go wrong with the shoulder in numerous ways.
As it is the most mobile joint of all, things can go wrong with the shoulder in numerous ways.

Is removing your jacket, reaching for the pantry snacks, or falling asleep literally a pain in the shoulder?

As it is the most mobile joint of all, things can go wrong with the shoulder in numerous ways. Sydney-based Orthopaedic Surgeon Professor George Murrell spends his days diagnosing, imaging and treating these shoulder conditions:

1. Rotator Cuff Dysfunction

Dull ache in one shoulder? Struggling to comb your hair? Fingers likely point to a rotator cuff injury. “The most common cause of shoulder pain, this involves the muscles and tendons that form the rotator cuff not working properly, or being torn,” Dr Murrell said. Repeated overhead movements tend to be responsible, making tennis players, painters and hairdressers typical candidates.

“Standard treatment for a tendon not working well is a cortisone injection above the tendon to remove some of the pain, followed by a physio-supervised rehab program. If the tendon is torn, [keyhole surgery attaches] the tendon back to the bone. A sling with a small pillow is then worn for six weeks, with rehab progressing slowly.”

2. Frozen Shoulder

“Reaching for something and suddenly getting what feels like an electric shock down your arm” is your typical frozen shoulder-sign, Murrell said. “This classically happens between age 40 and 60, is more likely in women, and on the left side.

“The shoulder lining gets red, thick and tight due to lots of blood vessels and nerves travelling [towards it]. This causes pain that’s about an eight out of 10 and classically worse at night.”

Murrell’s preferred treatment: arthroscopic capsular release. “Under local anaesthetic, this removes the tension and pain from the shoulder capsule, giving the patient their range of motion back.” An arthroscopic examination involves a keyhole incision in the skin, allowing a pencil-sized instrument with a camera and light attached to enter the joint.

3. Dislocation

This occurs mostly from sports-related trauma, for instance “an awkward rugby tackle or land while body surfing, which forces the shoulder out of its joint,” Murrell said.

“It is important to put the shoulder back in, but if [the dislocation] is from a trauma, especially in a young person, they’re quite prone to re-dislocating, in which case treatment [should be keyhole] arthroscopic stabilisation surgery, with a return to sport three to six months later.”

4. Arthritis

“Standard arthritis (wear and tear of the joint surfaces) is much less common in the shoulder than the knee but it does happen,” typically from age 60, Murrell said. If the pain is bad enough, he recommends a total shoulder replacement. “This involves a day or overnight hospital stay and wearing a sling for two days. Recovery is not that painful surprisingly, just oral painkillers for the first week or so, and a gradual [six-week] exercise rehab program.”

5. Fracture or Dislocation of the AC joint

“If you fall heavily on your shoulder, off a push bike for instance, the AC (acromioclavicular) joint at the end of your collarbone is a weak point,” Murrell said. The injury can present as shoulder pain. “Treatment can be done without surgery because the AC joint heals very well, but in some cases surgical ligament reconstruction is required.”

When to seek shoulder treatment

If your shoulder pain persists in spite of two-days-worth of ice and pain relief, Mr Murrell said to see your GP or physio. The most useful first-line investigations are an X-ray and ultrasound, depending of course on the problem.”

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