Shoulder Pathology

The shoulder is a highly complex structure that connects the arm to the torso. It consists of three bones—the humerus, scapula, and clavicle—that form three joints, along with various muscles, ligaments, and tendons. Among them, the rotator cuff stands out due to its importance. It is a group of four muscles (subscapularis, supraspinatus, infraspinatus, and teres minor) with their respective tendons that provide mobility and stability to the shoulder, along with the long head of the biceps. The shoulder is the most mobile joint in the body.

The shoulder is highly susceptible to muscular injuries, with rotator cuff pathologies being the most common. Their severity may vary, but if left untreated, they can lead to chronic shoulder weakness or permanent loss of movement.

The most common shoulder pathologies include:

• Tendinous injuries or tendinopathies: Affect the fibrous connective tissue of the tendons, primarily those of the rotator cuff and biceps.
• Tendinitis: Inflammation of a tendon, usually due to overuse of the affected area.
• Tendinosis: Chronic inflammation of the tendon, which presents degeneration and small fiber tears.
• Calcific tendinitis: Calcium salt deposits in the tendons, forming a pasty consistency.
• Tendon rupture: Partial or complete tearing of the tendons, usually due to wear and tear.
• Bursitis: Inflammation of the bursa, a fluid-filled sac surrounding the tendons to facilitate movement. It often occurs alongside tendinitis.
• Dislocation or subluxation: Displacement of the bone in front of, behind, or below the joint. It can be complete (dislocation) or partial (subluxation).
• Acute dislocation: Causes pain, functional impairment, and shoulder deformity.
• Shoulder instability or recurrent dislocation: The shoulder repeatedly dislocates more easily over time.
• SLAP lesion: Injury to the glenoid labrum, the cartilage ring surrounding the joint cavity. It is not very common.
• Fracture: A break or crack in the humerus (very common), clavicle, or scapula (rare and usually associated with other fractures).
• Strain: Stretching or tearing of muscle fibers.
• Adhesive capsulitis or frozen shoulder: Inflammation or contraction of the joint capsule surrounding the shoulder, restricting or preventing movement.
• Osteoarthritis or shoulder arthritis: A chronic degenerative disease that wears down and destroys the cartilage covering joint surfaces. As the cartilage deteriorates, it becomes rough, reducing the protective space between bones.

Symptoms

Different shoulder pathologies tend to present similar symptoms:

• Shoulder pain, either localized at the front or radiating to the elbow or forearm. It may be constant or occur only with certain movements.
• Inflammation.
• Numbness or tingling.
• Limited mobility.
• Loss of strength.
• Stiffness.
• Deformity in cases of dislocations.

Causes

The main causes of shoulder pathologies include:

• Trauma or falls with direct impact on the shoulder.
• Twisting or sudden movements.
• Muscle tension or poor posture.
• Repetitive forced movements.
• Overexertion.
• Progressive wear from use.
• Degenerative cartilage deterioration.
• Underlying rheumatic diseases.
• Calcium buildup in tendons.

Risk Factors

Risk factors that increase the likelihood of shoulder injuries include:

• Age: Tendons become less flexible and more vulnerable over time.
• Genetic factors: Structural flexibility and vulnerability can be hereditary.
• Occupations, hobbies, or sports requiring prolonged awkward positions or repetitive/forced movements.
• Proneness to falls.
• Engagement in extreme sports.
• Physical activity on hard surfaces.
• Intense exercise after a period of inactivity.
• Endocrine disorders such as hypertension or diabetes, which have been linked to calcific tendinitis and adhesive capsulitis.
• Circulatory problems, as poor blood circulation in the area can facilitate calcium deposits.
• Osteoporosis.

Complications

The most common complication of shoulder pathologies is recurrence, meaning injuries tend to happen more easily after the first occurrence. Additionally, joint stiffness often develops post-injury, especially in older individuals. In some cases, a dislocation may damage a blood vessel, disrupting blood flow and leading to severe consequences. Fractures may also fail to heal properly if the bone takes too long to recover or heals in the wrong position.

Prevention

To reduce the risk of developing a shoulder pathology, the following measures can be taken:

• Regular exercise to strengthen the shoulder muscles.
• Warm-up and stretching before exercising.
• Avoiding sudden movements.
• Preventing overexertion, especially if discomfort is present.
• Maintaining proper posture.
• Avoiding activities that require forced postures or repetitive and strenuous movements.

What Specialist Treats Shoulder Pathologies?

Shoulder pathologies are evaluated and treated by specialists in orthopedic surgery and traumatology, physiotherapy, pain management, rehabilitation, and family medicine.