Shoulder joint, another problematic region of the body that frequently come across in orthopaedic practice. Shoulder joint is a ball and socket joint and is formed by several bony structures with muscles and tendons within it, allowing wide range of motion. In view of its nature of high mobility, this can lead to increasing problems such as instability, soft tissue or bony injury and impingement resulting in pain.
Shoulder problem usually presented with pain can be acute or chronic. It may also be presented with difficulty to move due to stiffness. A history of injury may or may not be recalled by the patient. Some of this injury is due to a collective of trivial but repetitive injury that eventually give rise to the symptoms.
Some of the commonly seen shoulder problems:
1. Tendon inflammation namely bursitis or tendinitis. (Impingement)
2. Tendon tear (acute or chronic)
3. Instability such as acute dislocation or recurrent dislocation
4. Osteoarthritis (degenerative)
The management of shoulder pain is very much depended on the history of the presentation. In an acute injury such as a fall or direct blow, a fracture/dislocation or tendon tear should be the diagnosis. If the shoulder pain happens over a period of time or after some trivial injury such as carrying heavy object or moving the shoulder joint in an extreme position in order to reach an object, then tendinitis or bursitis may be likely the cause. Shoulder osteoarthritis is more commonly seen in elderly people and the pain is usually chronic and recurrent.
A simple x-ray is good enough to look for fracture dislocation and osteoarthritis. But if a tendon tear is suspected, then MRI of the shoulder will be necessary. Depending on the cause of the shoulder pain, in most cases, these problems can be treated conservatively with rest, ice compression, physiotherapy and medications. Shoulder dislocation should be treated immediately with close manual reduction. Surgery in the form of open or key hole (arthroscopy) may be needed in some cases of tendon tear. Shoulder joint injection (steroid, PRP or hyaluronic acid) may sometimes are helpful for tendinitis or bursitis.