The shoulder joint is a very mobile joint made up of the scapula or shoulder blade, and the humerus or arm bone. It contains joint fluid which is contained by a joint capsule and is surrounded by a cuff of tendons known as the rotator cuff which envelope the joint and are responsible for powering the various shoulder movements.
Shoulder pain can be a result of injury or pathology of these various structures. Patients may also have difficulty with moving their shoulder due to stiffness or may suffer from shoulder instability, when a sensation of the shoulder ‘coming out’ is felt during certain positions or activities. Outright dislocation of the shoulder may occur once or repetitively due to injury to the shoulder.
Common shoulder conditions include
This usually presents with shoulder pain which can be exacerbated by abducting or ‘lifting’ the shoulder up by the side of the body. In many cases, there may be no history of a specific trauma to the shoulder and the pain develops slowly over a period of weeks or months. Wearing clothes and performing overhead activities or lifting heavy objects may precipitate an increase in the pain.
- Dislocations / Instability
In this condition, the shoulder usually feels unstable and patients may feel like the shoulder is ‘coming out’ during certain positions or there may be a frank dislocation. There may be an episode of an initial injury to the shoulder during sports or after a fall.
A the name suggest, the shoulder joint feels ‘frozen’ as stiffness is frequently the main complaint, although patients may also experience varying amounts of pain associated with the stiffness
If you have shoulder pain, stiffness or instability that is interfering with your daily activities or causing difficulty with sports, or if a recent shoulder injury is not recovering well, you may wish to consult an orthopaedic surgeon.
It is usually helpful to write down your symptoms and make a list of any treatment and investigations that you may have received so far, including medications and X-rays.
On the day of the appointment, your doctor will take a full medical history and is likely to ask a number of specific questions regarding your shoulder.
This may include details such as
- Your initial injury, if any
- How long you have been having shoulder pain
- How the pain interferes with your activities
- If you have previously had shoulder pain or dislocations before
Your doctor will then perform an examination of your shoulder and may also order additional investigations including X-rays and in some cases, a magnetic resonance imaging appointment or MRI. Blood tests may also be required for some patients.
After a diagnosis has been established, your doctor will then discuss treatment options. This commonly includes a course of physiotherapy, medications and in some cases, surgery may be discussed to reconstruct your shoulder joint. Keyhole surgery may be recommended for sports injuries as it is minimally invasive and recovery is faster.
Sometimes, your surgeon may also prescribe an injection into your shoulder to assist in diagnosis or to provide immediate relief. This is a local injection done in the clinic which contains a local anaesthetic together with a low dose of steroid to provide pain relief and to reduce inflammation in the shoulder joint.
Post-operative care / Care tips
The post-operative care after shoulder surgery varies with the type of surgery performed and will also be customised according to your needs. Your doctor will usually discuss this with you before your surgery so that you will be clear as to what kind of post-operative recovery programme to expect.
The recovery period after shoulder surgery may vary from a few weeks to many months. Very often, your post-operative care will also include advice on caring for your wound and icing your shoulder to reduce swelling.
You will likely also be given an appointment with the physiotherapist to assist in your post-operative rehabilitation after shoulder surgery. After certain surgeries, you may also require a shoulder brace to support your shoulder, and in some cases your surgeon will recommend restriction of certain positions of the shoulder while awaiting healing of the reconstructed tissues in your shoulder joint.
The clinical outcome after shoulder surgeries to reconstruct sport injuries is generally very good. In many cases, the surgery performed is minimally invasive and designed to promote a rapid recovery and return to sports. However, your individual outcome will vary with the type and severity of injury sustained and your surgeon will discuss this with you when making preparations for surgery.