Shoulder Joint Problems
Shoulder injuries are common and may include fractures, dislocations and tendon ruptures. Conditions such as rotator cuff syndrome and frozen shoulder are also prevalent and affect many individuals. Fortunately, these conditions are generally treatable.
Shoulder Dislocation
The head of the arm bone (humerus) fits into the socket of the shoulder blade (glenoid), forming the shoulder joint, also known as the gleno-humeral joint. A firm rim of tissue (labrum) surrounds the socket, deepening it and helping the humeral head fit securely. When the head of the arm bone comes out of the socket, this is referred to as a shoulder dislocation. If the labrum is torn from the socket, it is called a glenoid labrum tear.
What should I do if my shoulder dislocates?
You should seek medical attention promptly to have the shoulder repositioned (reduced). An X-ray is often required to confirm that the dislocation has been properly reduced. If dislocations occur frequently, this is known as recurrent shoulder dislocation. When it begins to interfere with daily activities, surgery may be recommended.
What is recurrent shoulder dislocation?
Recurrent shoulder dislocation means the shoulder dislocates easily and repeatedly. The younger a person is at the time of the first dislocation, the higher the risk of recurrence. A torn glenoid labrum is often involved, and in some cases, damage to the glenoid bone may also contribute to repeated dislocations.
What are the causes of shoulder pain after dislocation?
There are several possible causes. Inadequate rehabilitation may be one. In younger patients, a glenoid labrum tear is often responsible. A biceps tendon tear may also be a factor. In older individuals, a rotator cuff tear is the most common cause.
How are they diagnosed?
Shoulder injuries are diagnosed through clinical assessment and confirmed with imaging studies. Your doctor will take a history of the injury and symptoms, followed by a physical examination. Imaging techniques such as MRI scans are particularly useful. In some cases, an arthrogram may be performed, which involves injecting contrast medium into the shoulder joint to highlight tears. This is often done in conjunction with an MRI scan.
How are they treated?
Non-operative treatment includes:
- Medication
- Local injection
Operative treatment
If the symptoms are not relieved by non-operative measures, surgery can be considered. In most cases, a torn glenoid labrum can be repaired using keyhole surgery (arthroscopy). The surgeon makes small incisions around the shoulder and inserts instruments to suture the torn labrum back into place using suture anchors. After surgery, the shoulder may be immobilised with a shoulder brace, and physiotherapy is often required to aid recovery.
Physiotherapy
Physiotherapy can also be helpful in relieving symptoms.
Rotator Cuff Tendonitis
The rotator cuff
The rotator cuff consists of four muscles and their tendons – supraspinatus, subscapularis, infraspinatus and teres minor – which wrap around the upper arm at the shoulder joint. This group stabilises the shoulder and enables arm rotation by holding the head of the humerus (upper arm bone) within the shoulder socket.
What causes the tear?
Rotator cuff tears often result from wear and tear, and may be linked to overuse of the muscles and tendons. Individuals who perform repetitive overhead activities, such as tennis or weightlifting, are particularly at risk. However, a single traumatic event, such as a fall, can also cause a tear. It may be associated with a fracture or shoulder dislocation. Most patients experience recurring shoulder pain over several months. People over the age of 40 are more commonly affected.
What happens when it is torn?
A tear in the rotator cuff can lead to pain and reduced function. Most tears occur in the supraspinatus tendon, although other parts of the rotator cuff may be involved. Pain is often worsened when lifting or lowering the arm. Some may notice a crackling sensation in the shoulder joint during movement, or feel weakness in the arm. In severe cases, pain may persist at night or when lying on the affected shoulder.
How is it diagnosed?
Rotator cuff tears are diagnosed clinically. Investigations such as X-rays, MRI scans and ultrasound are useful in confirming the diagnosis. Your doctor will take a detailed history and perform a physical examination of the shoulder, neck and abdomen to rule out other causes. X-rays may reveal bone spurs, while MRI scans provide detailed images of soft tissues and the extent of the tear.
How is it treated?
Non-operative treatment aims to relieve pain and improve shoulder function, and may include:
- Medication to reduce pain and inflammation
- Rest
- Physiotherapy
- Local steroid injection
Operative treatment is recommended if:
- Symptoms persist despite non-operative measures
- The tear is acute, caused by recent trauma and results in significant symptoms
- High shoulder function is required for daily activities or occupation
Surgical options include:
- Removal of bone spurs to prevent tendon irritation
- Repair of the torn tendon
These procedures are often performed arthroscopically, although in some cases a mini-open or open technique may be advised to achieve the best outcome.
Rehabilitation after surgery
Following tendon repair, the shoulder is immobilised using a shoulder brace until healing occurs. The duration of immobilisation depends on the size and severity of the tear. Gradual movement and exercise are introduced to restore function. Full recovery may take several months.
Happy Valley
- Address:
- 2/F, Li Shu Fan Block,
Hong Kong Sanatorium & Hospital,
2 Village Road, Happy Valley, Hong Kong
- Service hours:
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Monday to Friday: 10:00 am - 6:00 pm
Saturday: 11:00 am - 3:00 pm
Closed on Sundays and Public Holidays
Consultation by Appointment
- Tel.:
- (852) 2835 7890
- Email:
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- Fax:
- (852) 2892 7517
- WhatsApp:
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(852) 2835 7890
(For non-emergency cases)