Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Houston Methodist Orthopedics & Sports Medicine

Common Injuries - Shoulder

Biceps Tendonitis

The two tendons from the biceps muscle insert in and around the shoulder. Repetitive overhead activities such as swimming or tennis can cause the tendons to become inflamed. This is known as biceps tendonitis. It can usually be treated with rest and anti-inflammatory medicines, and occasionally a corticosteroid injection. Persistent symptoms may be due to tears or instability of the tendon which can be treated with shoulder arthroscopic repair or re-attachment.

Clavicular (Collarbone) Fracture

The clavicle is the bone which sits between the chest bone (sternum) and the shoulder blade (scapula).  It acts as a strut to hold the shoulder out in position.  Because it sits directly under the skin and has very little padding, it is the most common larger bone fracture seen in adolescents and athletes of all ages.  While they generally heal with non-operative treatment, surgery may be recommended to straighten the bone if the alignment is not optimal.

Frozen Shoulder (Adhesive Capsulitis)

A frozen shoulder is one in which the lining of the joint has contracted to the point that the shoulder does not have a normal range of motion. It usually has an insidious onset in someone without a history of shoulder problems, but also can occur after an injury. Risk factors include female gender, age 40-60, and diabetes.  It is initially painful as well as stiff. This is treated with supportive measure such as injections, physical therapy and gentle stretching. Once the pain resolves, if the shoulder remains stiff, an arthroscopy can be done to release any remaining scar tissue and restore normal motion.

Labral Tears - Shoulder

The labrum is the rubbery lining of the shoulder socket (glenoid) which helps to keep the ball (humeral head) in position. Tears may occur from acute trauma, such as a shoulder dislocation, or from repetitive activities like baseball pitching. This is a common athletic injury. These tears often cause pain and popping in the shoulder which can limit activities. Superior labral tears (SLAP tears) are associated with rotator cuff problems. Anterior and posterior tears are associated with instability and shoulder dislocations. These have a limited ability to heal and often require shoulder arthroscopy to repair them and restore normal function.

Brachial Plexus Injuries

The brachial plexus is a group of nerves located along the spinal cord near the neck. Two different types of nerves are found within the brachial plexus: one to carry messages from the brain to create movement (motor nerves), and the other carrying messages to feel sensations (sensory nerves) such as pain, pressure and temperature.
Injuries to the brachial plexus can affect the body's ability to move the arms, hands and wrists, or to feel sensations. Injuries can occur from trauma, such as a blow to the head. In severe cases, the nerves can become completely detached from the spinal cord, causing parts of the body to become paralyzed. Microsurgical techniques can repair detached nerves and restore function of the brachial plexus system.

Rotator Cuff Impingement (Bursitis and Tendonitis)

The rotator cuff is a sheet of tendons that surround the shoulder and function to keep the ball and socket well-aligned and assist with movement.  These tendons arise from four small muscles known as the rotator cuff muscles: supraspinatus, infraspinatus, teres minor, and subscapularis.  The term rotator cuff impingement syndrome is used when they become inflamed from overuse or mild injury.  It includes a spectrum of pathology from tendonitis and bursitis to tearing of the tendons.  Patients generally have good range of motion, but aching pain on the side of the arm that is worse with reaching. Non-operative treatment with physical therapy and an injection is usually successful. Persistent cases may be due to bone spurs or calcium deposits within the tendon that can both be treated with arthroscopic surgery.

Rotator Cuff Tears

The rotator cuff is a sheet of tendons that surround the shoulder and function to keep the ball and socket well-aligned and assist with movement.  These tendons arise from four small muscles known as the rotator cuff muscles: supraspinatus, infraspinatus, teres minor, and subscapularis.  Tears can be attritional from overuse or from acute injury, such as a fall.  Patients often complain of arm pain, pain at night, loss of motion, and weakness.  These tears have limited ability to heal and can become larger over time.  Fortunately, these tears can be repaired arthroscopically by suturing (sewing) the tendon back down to the bone.

Shoulder Dislocation

When the ball (humeral head) slides off of the socket (glenoid) it results in a dislocated shoulder.  This is a common athletic injury in younger athletes from a fall or collision with another player.  It often causes a stretching or tearing of the labrum and the ligaments resulting in an unstable joint.  The ball may continue to come part of the way (subluxation) or all of the way (dislocation) out of the socket.  This often requires arthroscopic surgical stabilization and repair.

Shoulder Separation (AC Joint Sprain)

A fall on the point of the shoulder may disrupt the ligaments between the collarbone and the shoulder blade. This is also known as an acromio-clavicular (AC) joint sprain.  There are different degrees of injury.  A mild sprain may cause tenderness or even a slight bump but can generally be treated non-operatively.  Higher grade injuries cause a loss of alignment at the joint and   the end of the collarbone may appear as though it is sticking up out of position. Surgery may be recommended to repair or reconstruct those ligaments if the loss of alignment will affect long term shoulder function.