Second Opinion on Shoulder joint conditions

The shoulder joint is a very complex mechanism that functionally consists of several, including small, joints. This structure allows for a much greater volume of movement compared to, for example, the knee or ankle.

Shoulder mobility is ensured primarily by the interaction of many different muscle groups, as well as by the ligamentous and capsular apparatus. This is why the shoulder can be compared to a clockwork mechanism, in which all the gears are in a clutch, and if one of them fails, everything stops. Likewise, if one of these "cogs" in the shoulder joint is damaged, the entire function of the shoulder can be greatly limited.

Abnormal conditions are indicated mostly by pain

Usually, problems with the shoulder are signaled by pain, which may be accompanied by a feeling of stiffness. As a result, there are difficulties in performing a number of movements.

Such symptoms should be a reason to contact a specialist. His first task is to determine the cause of the complaints, which includes ruling out the presence of causes outside the shoulder apparatus, such as spinal problems.

What will your doctor do about it

The complex structure of the shoulder joint requires precise and targeted diagnosis to correctly identify the cause of pain.

It is very important to take the patient's medical history (anamnesis). This involves carefully recording the duration and type of complaints. A number of clinical tests are also used, which alone can sometimes quite clearly point to a particular disease.

The examination is supplemented by special radiological diagnostics, which allows detecting incorrect positioning of joint components, wear and tear of joints, calcium deposits and other abnormalities. An effective and safe way to identify various problems of the shoulder is an ultrasound examination. In some cases, a magnetic resonance imaging scan, in which the various structures can be pictured even more accurately and specifically, is required for a more precise assessment.

In exceptional situations, computed tomography or scintigraphy may be recommended (in particular to visualize blood flow and tissue metabolic activity).

Shoulder joint disorders: an overview

Most shoulder issues fall into the following major groups: tendons (inflammation or tear); torn rotator cuffs; dislocation; arthritis.

Long head of biceps tendon conditions

The large flexor muscle of the shoulder (biceps) is attached to various parts of the scapula by two tendons called the "long head" and the "short head." The first of the two is especially prone to injury and inflammation, such as:

- damage to the upper part of the articular lip of the scapula (SLAP injury);

- damage to the block of the humerus (pulley injury);

- tendinitis (inflammation);

- tear/partial tear.

Long head of biceps tendon injuries are difficult to recognize, so only experienced orthopedic surgeons can diagnose them.

Ultrasound and X-rays are often inaccurate, and MRI does not always show SLAP and pulley damage because it requires injecting a contrast agent directly into the joint. However, it is often possible to see indirect signs, such as signs of inflammation and other associated issues (e.g., a tear of the rotator cuff).

Therefore, very often only a detailed history (accidents, sports activities, complaints) and a specific examination of the shoulder joint are indicative enough.

Calcific tendinitis

A very painful pathological condition caused by the deposition of calcium salts in the tendon attachment area (usually the rotator cuff) is called calcific tendinitis.

The first stage is the overgrowth of fibrous cartilage; then calcium salts are deposited in these areas. The deposits begin to liquefy, taking on a toothpaste-like consistency. At this stage, our immune system begins to work: calcium deposits are absorbed by macrophages, the "scavenger" cells of the immune system. As a result of the inflammation, the volume and pressure increase and the pain becomes more severe.

The complaints of calcific tendinitis can vary, depending on the stage of the disease, the location and size of the calcium deposits. At first, the disease may not manifest itself at all, but later severe pain develops. The condition is diagnosed by ultrasound and X-rays, and is usually amenable to conservative treatment including:

- anti-inflammatory or pain medications;

- Subacromial infiltrations;

- cryotherapy;

- shockwave therapy.

Rotator cuff tear

The four muscles (scapula, supraspinous, plantar, and small round muscle) located all the way from the scapula to the head of the humerus, form a group called the rotator cuff. It allows us to lift and rotate the arm. However, we usually become aware of its existence only when it is damaged (torn). This is usually due to wear and tear, so the problem is common in older patients. However, the tear can also be caused by an external impact on the shoulder as a result of trauma.

Therapy depends on the size of the tear, the condition of the tendons by which the muscle is attached to the bone, and the accompanying injuries.

For complete tears and reasonably intact tendons, surgery is performed with suturing/reconstruction of the tendon to prevent progression of the disease.

In the case of incomplete and very large tears, which preclude reconstruction, conservative therapy is recommended, its type depending on the accompanying injury.

Impingement

A shoulder condition in which tissues become compressed between the head of the humerus and the acromion (the lateral end of the scapula articulating with the articular surface of the clavicle), resulting in limited movement in the joint, is called impingement or compression syndrome. In primary impingement syndrome, this compression is caused by bony growths, certain congenital deformities of the acromion, osteoarthritis of the acromial-clavicular joint, or a protruding supracondylar process of the humerus. However, the space can also be narrowed by swelling of the periarticular sac (bursa), calcium deposits, and improper loading. In this case it is a secondary syndrome.

Impingement is diagnosed by taking a medical history, as well as a detailed physical examination, radiology scans, ultrasound, and, if necessary, magnetic resonance imaging.

Initially, conservative, non-surgical treatment is always attempted, which in many cases is successful.

Standard conservative therapy may include anti-inflammatory or analgesic drugs, subacromial injections, and physical therapy. Additional methods include deep cryotherapy or shockwave therapy.

If conservative measures do not ease the symptoms, or if the constriction is too large, relatively uncomplicated surgery may be performed.

Dislocations

A dislocated shoulder can result from an accident or congenital weakness of the shoulder capsule and ligaments. A small but irregular movement is enough to cause it.

In this case, the condyle of the humerus slips out of the depression of the scapula. If the head of the joint completely comes out of the hollow, we are talking about a complete dislocation, if not all the way out - a partial dislocation.

Even if the complaints are minor or absent, an orthopedist should be consulted to avoid further damage. Treatment depends on the concomitant injuries and symptoms.

Shoulder osteoarthritis

Osteoarthritis of the shoulder, referred to as omarthritis, is wear of the cartilage of the joint socket and head of the humerus. It is less common than osteoarthritis of the hip or knee.

Healthy cartilage, along with synovial fluid in the joint, ensures that there is no direct friction between the head of the humerus and the joint cavity. If the cartilage is severely worn, the bone rubs against the bone. This condition is usually preceded by years of progressive wear, during which time pain increases and mobility decreases.

Depending on the symptoms and severity of the arthritis, there are various conservative and surgical treatment options.

Conservative therapy: anti-inflammatory or pain medications, intra-articular injections (ACP), physical therapy, cryotherapy, hyaluronic acid, magnetic field therapy.

Surgical therapy: arthroscopy, shoulder replacement

Why might a second opinion be needed?

The rapid development of endoscopic technology in shoulder surgery in recent years has caused a high degree of specialization in this field. Procedures that were previously performed using open-surgical techniques and did more harm than good, can now be performed in a gentle, minimally invasive manner. This often allows complete restoration of pain-free joint function even in cases of severe shoulder injuries.

However, there are also many clinical situations that do not require shoulder surgery at all. In these cases, conservative treatment or simply a watch-and-wait strategy can lead to the complete disappearance of symptoms.

It takes a great deal of experience and expertise to develop a clear treatment plan for a patient in this complex, rapidly evolving area. It may also be the case that your primary physician does not have the latest updates on the issue.

A second opinion consultation for shoulder disorders gives you the opportunity to get an evaluation by a highly qualified specialist and an informed expert opinion on your issue within just a few days - no travel and no waiting time is needed.