WHAT’S BEHIND THAT SORE SHOULDER?

Your shoulder would win many design awards if we had made it in a lab rather than over ions of evolution. It’s an amazing bit of engineering that allows a wide degree of motion in your arm — everything from smashing a tennis ball to paddling out through the break at Trestles to throwing a curveball. The shoulder consists of several joints and an assortment of tendons and muscles.

But complexity has its shortcomings; the shoulder can be a source of pain and weakness, both from acute injury and also from the simple effects of wear and tear. From tearing the rotator cuff (Dodger pitcher Tommy John made that injury famous) to separating the shoulder to AC joint pain, myriad issues can develop with the shoulder

At Orthopaedic Surgery & Sports Medicine, Dr. Dini is all about diagnosing and treating your shoulder problems. Here are some of the most common factors causing your shoulder pain.

SHOULDER ANATOMY 101

Your shoulder consists of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The head of the humerus fits into a socket in the shoulder blade. A combination of muscles and tendons, known as the rotator cuff, keeps the humerus centered in the socket. They attach the humerus to the shoulder blade.

CAUSES OF YOUR SHOULDER PAIN

Your shoulder pain usually comes from one of four areas: tendon issues, instability, fracture, or arthritis. Here’s a more detailed breakdown.

• Tendonitis — A tendon is a cord that connects muscle to bone. Tendonitis is simply an inflamed tendon. It can occur from excessive use, such as throwing a baseball 88 times at 95 mph, hitting a golf ball off a synthetic mat day after day, or from having to work above your head with your arms for long periods. Or it can simply be degenerative from wear and tear over the decades.
• Tendon tears — A tendon tear is the basis of one of the most common shoulder ailments that you hear about when watching a Dodgers game — a torn rotator cuff. While the excessive throwing mentioned above can lead to tendonitis, if the movement is sharp enough it can also tear the tendon. If this happens the tendon is pulled away from its attachment to the bone. Other tears can be partial. If you tear a tendon in your shoulder, your usage will be severely restricted.
• Instability — This is the big pain of the shoulder world. Dislocations, separations. Few things can be as painful. They happen when the humerus is forced out of the shoulder socket. This usually happens in a sudden injury, when a quarterback is sacked from the side and his shoulder impacts the ground first, for instance. But it also has a chronic component where a shoulder joint has become loosened over time allowing more movement of the humerus. Once the ligaments, tendons, and muscles around the shoulder become separated, future separations or dislocations are more likely.
• Bursitis — Some people will say they have bursitis as a catch-all pain when it can actually be tendonitis or even a tear. The bursae are small, fluid-filled sacs that can be found in the joints throughout the body, including the shoulder. They basically act like little pillows between the bones and the soft tissues moving around them. They reduce friction. If you overuse your shoulder, especially in repetitive movements, your bursae sacs in the area can become inflamed — bursitis. This can make the simplest movement with your arm painful.
• Fractures — The most commonly broken bone in the shoulder is the collarbone (clavicle), but the humerus and shoulder blade can also be broken.
• Arthritis — Like all of your joints, your shoulder pain can come from arthritis. In the shoulder, the most common form is known as osteoarthritis. This develops over time from simple wear and tear. Symptoms of osteoarthritis in the shoulder are swelling, pain, and stiffness, and they grow more painful with time. Also, if you’ve dislocated your shoulder or had issues with your rotator cuff, you can develop another form of arthritis that involves the joint lining.

If you have shoulder pain, finding the cause is the first step toward providing relief. That’s Dr. Dini’s focus at Orthpaedic Surgery & Sports Medicine. He has extensive experience with sports injuries and can help with your shoulder. If you have lasting pain or weakness, call us at our Los Angeles office, (323) 525-0101, or our Encino office, (818) 784-1020, to make an appointment.