The shoulder is a complicated and sensitive joint due to its enormous mobility. Perfect interaction between muscles, tendons and ligaments is essential for it to function smoothly in the truest sense of the word. Due to the great complexity of the anatomy, a shoulder can suffer a number of injuries or signs of wear and tear that can put a strain on the patient.
Below you will find selected shoulder specialists as well as information on the anatomy and diseases of the shoulder.
The shoulder consists not only of a main joint, but also of several secondary joints. These include the acromioclavicular joint or the subacromial space (space between the acromion and humeral head).
The shoulder joint consists of
As the shoulder is a ball and socket joint, it is very flexible by nature. This joint allows people to move their arm forwards and backwards or rotate it inwards and outwards, which makes the dynamic structures (tendons, muscles) of the shoulder particularly important compared to the hip, for example, where the static structures (bones) are required more due to the high mechanical load when standing.
The humeral head is larger than the glenoid cavity. This means that although there is greater mobility, this is achieved at the expense of stability. Well-trained shoulder muscles are therefore a must in order to stabilize the shoulder.
Chronic shoulder pain is on the increase and has a very restrictive effect on those affected. Triggers for shoulder pain can be harmless in nature. However, there are often serious illnesses or injuries that make treatment necessary. We briefly present the most common ailments below.
Impingement syndrome is when the shoulder no longer runs smoothly for various possible reasons and the shoulder joint becomes "too tight". Among other things, the humeral head can then hit the acromion. It can also lead to bursitis, tendon irritation, inflammation and damage to the rotator cuff. In the vast majority of cases, however, targeted muscle rebuilding is sufficient to restore the shoulder joint's smooth movement.
Inflammation of the bursa (bursitis) can also occur in the shoulder (subdeltoid bursitis). It is often a concomitant symptom of another shoulder problem and can also be perceived as a warning sign rather than a disease in its own right. Pain - even at night - and restricted movement are among the symptoms. In most cases, the bursa above the acromion is affected, but bursitis can also occur in the area of the deltoid muscle.
The most common cause of shoulder problems and shoulder operations is rotator cuff tears. These can be degenerative, i.e. due to wear and tear, or due to accidents. They are often only tears and not complete tears. A large number of tears can be successfully treated conservatively, but if the shoulder mechanics fail, surgery should be considered. There is a risk of cuff insufficiency
As with the knee, injuries to the articular cartilage - the sliding layer between the humerus and shoulder blade - can also occur in the shoulder. As the shoulder is not a weight-bearing joint, small defects are often well tolerated. However, larger cartilage defects can cause pain, restrict mobility and develop into genuine shoulder osteoarthritis. In the past, these defects were often ignored or considered clinically irrelevant, but today there are minimally invasive and non-invasive treatment options.
Omarthrosis is osteoarthritis of the shoulder caused by degenerative damage to the cartilage in the humeral head and/or glenoid cavity. It is often seen in connection with accidents, systemic diseases such as rheumatism or simply increasing age. Osteoarthritis causes pain and restricted movement, particularly in rotation (behind the back) and abduction (over the head). As the shoulder is not a load-bearing structure, osteoarthritis is often well tolerated for a long time.
A special form of shoulder osteoarthritis is so-called cuff insufficiency, i.e. failure of the tendons of the rotator cuff, which leads to eccentric movement of the shoulder and thus increased abrasion of the joint.
A shoulder dislocation is the dislocation of the shoulder when the humeral head slips out of the socket. A reduction is often necessary. Pain, accompanying injuries and instability can be the result. In very many cases, however, spontaneous reduction also occurs, i.e. the shoulder springs back on its own. Patients are often surprised to learn that they have had a shoulder dislocation.
In order for the shoulder to dislocate, stabilizing tissue must give way, i.e. be injured. Depending on age, these are typically different structures, but what they all have in common is that they can heal on their own in the vast majority of cases. However, if they do not heal properly, the shoulder can remain unstable and cause further problems. The greatest danger here is shear stress on the joint surfaces, which can damage the cartilage.
Shoulder instability is a problem that must be considered separately from shoulder dislocation. It can be a consequence of a shoulder dislocation, but can also occur without an accident. In the latter case, a weakness of the connective tissue is often responsible, which can be acquired or congenital. Congenital connective tissue weaknesses are often associated with other diseases. The symptoms of shoulder instability are often non-specific and in many cases the diagnosis is delayed. Nevertheless, the problem can be treated well once it has been correctly diagnosed.
A calcific shoulder occurs when calcium deposits form in the area of the tendons, especially the supraspinatus tendon. Poor blood flow to the rotator cuff is thought to be the cause. Active calcific shoulder is considered one of the most painful experiences in medicine, and patients like to report that broken bones or even birth pains would have been less severe than the calcification in the shoulder.
Fractures around the shoulder are very common and occur in many forms. Most people are familiar with clavicle fractures from direct and indirect experience, and they occur at all ages. If the spherical head of the humerus breaks, this is referred to as a humeral head fracture. This is mainly a problem in middle-aged and elderly people, but can also occur in young patients if the trauma is severe enough. Shoulder dislocations can also lead to fractures of the glenoid cavity. The shoulder blade itself fractures relatively rarely. Not all fractures require surgical treatment. The shoulder is capable of considerable compensation!
Frozen shoulder is an inflammation that initially affects the joint lining and then leads to shrinkage of the capsule. This in turn can lead to painful adhesions, for example in the bursa. There are a number of possible causes, but sometimes the problem occurs spontaneously. Frozen shoulder is self-limiting, i.e. it goes away, but the course of the disease is long, often months, and painful.
Children and adolescents of growing age have a number of special risk factors and shoulder problems that are not known in adults. For example, the shoulder, like all joints, is naturally much more flexible in growing children than in adults. However, this also means that children run the risk of developing shoulder instability without an accident. In these cases, the rotator cuff is compensatorily overloaded and bursitis develops as a result. These connections are often only recognized late, but the rule of thumb helps: bursitis or impingement in children and adolescents is almost always a hidden instability.
Another particular vulnerability in children are the growth plates, the points at which the bones grow in length. Intensive sport can lead to loosening, i.e. the bone falls apart. This is known as the "little league shoulder". Bony tears of the rotator cuff tendons can also occur.
Shoulder surgery is a specialized field of surgery. In this type of surgery, it is particularly important that the surgeon works very precisely in order to maintain the functionality of the shoulder. In this way, the shoulder surgeon can correct both degenerative restrictions and injuries.
Endoprosthetics of the shoulder joint is also one of the disciplines of shoulder surgery. By inserting an artificial joint, the function of the shoulder is also maintained and restored.
This text was edited by PD Dr. med. univ. Patrick Vavken.
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