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© 2023 by Justin Chronister, MD 

Understanding Shoulder Pain

Your joints are involved in almost every activity you do. Daily activities such as brushing your hair, putting on your clothes or reaching to grab something out of a cabinet require the use of your shoulder. When your shoulder becomes diseased or injured, the resulting pain can severely limit your ability to perform your daily activities and work.

The shoulder is a complex ball and socket joint that involves three bones and several key muscles. The three bones that form the shoulder joint are the humerus, scapula (shoulder socket) and the clavicle (collar bone).

The shoulder is very unique as it has the greatest range of motion of any joint in the body. The shoulder can rotate, spin, and translate allowing for global movement to position the hand anywhere in space.

A smooth substance called articular cartilage covers the surface of the bones where they touch each other within a joint. This articular cartilage acts as a cushion between the bones. In addition, lubricated sacs of tissue called bursae also protect muscles and tendons, allowing them to slide against each other with less friction

Unlike the hip joint, which is also considered a ball and socket joint, the healthy shoulder is not as constrained within the bony anatomy. The shoulder has the ability to glide and move due to the important soft tissue (muscles and ligaments) that support the top of the humerus (ball) to the glenoid (shoulder socket).

There are 4 very important muscles of the shoulder that work together to keep the humeral head (ball) in proper position against the glenoid (socket). A common name for this muscle group is the rotator cuff. The rotator cuff is key in providing stability and balance to the shoulder joint. Proper rotator cuff balance is essential for arm lifting and rotation.1

Common Causes of Shoulder Pain

Osteoarthritis (OA) is sometimes called degenerative arthritis because it is a "wearing out" condition involving the breakdown of cartilage and bones. With osteoarthritis, the cushioning cartilage at the end of the humerus may have worn down, making shoulder movement painful as bone rubs against bone.

Shoulder OA commonly occurs many years following a shoulder injury, such as a dislocation, that has led to joint instability and repeated shoulder dislocations ‐ damaging the shoulder to the point that OA develops.

Post-Traumatic arthritis may develop after an injury to the shoulder joint in which the bone and cartilage do not heal properly. The joint is no longer smooth and scar tissue develops. The scar tissue causes pain in the shoulder joint.1

Cuff tear arthropathy may develop after an significant injury to the rotator cuff muscle(s). In the presence of cuff tear arthropathy, multiple bony and soft tissues changes are present which may decrease the function and strength of your arm.

Rheumatoid Arthritis (RA) is an autoimmune disease in which the body's immune response negatively affects the lining of the joints (called the synovial membrane), causing chronic inflammation and pain. The synovium becomes thickened and inflamed. In turn, too much synovial fluid is produced within the joint space, which causes a chronic inflammation that damages the cartilage, and wears out the ball and socket. This results in cartilage loss, pain, and stiffness.

Avascular Necrosis (AVN) results when bone is deprived of its normal blood supply. Without proper nutrition from the blood, the bone's structure weakens, may collapse and damage the cartilage. Since this is most often seen at the ends of bones, your joints may be greatly affected. This is especially true of the shoulder joint and most commonly appears at the top end of the upper arm bone, the long bone that extends from the elbow to the shoulder.

Treatment Options for Shoulder Pain

Take the first step towards returning to the everyday activities you enjoy by scheduling an appointment with a surgeon today. Your orthopedic surgeon will review and discuss their diagnosis with you. Based on his/her diagnosis, your treatment options may include: 

Shoulder implants are designed to enable the joint to move more similar to that of a healthy, functioning joint When speaking with your surgeon about shoulder replacement surgery, it is important to understand the different surgical techniques and options available to you in addressing your joint pain. 

When learning about surgical treatment options, a few common terms to know are TSA, Total Shoulder Arthroplasty, and RSA, Reverse shoulder arthroplasty. Arthroplasty is a medical term used to describe a procedure in which the effected joint is reconstructed or replaced which may allow it to move more naturally after the procedure.

Both, a TSA and RSA are intended to relieve pain and restore some function in the shoulder. The surgical approach, or incision for a TSA and RSA are very similar and involve the restoration of the ball (humeral head) and socket (glenoid implant). There are other surgical options such a hemi arthroplasty (or partial shoulder replacement) where only the humeral head is replaced due to various reasons, an example being avascular necrosis.7