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Sometimes we might feel as if we have the weight of the world on our shoulders. But there is a lot that can weigh on our shoulders in a physical sense, too.
The shoulder is a highly complex mechanism for enabling movement that can quickly and easily be put out of line – either from frequently working at shoulder height, receiving a blow to the shoulder, poor posture, a pulled muscle and so on.
Read on to learn more about the shoulders, elbows and the most common problems and diseases. You can also find the right contact person to assist with your enquiry.
The part of the body we call the ‘shoulder’ is made up of five different joints and twenty muscles, as well as countless ligaments, bursae, nerves and blood vessels. Together these elements enable a huge range of movement. The shoulder features a bone with a hollow section known as the glenoid cavity. The head of the humerus (upper arm bone) rests inside this almost completely vertical cavity, where it is kept in place by the joint capsule and numerous ligaments.
The stability and mobility of the shoulder owes much to a large belt of muscles known as the rotator cuff, which consists of four individual muscles. These four muscles emanate from the shoulder blade and join together to form the rotator cuff that secures the head of the humerus. They stabilise the joint, move the humerus and hold the cavity in its place.
3. Upper rotator muscle
5. Lower rotator muscle
6. Shoulder blade
The joint commonly known as the elbow is actually made up of three joints, which are enclosed by a single joint capsule. Its name is derived from the bony extension of the ulna bone (in German Elle) directly at the joint, which sticks out slightly when the arm is bent. The complex elbow joint connects the forearm and the upper arm. It can bend and straighten the limb, as well as rotate. The joint is guided by several strong ligaments, whereas the actual movement is generated primarily by the muscles in the upper arm (in part also by the forearm muscles). The areas most subject to wear and tear are equipped with a bursa, which minimises the pressure and friction between the bones, muscles, tendons and skin.
Here are some of the common problems and diseases that can affect the shoulders and elbows.
It is not a comprehensive list.
Broken arms, elbows, shoulders and collarbones are usually caused by falling over. People with reduced bone density (osteoporosis) face an increased risk. Depending on the break, the bones can be treated conservatively (without surgery, for example using a splint), or the bone fragments might have to be surgically fixed into position (using wires or screws, for instance).
The rotator cuff is a group of four muscles and the associated tendons. The muscles emanate from the shoulder blade and join together to form the rotator cuff that secures the head of the humerus. Joint wear or a fall can cause the tendons to tear, which is known as a rotator cuff rupture. If the tendons tear completely, certain movements will be limited (similar to paralysis), because the muscles will no longer be able to function properly.
The muscle most commonly affected by a torn tendon is the muscle directly below the acromion (the supraspinatus muscle). Another condition that affects the rotator cuff is known as impingement syndrome. It involves the narrowing of the subacromial space, which causes pain. An impingement near the subacromial arch can be caused by many things, such as an irritated bursa or osteoarthritis of the acromioclavicular joint.
Possible treatments for a rotator cuff rupture range from infiltrations or physiotherapy, through to operations to reattach the tendon in its original position (plastic surgery). The choice of treatment depends on various individual factors. In addition to the medical results, doctors take into consideration the person’s occupational requirements, age and any sports they play.
The shoulder is one of the most mobile joints in the human body, so it is at great risk of becoming dislocated (the medical term is shoulder luxation). When the shoulder becomes dislocated, the head of the humerus slips out of the joint socket. And since the joint is surrounded by muscles, ligaments and tendons, dislocation frequently causes other injuries, like a tear in the rotator cuff. Falling over is the most common cause of a dislocated shoulder, for example falling off a bicycle or a skiing accident. When it happens, the shoulder must first be carefully returned to its socket by a doctor. Then an x-ray examination should be carried out. If there are no additional injuries, the arm is immobilised and the patient is given medication to reduce the swelling. However, if the capsule has been damaged, for example, a medical specialist must perform arthroscopic surgery on the shoulder to assess the extent of the damage. Depending on the results, a subsequent operation may be necessary – particularly in the case of recurring shoulder luxation.
Tennis elbow and golfer’s elbow both refer to an inflammation of the elbow. These conditions affect the area where the muscles responsible for extending and bending the forearm and the hand attach to the bone. The inflammation is assumed to be the result of strain caused by repeated movements, such as hitting a tennis ball. The main symptom of tennis elbow is pain on the outside of the elbow, which becomes more intense if the person makes a fist or bends their wrist upwards towards the back of their hand.
Similar symptoms are displayed by golfer’s elbow, which is less common, although generally it is the inside of the elbow that hurts.
As soon as the pain starts, it helps to cool the area. After that, the injury needs time to heal. The arm should first be rested and supported (using an elbow sleeve or brace) and later treated with physiotherapy involving stretching, strength-building and relaxation exercises. If these measures do not resolve the problem, surgical intervention to reduce the pressure on the tendons should be considered.
Our medical specialists regularly answer readers’ questions in newspapers, magazines and online. We have put together a few of these questions and answers for you here. Please note that the Q&A is purely informative. The advice provided is not comprehensive and does not substitute a consultation with a medical professional.
«I would like to ask a question on behalf of my colleague: three months ago she was playing with her nephew and during the rough and tumble he accidentally hit her, and something went click in her shoulder. Then she also started having pain in her shoulder and couldn’t lie on it any more. The pain still hasn’t gone away and she keeps waking up during the night whenever she rolls onto her left shoulder. For the last three or four days she has been in pain virtually all day and she can’t extend her arm that well either. Is that just bruising or something more serious?»
Unfortunately the information you have provided is not specific enough for us to come up with a tentative diagnosis. An acute injury, like the one your colleague suffered when playing with her nephew, should generally be checked out immediately by a doctor. It’s important to establish whether the shoulder has been dislocated or not (shoulder luxation). The examination should also check whether any tendons have been torn. In these kind of situations, I recommend getting checked out by a medical specialist relatively soon after the injury has occurred.
Dr. med. Walter Seelig, Hirslanden Klinik Birshof, Münchenstein Basel
«My father’s partner (78) had a fall 10 weeks ago. They both live abroad. She tore the ligaments in her shoulder and needs an operation. The earliest appointment she could get for the operation is in 7 months. She has very severe pain, particularly at night. She’s currently doing physiotherapy and taking pain killers that have various side effects. She has already had an ultrasound, so would it be possible to have the images evaluated by a specialist in advance?»
Based on your description, I assume that your father’s partner has a torn rotator cuff (tear in the inner tendon). It is treated using a routine operation that is frequently carried out these days. An arthro-MRI examination is usually required to assess the possibility of reconstructing the cuff and the expected outcome. Sonographic (ultrasound) images can only be interpreted by the person performing the examination. An external assessment of the sonographic images is not possible. If an operation is indicated (is necessary and has a good chance of success), in Switzerland, the procedure can usually be scheduled and performed relatively quickly. However, the patient must have sufficient insurance coverage.
Dr. med. Walter Seelig, Hirslanden Klinik Birshof, Münchenstein Basel