Shoulder, Arm & Elbow Care

A rotator cuff injury is one of the most common causes of pain in adults. Your rotator cuff is made up of tendons that join shoulder muscles and your humerus to keep your arm in the shoulder socket and assists with lifting and rotating your arm. When a tendon frays or pulls away from the bone, either partially or completely, this is called a rotator cuff tear. 

Common Causes

• Acute tear. Falling on an outstretched arm, jerking motion while lifting, other shoulder trauma.
• Degenerative tear. Occurs over time, more common in dominant arm, often with repetitive movement.

Common Symptoms

• Pain at rest. Often, while lying on the affected shoulder.
• Pain or weakness while lifting your arms.
• “Crackling” sensation in certain positions.

Arthritis is inflammation of a joint. Shoulder arthritis is very common. Your shoulder actually contains two joints – the AC(acromioclavicular) joint, where your collarbone meets the tip of your shoulder blade, and your glenohumeral joint, where the humerus fits into the scapula. You may develop arthritis in either shoulder joint.

Common Causes

• Wear and tear. Osteoarthritis develops over time.
• Untreated rotator cuff tears, which stress the joint
• Rheumatoid arthritis, which likely impacts both shoulders

Common Symptoms

• Pain, aggravated upon activity and worsening over time
• Limited range of motion, such as lifting arms above head
• Nighttime pain, as disease progresses

Also called adhesive capsulitis, frozen shoulder is caused by thickening and stiffening of the shoulder capsule. Your shoulder capsule is made up of strong connective tissue, which surrounds the joint and rotator cuffs and contains lubricating synovial fluid. Thickening of the capsule causes bands of tissue to develop and restricts synovial fluid. Frozen shoulder often develops slowly, so prompt treatment is critical.

Common Causes

• Causes are not well understood.
• Diabetes, thyroid conditions, cardiac disease may increase risk.
• Immobilization following surgery or fracture

Common Symptoms

• Dull or aching pain
• Stiffness in the joint
• Pain that worsens with movement

Your humerus is your upper arm bone, from your elbow to your shoulder. Breaks in the upper part of your humerus, called proximal humerus fractures, are fairly common. Fractures may be stable, meaning the bones are still aligned, or unstable, which require realignment. Humerus fractures are more common in older adults or those with osteoporosis.

Common Causes

• Direct blow to the upper arm
• Falling from a standing height
• Motor vehicle accidents

Common Symptoms

• Severe swelling of the shoulder
• Very limited range of motion
• Severe pain

The broad range of motion offered by your shoulder makes it susceptible to dislocation. Dislocations may be partial (subluxation) or complete. A complete dislocation means that the head of your humerus has slipped completely out of the socket. Shoulder dislocations are likely to cause additional ligament or tendon damage, and can occur in any direction.

Common Causes

• Pulling or twisting of the arm with great force
• Falling on an outstretched arm
• Direct blow to the shoulder

Common Symptoms

• Swelling and bruising of the joint
• Visible deformity of the joint
• Weakness and numbness of the arm and shoulder

Your shoulder has incredible range of motion, however this makes it susceptible to repeat injuries such as dislocation. Once your shoulder has been dislocated, sometimes the ligaments and tendons loosen and it becomes unstable. Chronic shoulder instability means that the tissues designed to keep your shoulder snugly in place are compromised, and you are prone to dislocation.

Common Causes

• Sever or traumatic shoulder dislocation
• Repetitive strain (i.e. swimming, tennis, volleyball)
• Naturally occurring (people with loose ligaments)

Common Symptoms

• Pain as a result of injury
• Repeated dislocations
• Repeated sensation of shoulder “giving out”

Shoulder impingement and rotator cuff tendinitis are common sources of shoulder pain. Your rotator cuff attaches your humerus to your shoulder blade. When it becomes irritated or damaged, this is called tendinitis. Shoulder impingement occurs when there is friction within your shoulder joint due to internal inflammation. Early symptoms are often mild, but progress with time.

Common Causes

• Sports - repetitive lifting or overhead motion
• Occupational - repetitive lifting or overhead motion
• Minor injury

Common Symptoms

• Swelling and tenderness in the front of the shoulder
• Pain and stiffness when lifting arm
• Difficulty moving arm behind the back

Your clavicle, also known as your collarbone, connects your arm to your ribcage. Clavicle fractures are common at all ages, and typically occur in the middle of the bone versus the connection points. The severity of clavicle fractures can vary widely, from slight cracks to comminuted fractures (break into many pieces). Healing of clavicle fractures often takes longer than other fractures.

Common Causes

• Direct blow to the shoulder or bone
• Falling onto the shoulder
• Motor vehicle accidents

Common Symptoms

• Sagging of the shoulder
• Inability to lift arm due to pain
• Visible deformity/bump

This type of tear, also called a glenoid labrum tear, was virtually undiagnosable until recently. Your shoulder socket is called the glenoid, and the labrum is the soft fibrous tissue rim that surrounds it. The labrum deepens the socket, cushion the head of the humerus, and helps stabilize the joint. A glenoid labrum tear is an injury to that soft tissue rim. 

Common Causes

• Falling on an outstretched arm
• Violent overhead reach
• Sudden pull, i.e. lifting a heavy object

Common Symptoms

• Shoulder dislocation
• Pain with overhead motion
• Catching, locking, popping or grinding

SLAP stands from Superior Labrum Anterior and Posterior. Your labrum is the ring of strong, fibrous tissue that surrounds your shoulder socket (glenoid). It helps deepen and stabilize the joint. A SLAP tear is a tear to the top part of the labrum, where the biceps tendon attaches, to both the front and back. SLAP tears may be acute or as a result of wear and tear.

Common Causes

• Forceful pulling of the arm, such as catching heavy objects
• Falling onto an outstretched arm
• Rapid or forceful arm movement above shoulder level

Common Symptoms

• Pain with movement or lifting
• Decreased strength and range of motion
• Catching, locking, popping or grinding

Your forearm consists of both the radius and the ulna. Often, a fracture in your forearm means a break to both bones because of the force required. A break of only the ulna may occur with a direct blow to the outside of the arm. Fractures often occur at any point in these bones, and can vary widely in severity.

Common Causes

• Direct blow to the forearm
• Falling onto an outstretched arm
• Motor vehicle accidents

Common Symptoms

• Immediate pain and swelling
• Visible deformity
• Inability to rotate arm

Your biceps tendons attach your biceps muscle to your elbow and to your shoulder. A biceps tendon tear at the elbow is less common, but a serious injury. Biceps tendon tears do not repair themselves, making surgery often necessary to regain full arm function. Tears may be partial or complete, but more frequently complete, meaning the tendon has completely detached from the bone.

Common Causes

• Sudden injury
• Elbow forcibly straightened against resistance
• Elbow forcibly bent against a heavy load

Common Symptoms

• “Pop” and severe pain at elbow upon rupture
• Weakness in bending elbow or twisting forearm
• Bulge in muscle; gap at front of elbow

A fracture of your distal humerus is a break at the lower end of your humerus bone, nearer your elbow than your shoulder. Distal humerus fractures are often quite painful, but include a broad range of severities. They often require surgical repairs, as a distal humerus break impacts the range of motion of your forearm and elbow. They are more common in people with osteoporosis.

Common Causes

• Falling directly on the elbow
• Direct blow to the elbow
• Falling onto an outstretched arm with locked elbow

Common Symptoms

• Inability to move elbow
• Swelling, bruising, stiffness at the site
• Feeling of elbow joint instability

A bursa is a fluid-filled sac that cushions a bone. They help allow for free movement of joints. Your olecranon bursa is located on the boney tip of your elbow, and is typically flat, filled with only a small amount of lubricating liquid. When it becomes inflamed, it fills with more liquid and causes pain and irritation at the site, potentially limiting range of motion.

Learn more at orthoinfo.aaos.org

Common Causes

• Trauma to the tip of the elbow
• Prolonged pressure on the elbow
• Rheumatoid arthritis and gout

Common Symptoms

• Swelling of the elbow
• Pain that worsens with pressure
• Warm, red skin at the elbow

Your olecranon is the bony tip of your elbow, and the upper part of your ulna. The olecranon is the “hinge” of the elbow. Without much padding or protection, your olecranon is susceptible to fractures from a direct blow. An olecranon fracture can be very painful, with varying degrees of severity. Elbow fractures are fairly common, and can be isolated injuries or part of a more complex injury.

Common Causes

• Falling directly on the elbow
• Direct blow to the outside of the elbow
• Falling on an outstretched arm with a locked elbow

Common Symptoms

• Sudden, intense pain
• Numbness in the fingers
• Pain with elbow movement, tenderness to touch

Your elbow is a complex joint, as both a hinge and ball joint. An elbow dislocation can occur in either of these locations. A dislocation is the separation of the joint surfaces, either partial (subluxation) or complete. Elbow dislocations are not very common, and are typically the result of a trauma.

Common Causes

• Falling on an outstretched hand
• Motor vehicle accidents
• Natural anatomy that increases the risk

Common Symptoms

• Severe pain (complete)
• Visible deformity (complete)
• Extremely limited motion (complete)

Your flexor tendons are located in your forearm and are responsible for moving your fingers. They stretch from your arm muscles and attach to your finger bones. An injury to these tendons can vary from tendinitis, causing pain and inflammation, to torn tendons, making it impossible to bend your finger. These tendons are very close to the skin, making them prone to injury.

Common Causes

• Deep cuts on the forearm, hand or fingers
• Sharp pulling or jerking of a finger
• Preexisting conditions, such as rheumatoid arthritis

Common Symptoms

• Pain upon bending your finger
• Inability to bend or move finger joint(s)
• Numbness in the fingers

Elbow overuse injuries are particularly common among throwing athletes, such as pitchers, or anyone who throws overhead repetitively. Injuries to the Ulnar Collateral Ligament (UCL) as well as Ulnar Neuritis are among the most common. Your UCL is the ligament on the inside of the elbow that stabilizes the joint while throwing. The ulnar nerve runs behind the elbow, and is stretched repeatedly when throwing.

Common Causes

• Overuse, repetitive stress
• Throwing while fatigued
• High velocity throwing

Common Symptoms

• Pain during or after throwing
• Limited strength/velocity of throws
• Numbness & tingling in the arm or hand (ulnar neuritis)

Lateral Epicondylitis, commonly called Tennis Elbow, is an overuse condition that involves the tendons that join outside of the elbow to the forearm muscles. Your epicondyles are bony bumps at the bottom of your humerus, the attachment point for your forearm tendons, particularly your extensor carpi radialis brevis (ECRB). When it becomes inflamed or damaged, this is called lateral epicondylitis.

Common Causes

• Overuse, repetitive stress from sports
• Occupational overuse, i.e. painting, plumbing, carpentry
• Improper technique in racquet sports

Common Symptoms

• Gradually developing pain
• Pain or burning on the outer elbow
• Weak grip strength