Common Shoulder Problems

Basic Anatomy of Shoulder

The shoulder is a ball and   socket  joint. It is made up of three

bones: the upper arm bone (humerus), wing bone (scapula)

and collarbone (clavicle).

The shoulder ball fits into the small  socket  (glenoid) The

glenoid is surrounded by a soft cartilage lip (labrum), which

deepens the  socket .

The upper part of the wing bone (acromion) projects over the

shoulder joint. One end of the collarbone is joined to the

acromion by ligaments to form the acromioclavicular (AC) joint.

The rotator cuff is a group of muscles and tendons

that attach your humerus to your scapula and allow you to lift your arm


A fluid filled sac (bursa) lies between the rotator

cuff and the acromion. Its function is to provide

smooth motion of the rotator cuff as the arm is


Various Shoulder Conditions

Impingement Syndrome causes bursitis (inflammation of the bursa sac) and/or

tendonitis (inflammation of the rotator cuff tendons). Impingement occurs when the

tendons and bursa are squeezed under the acromion. This typically happens as a result

of bone spurs, injury, repetitive overhead lifting or muscle weakness. Most patients with

impingement syndrome will have pain with use of the arm, particularly overhead, as well

as pain when sleeping on the shoulder at night. Initially, these problems can be treated

with rest, anti-inflammatory medicines, cortisone injection, and an exercise program to

strengthen the rotator cuff muscles. If pain continues after this treatment, arthroscopic

surgery may be required to remove the swollen bursa sac and/or to remove bone spurs

that are pushing on the rotator cuff.

Partial rotator cuff tears can occur if the rotator cuff rubs against bone spurs for a

period of time or as a result of an injury. In many cases arthroscopic surgery is needed

to remove the spurs that are pushing against the rotator cuff and to repair the rotator

cuff. If left untreated a partial tear could progress to a complete rupture of the rotator


Complete Rotator Cuff Tears may occur from years of repetitive rubbing of bone spurs

against the rotator cuff, repetitive heavy lifting or from a sudden injury. When this occurs

the rotator cuff “pulls” away from the humerus bone. This causes pain and weakness.

Surgery is usually required to repair the tears. Dr. Goradia performs almost all rotator

cuff repairs arthroscopically with a small camera instead of making a large cut on the


Dislocations & Instability occurs when the ball (humeral head) slips out of the  socket 

(glenoid). This can happen as a result of sudden injury or from overuse of the shoulder

ligaments. In general young, active patients after a first time sudden dislocation have up to a 75-

90% chance that their shoulder will dislocate again. For this reason, there has been a

trend towards arthroscopic repair after a 1st time dislocation in patients under 25 years

of age. Older or less active individuals usually do very well with rest and an exercise

program. Surgery may be needed for those that continue to have problems.

Many surgeons repair the torn ligaments by making large incisions on the shoulder. As

instruments have improved, most patients can be successfully treated by arthroscopic

surgical repair on an outpatient basis as Dr Goradia performs regularly.

Labral Tears can occur when falling on the arm/shoulder, having the arm suddenly

pulled, a lifting injury or repetitive overhead activity with the arm. The labrum is the

cartilage “lip” that lines the shoulder  socket  or glenoid. This lip helps to deepen the

 socket  so the shoulder ball will stay in the  socket  better. When this labrum tears away

from the  socket  bone, patients experience pain, catching, clicking and/or locking. This

condition is best treated with arthroscopic surgery. You may hear or read about a SLAP

Tear. This is a specific type of Labral Tear that occurs on the top part of the  socket .

Biceps tendon tears often result in a “Popeye” muscle appearance of the arm. The

biceps muscle in the arm has a tendon that attaches to the glenoid or  socket  within the

shoulder. If the tendon tears loose the muscle sometimes “falls” down into the arm.

Although this looks strange, most patients do not have pain or significant weakness and

therefore do not need to have surgery. Partial tears however may be painful and often

need surgery.

Shoulder Separations are common injuries that are often confused with shoulder

dislocations. A separation occurs when the ligaments between the acromion and the

clavicle (acromioclavicular ‘AC’ joint) are injured. Most of these injuries are treated with

a sling. Only severe separations require surgical repair.

A Frozen Shoulder can occur when an injury causes pain and the patient stops using

the arm. Within a short period of a few weeks the shoulder can become very stiff and

painful with scar tissue. In a small number of patients a frozen shoulder can occur for no

reason at all without any injury. Patients with diabetes and thyroid problems are more

likely to develop a frozen shoulder. In most cases patients can be treated with a

cortisone shot and stretching exercises with a physical therapist. If the shoulder

continues to stay frozen some patients will need a manipulation of the shoulder or

arthroscopic removal of scar tissue.

Osteoarthritis can cause destruction of the shoulder (glenohumeral joint) and

surrounding tissue, as well as tearing of the rotator cuff. For patients who do not

respond to an exercise program, medications and/or cortisone injections, shoulder

replacement surgery may be necessary.

Seeing a Shoulder Specialist

Although any general orthopedic surgeon can treat shoulder problems, many of these

conditions may be better treated by someone with expertise and advanced training in

their diagnosis and treatment. There are a limited number of such specialists in


Dr. Goradia is fellowship trained in Sports Medicine, Arthroscopic Surgery and Knee &

Shoulder Reconstructive Surgery. He has taught arthroscopic surgery to other

orthopedic surgeons at national conferences and has produced educational videos of

his surgeries for teaching surgeons on the website of the Arthroscopy Association of

North America.