Damaged cartilage or tendons are a common cause of shoulder pain. These conditions often lead to decreased movement and difficulty with daily tasks. Shoulder pain frequently resolves on its own. Pain that lasts more than a few days, however, could be tendinitis or torn cartilage, conditions that require medical attention.
Anatomy
The shoulder joint is formed by the upper arm bone and the shoulder blade. This ball-and-socket joint is very mobile but susceptible to injury. The ball is held in the socket by muscles that move the shoulder. It is also stabilized by ligaments, attaching bone to bone. Cartilage in the shoulder joint – called the labrum – plays an important role in shoulder stability. The labrum forms a ring around the edge of the socket, making it deeper.
Overview
Tendinitis is usually caused by overuse of muscles in the shoulder joint. It typically develops over time, particularly with repetitive movements of the joint. Overhead activity places increased pressure on the shoulder tendons, making them more susceptible to tendinitis. Cartilage tears can occur with tendinitis, particularly with repetitive overhead activities, such as throwing. Tendinitis and cartilage tears can also be caused by trauma, such as falling on an outstretched arm or a motor vehicle accident. Both of these conditions cause pain in the shoulder that increases with use of the arm. The shoulder may feel weak and mobility of the joint may be decreased. Cartilage tears also cause a “clicking” sensation or sound in the shoulder with movement. The shoulder may feel like it is “catching” or getting stuck in certain positions.
Diagnosis
Shoulder tendinitis and cartilage tears are often apparent with a physical examination. The arm is put in positions that increase pressure on the tendons, causing increased pain. Joint mobility – movement of the ball of the joint within the socket – can cause clicking, indicating a possible cartilage tear. X-rays are commonly taken to rule out damage to the bones in the joint. Magnetic resonance imaging is used to visualize the ligaments, tendons and cartilage that do not show up on x-rays. Dye is typically injected into the shoulder joint before the images are taken. If the cartilage is torn, the dye will leak into the shoulder joint. Inflammation may also be detectable in areas of tendinitis.
Treatment
Conservative treatments are usually prescribed for shoulder tendinitis and minor cartilage tears. Doctors often inject cortisone directly into the joint to decrease pain and inflammation. Physical therapy uses heat, ultrasound and electrical stimulation to decrease pain and increase blood flow to the irritated shoulder. Range of motion exercises reduce stiffness and manual stretching is performed by the therapist to decrease joint tightness. Surgery is sometimes required to repair torn cartilage, particularly if the ball is moving out of the socket. The cartilage is sewn back together and specific instructions are followed after surgery to allow it to heal. The surgeon may also clean up any scar tissue in areas of tendinitis. Physical therapy is usually required to regain function after this procedure.