Anatomy: Behind the upper edge of the shoulder blade in a small channel (incisura scapulae) closed by a ligament (ligamentus transversum), runs a nerve (N suprascapularis) that distributes nerve fibres to parts of the shoulder joint-capsule and the upper and lower shoulder blade muscle (M supraspinatus and M infraspinatus)

Symptoms: Usually a burning or cutting pain in the shoulder. Possibly a sense of weakness in the shoulder. In case of long-term symptoms degradation of the shoulder blade muscles will occur.

Examination: Uncharacteristic shoulder symptoms, not improved by relief, should be examined by a physician. If the results of the examination indicate nerve entrapment the diagnosis is made by a nerve conduction velocity test (EMG).

Treatment: The treatment involves relief from the pain inducing activity, stretching and rehabilitation of the muscles around the shoulder. If no progress is made with relief and rehabilitation, surgical intervention may be attempted (article-1) (article-2).

Relief is the primary element, and it is particularly important that the rehabilitation does not cause any discomfort. Fitness training should not be resumed until the pain has stopped

Complications: If satisfactory progress is not made, a physician should be consulted to ensure that the diagnosis is correct and that no complications have arisen. Amongst others the following should be considered:

• Slipped disc in the neck
• Frozen shoulder
• Rupture of the upper shoulder blade muscle
• Inflammation of the tendon sheath of the upper shoulder blade muscle
• Inflammation of the bursa
• Rupture of the deltoid muscle
• Rupture of the biceps muscle
• Tendon sheath inflammation of the biceps muscle
• Partial luxation in the shoulder joint
• Luxation in the joint between the shoulder blade and the collar bone
• Muscle infiltrations
• Sprained shoulder
• Meniscus lesion in the shoulder (laesio labrum glenoidale)
• Impingement

Anatomy: Four muscles are part of the rotator cuff surrounding the shoulder joint, and controls, coordinates and assists movement of the shoulder: M supraspinatus (the upper shoulder blade muscle), M infraspinatus (the lower shoulder blade muscle), M subscapularis and M teres minor. When the arm is moved away from the body and above the head (abducated) the supraspinatus muscle slips under the upper bone projection of the shoulder blade (acromion).

Symptoms: Slowly insetting local tenderness after the load, externally and to the front of the shoulder. Sometimes radiating down the upper arm. Pain deteriorates when external pressure is applied to the supraspinatus muscle, on the front of the shoulder and when the muscle is brought into contact with the meniscus in the shoulder (throwing exercises) or when the arm is brought approx. 80-120 degrees away from the body (abduction).

Acute treatment: Click here.

Examination: If no progress is made with relief and discontinuance of the pain inducing activity, a medical examination should be carried out to ensure that the diagnosis is correct and to commence the correct treatment. It is important to make the diagnosis as fast as possible, since the injury may otherwise slowly deteriorated (article). Ordinary medical examination is usually sufficient to make the diagnosis (internal impingement-test: Chicken-wing test), but if there is uncertainty concerning the diagnosis, it should be supplemented with an ultrasound scan, which is the most suitable examination for shoulder injuries (article). Though it is not rare for the diagnosis only being made after a arthroscopic examination is carried out (telescopic examination of the shoulder joint).

Treatment: The treatment primarily involves relief from the pain inducing activity, stretching and rehabilitation of the muscles around the shoulder, Impingement syndrome in athletes. In case of lack of progress a medical treatment can be considered, rheumatic medicine (NSAID) or injection of corticosteroid (usually in the subacromiale bursa and possibly in the shoulder joint itself as well (internal impingement with signs of synovitis)). Since the injection of corticosteroid is part of a long-term rehabilitation of a long-term injury, it is often necessary for the rehabilitation period to stretch over several weeks to months in order to reduce the risk of recurrences. Ultrasound guided injections offer the optimal effect with a minimum of risk, (article). In case of lack of progress in the rehabilitation and medical treatment, an operative treatment can be attempted.

Complications: If progress is not smooth, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

• Rupture of the upper shoulder blade muscle
• Inflammation of the upper shoulder blade muscle
• Rupture of the lower shoulder blade muscle
• Rupture of the deltoid muscle
• Rupture of the biceps muscle
• Tendinitis of the biceps muscle
• Luxation in the joint between the shoulder blade and the collarbone
• Frozen shoulder
• Muscle infiltrations
• Sprained shoulder (distorsio art. humeroscapularis)
• Meniscus lesion in the shoulder (laesio labrum glenoidale)
• Luxation in the shoulder
• Nerve entrapment on the back of the shoulder blade

Anatomy: Along the edge of the articular surface (cavitas glenoidalis) in the shoulder is a meniscus (labrum glenoidale). The meniscus is important to the stability of the shoulder.

Symptoms: Pain in the shoulder joint with certain movements. A sense of something “slipping” in the joint is common.

Acute treatment: Click here.

Examination: A suspicion of a meniscus lesion in the shoulder (“slipping sensation”) and lack of progress should always lead to a medical examination (Apprehesion test, relocation test). An impression of the meniscus can be formed with MR and ultrasound scan, but the lesion is best assessed using arthroscopy (telescopic examination of the shoulder joint), where treatment can be performed at the same time.

Treatment: A referral to arthroscopy is advised where there is a suspicion of a meniscus lesion and smooth progress is not achieved with relief and rehabilitation, where it will be possible to determine the diagnosis, and whether it is possible to stitch the meniscus in place or whether parts of it should be removed. The results of the operation in cases of isolated meniscus lesion are usually good (article).

Complications: If progress is not smooth, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

• Rupture of the upper shoulder blade muscle
• Inflammation of the upper shoulder blade muscle
• Rupture of the lower shoulder blade muscle
• Rupture of the deltoid muscle
• Rupture of the biceps muscle
• Tendinitis of the biceps muscle
• Luxation in the joint between the shoulder blade and the collarbone
• Frozen shoulder
• Muscleinfiltrations
• Sprained shoulder (distorsio art.humeroscapularis)
• Impingement syndrome
• Partial luxation in the shoulder
• Nerve entrapment on the back of the shoulder blade

Anatomy: The shoulder joint consists of the head of the humerus (caput humeri) and the articular surface on the shoulder blade (cavitas glenoidalis). Along the edge of the articular surface on the shoulder blade is a meniscus (labrum glenoidale). The joint is surrounded by a joint-capsule, which is strengthened by numerous ligaments. The shoulder muscles surrounding the joint-capsule further strengthen the joint.

Symptoms: Pain corresponding to the front of the shoulder. Normal passive mobility, but often restricted active mobility.

Acute treatment: Click here.

Examination: Light cases require no immediate treatment, but in case of powerful pain and movement constriction, or in lack of progress, a medical examination should be performed for a precise diagnosis. It may be necessary to supplement with further examinations (X-ray, MRI (article), or ultrasound). In some cases the injury is combined with a meniscus lesion in the shoulder (laesio labrum glenoidale).

Treatment: Most cases heal in a few weeks with relief and carefully increasing load within the pain threshold. Rehabilitation is aimed at strengthening the muscles around the shoulder joint (article).

Complications: If satisfactory progress is not made, a physician should be consulted to ensure that the diagnosis is correct and that no complications have arisen. Amongst others the following should be considered:

• (Partial) luxation of the shoulder
• Rupture of the upper shoulder blade muscle
• Inflammation of the upper shoulder blade muscle
• Rupture of the lower shoulder blade muscle
• Meniscus lesion in the shoulder (laesio labrum glenoidale)
• Muscle infiltrations
• Impingement

Anatomy: Numerous muscles origin and fasten around the shoulder/neck.

Symptoms: Tenderness in the muscles exaggerated when applying pressure on the muscle. There are often radiations to the arm (from muscle infiltrations around the shoulder blade) and to the head (tension head-ache with pressure behind the eyes) in cases of muscle infiltrations on the muscle fastenings in the back of the head.

Examination: Muscle infiltrations do not usually require closer examination, but in case of long-term discomfort the triggering cause should be ruled out.

Treatment: If possible the provoking cause must be removed or treated. The treatment of muscle infiltrations is furthermore stretching and increasing fitness training (article-1) (article-2) (article-3), (article-4).

Complications: If progress is not smooth, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

• Rupture of the upper shoulder blade muscle
• Inflammation of the upper shoulder blade muscle
• Rupture of the lower shoulder blade muscle
• Inflammation of the biceps tendon
• Luxation of the joint between the shoulder blade and the collarbone
• Partial luxation on the shoulder joint
• Frozen shoulder
• Sprained shoulder (distorsio art. humeroscapularis)
• Meniscus lesion in the shoulder (laesio labrum glenoidale)
• Indeklemningssyndrom (impingement)
• Nerve entrapment on the back of the shoulder blade
• Degenerative arthritis in the neck
• Slipped disc in the neck

Anatomy: The shoulder joint consists of the head of the humerus (caput humeri) and the articular surface on the shoulder blade (cavitas glenoidalis). Along the edge of the articular surface on the shoulder blade, is a meniscus (labrum glenoidale). The joint is surrounded by a joint-capsule, which is strengthened by numerous ligaments. The shoulder muscles surrounding the joint-capsule further strengthen the joint.

Symptoms: Usually pain in the shoulder (in many cases from an inflammation of the bursa (bursitis subacromialis)). After a few months, movement constriction of the shoulder joint occurs resulting of the reduction of all movement. After a few years (on average 2½ years) pain diminishes and after another few months mobility in the shoulder joint is normalized (article).

Examination: Anyone suspecting a frozen shoulder should be medical examined. A normal medical examination is usually sufficient in order to make the diagnosis There is typically movement constriction in all directions, including when the arm is passively rotated outwards. If the shoulder blade is held fixed, only very modest mobility will be possible.

Treatment: Since the condition is benign and usually heals spontaneously, treatments with the risk of side effects, should be used with restraint. Usually mild painkillers are recommended (paracetamol) or, if needed, rheumatic medicine (NSAID). In the absence of any effect corticosteroid can be injected into the shoulder joint and the bursa, if inflammed (article). Some have used corticosteroid in pill form. Various operations have been attempted, where the joint capsule is cut through (or split), however, further complications are often associated with these operations, so a certain amount of restraint is advised (article).

Complications: The diagnosis should be verified through a medical examination. Amongst other things consideration must be given to:

• Rupture of the upper shoulder blade muscle
• Inflammation of the upper shoulder blade muscle
• Rupture of the lower shoulder blade muscle
• Meniscus lesion in the shoulder (laesio labrum glenoidale)
• Muscle infiltrations
• Impingement
• Nerve entrapment on the back of the shoulder blade

The physician will also consider an X-ray of the lungs and a glucose measurement, since the condition is described slightly more often in people with lung cancer and diabetes.

Anatomy: The collar bone (clavicula) forms a joint with the breastbone and the shoulder blade’s upper bone projection (acromion). Amongst other functions the collar bone acts as the anchor for many shoulder and chest muscles.

Symptoms: Pain in the collar bone and upon movement of the shoulder joint. In cases of a fracture with displacement of the bone, a bump is often visible on the collar bone.

Examination: Sudden, powerful pain in the shoulder with constriction of movement after a fall should always lead to acute medical examination. The fracture is usually visible on x-rays and on the basis of the type of fracture, the treatment can be determined.

Treatment: Depending on the type of fracture, rest and possibly a sling may be employed until pains decrease after a couple of weeks. In some instances, a sling is chosen to fixate the fracture (Madsens figure-8 bandage). In more complex fractures, and fractures with ruptured ligaments a surgical fixation of the fracture is most often chosen. In some cases it is an option to fixate certain fractures with a plate, which allows a faster return to sports, but the operation has a relatively high risk of complications (article).

Rehabilitation: When the pain has diminished (after 2-3 weeks) physical fitness training in the form of running may be commenced, and retraining according to the guidelines under rehabilitation, general. After 4-6 weeks careful muscle training of the shoulder muscles may be started. Participation in contact sports will be possible after a couple of months have elapsed.

Complications: In the vast majority of the cases the fracture will heal without complications, although some suffer long-term discomfort, even if the fracture heals. Some fractures form a false joint (pseudoartrosis), which requires (renewed) surgery.

Anatomy: The upper arm (humerus) consists of the head (caput), the neck (collum), the long tubular bone (corpus) and the epicondyle.

Symptoms: Sudden pain and pain induced constriction of movement of the arm and shoulder after a fall.

Acute treatment: Click here.

Examination: Sudden, powerful pains in the arm with constriction of movement after a fall, should always lead to acute medical examination. The fracture is usually visible on x-rays, and on the basis of the type of fracture, the correct treatment can be determined.

Treatment: Depending on the type of fracture, rest and possible use of bandaging until pain decreases and the fracture is fixed (which usually takes approx. 6 weeks). Most fractures are treated non-operatively (article). In certain types of fractures, an operative fixation is an option.

Rehabilitation: When pain has decreased (after 2-3 weeks) physical training in the form of cycling may be started along with retraining as specified under rehabilitation, general. After approximately 4-6 weeks running can be commenced, and subsequently careful training of the upper arm and shoulder muscles. Participation in contact sports will be possible after approx. three months have elapsed.

Bandage: Special plastic bandages can be made for use when contact sports are resumed.

Complications: In the vast majority of cases the fracture heals without complications, although in some cases a delayed healing occurs, possibly with the development of a false joint (pseudoartrosis) requiring (renewed) surgery. In some cases, the fracture can affect the nerve supply to the arm (N radialis), which can cause sensory disturbances in the hand (and is usually treated with (renewed) surgery).

Anatomy: The shoulder joint consists of the caput of the upper arm (caput humeri) and the articular surface on the shoulder blade (cavitas glenoidalis). All around the edge of the articular surface on the shoulder blade is a meniscus (labrum glenoidale). The joint is surrounded by a joint-capsule, reinforced by additional ligaments. Around the joint-capsule lies the shoulder muscles as further reinforcement of the joint.

Symptoms: In case of total luxation there is immediate pain in the shoulder after a powerful load or fall. Mobility in the arm is greatly reduced due to pain. It will often (but not always) be visible on the shoulder that it is out of joint. In other cases only partial luxation occurs (subluxation), dislodging the capitulum only brieftly, and then sliding back into place. The ruptures of the joint-capsule and ligaments can lead to chronic looseness in the shoulder, causing repeated dislodging of the shoulder, which can be felt as a sudden pain and reduction of strength (“Dead Arm”), when the arm is held over and behind the head (abducated and outwards rotated) (article).

Acute treatment: Click here.

Examination: Medical examination is required in all cases where a total or partial luxation of the shoulder is suspected, often combined with special X-ray examinations or CT- or MR-scanning (article).

Treatment: Most cases of partial luxation and looseness in the shoulder can be rehabilitated. The rehabilitation seeks to strengthen the muscles around the shoulder joint (article). In some cases of total luxation and in most cases where luxation is combined with other injuries like meniscus or cartilage/bone damage surgery will be advised. If, in spite of rehabilitation, (partial) luxation continues to occur, the possibility of surgery should be re-evaluated (article).

Rehabilitation of partial, not operated, luxation of the shoulder joint (subluxation)

Complications: After (partial) luxation in the shoulder, a looseness of the shoulder joint often occur, which increases the risk of follow-on injuries in the form of:

• Rupture of the upper shoulder blade muscle
• Inflammation of the upper shoulder blade muscle
• Rupture of the lower shoulder blade muscle
• Rupture of the deltoid muscle
• Meniscus lesion in the shoulder
• Impingement syndrome