The shoulder region is put to work the moment we are born and serves us well for a lifetime. Over time, though, injury or degeneration can develop, and in some cases surgery is required. The shoulder is the most mobile joint in the body, and it relies on soft tissue, namely the labrum, the capsule, the ligaments and the rotator cuff tendons, rather than on bony constraint to keep the ball centred in a shallow socket. That design allows an extraordinary range of movement, but it leaves a number of structures exposed to injury and wear.
Shoulder problems broadly fall into a few groups. Some are problems of the tendons and the space they move through: tendonitis, bursitis, impingement, calcific deposits and rotator cuff tears. Some are problems of stability, where the joint dislocates or slips out of position. Some are problems of the joint surfaces, as in osteoarthritis and inflammatory arthritis. And some are problems of the capsule itself, as in frozen shoulder, where the lining of the joint becomes inflamed and contracts. The AC joint, at the point of the shoulder where the collarbone meets the shoulder blade, can be affected independently of the main ball-and-socket joint.
A number of these conditions produce very similar symptoms: pain down the outer arm, pain at night, pain on lifting the arm overhead. That is why an accurate diagnosis matters. Assessment combines the history, examination of movement and strength, and imaging, which may include X-ray, ultrasound, MRI or CT depending on what is suspected. It is also worth saying plainly that many shoulder conditions settle without an operation. Activity modification, physiotherapy, simple analgesics and, in selected cases, an injection resolve or control a great many shoulder problems, and surgery is considered when those measures have not worked or when the structural damage makes it unlikely that they will.
The pages below cover the conditions most often seen in the clinic. Each explains the symptoms, the causes, how the diagnosis is made and the treatment options, including both non-surgical and surgical approaches.
Conditions of the shoulder
Partial or full thickness tearing of the rotator cuff tendons, which may be degenerative or follow an injury, and typically causes night pain, weakness and pain on lifting the arm.
The rotator cuff tendon catching under the acromion, producing a painful catch as the arm is raised to around shoulder height.
Inflammation of the gliding space between the rotator cuff and the acromion, causing aching down the outer arm and impingement symptoms.
Inflammation of the rotator cuff tendons, most often the supraspinatus, with aching on the outer side of the upper arm and discomfort on lifting the arm away from the body.
A deposit of calcium within a rotator cuff tendon. The pain comes from the body’s inflammatory reaction to the deposit, and can range from nothing at all to acute, severe pain.
Also called adhesive capsulitis. The joint capsule becomes inflamed and contracts, producing marked stiffness and pain, most often between the ages of 40 and 60.
A shoulder that dislocates or slips out of position, divided into traumatic instability following an injury and multidirectional instability in people with naturally loose soft tissues.
Traumatic dislocation of the shoulder out the front of the joint, the most common instability pattern, with a significant risk of further dislocation in younger, active patients.
Wear or inflammatory destruction of the cartilage surfaces of the ball-and-socket joint, causing pain, stiffness and a grinding sensation that worsen as it progresses.
Arthritis of the joint between the collarbone and the shoulder blade, causing pain on top of the shoulder that is worse with overhead lifting, sometimes with a tender bony lump.
What to do next
If you recognise your symptoms on one of these pages, the next step is an assessment, because several of these conditions overlap and more than one can be present at the same time. Background on how the joint is put together is on the shoulder anatomy page. The operations used to treat these conditions are described under shoulder surgery, recovery is covered under rehabilitation, and patient videos are indexed under videos.
To arrange an assessment, see consultation. The consultation FAQs explain what to bring and what to expect, the surgery FAQs answer common questions about having an operation, and accommodation has information for patients travelling to Brisbane.
These pages are general information and are not a diagnosis. Individual circumstances vary, and the right treatment for you can only be determined after assessment. Any procedure carries risk; these are discussed in consultation.
