Conditions Knowledgebase
Find answers to common questions about bone and joint conditions organised by diagnosis, location and procedure. Filter the answers by selecting one of the keywords displayed.
Shoulder & Elbow
All/Acromioclavicular Joint/Cortisone/Diagnosis/Frozen Shoulder/Labrum/MRI/Rotator Cuff/Shoulder Click/Shoulder Impingement/Shoulder OA/Shoulder Replacement/Subacromial Bursitis/Surgery/
I have a tear in my rotator cuff – do I need surgery?
Rotator cuff tears are the most common cause of shoulder pain.
However, tears in the rotator cuff are also a common occurrence in a non-painful shoulder and may not necessarily be the cause of your shoulder pain. Additionally, people who have a rotator cuff tear have probably had it for some time and it is only with irritation to other surrounding structures that pain begins.
Most importantly, the majority of rotator cuff tears can be managed with an individualized exercise program.
Will my rotator cuff tear progress?
The literature suggests that progression of a rotator cuff tear is dependent on the size of the initial tear and the age of the person. Larger tears are more likely to progress in size and to become painful, whereas a small tear, often called a partial tear, may not progress at all.
Do I need a magnetic resonance imaging (MRI) study to diagnose my problem?
The short answer is no. But when you suffer from pain you want to do all you can to help get a diagnosis, so why not get an MRI?
MRI is one of the most common imaging techniques used to show the soft tissues inside the shoulder. However, an MRI only shows the structures within the shoulder or elbow, not which structure is causing pain. A thorough clinical history and exam will provide the answers you need to begin the process of helping your shoulder pain. MRI can be used for surgical planning by a specialist, so expect to have an MRI if you require surgery.
What is shoulder impingement?
Shoulder impingement is a common cause of pain and is caused by soft tissue structures being pinched in between bone when the shoulder is moved. The most common type of impingement is in the subacromial space (link to image). There are multiple causes of impingement and it is important that your health care provider complete a thorough assessment to determine if it is the cause of your pain.
Why does my shoulder make a clicking noise?
Clicking is a common occurrence in many shoulders and does not necessarily mean there is anything to worry about. If you have not injured your shoulder and clicking is not painful, then the sound is most likely due to normal structures moving over each other.
If you have suffered a trauma to your shoulder and feel a new clicking in the joint, ask your family doctor to complete an assessment.
What is cortisone and will it help my pain?
Cortisone is a steroid commonly injected into the shoulder and to a lesser extent the elbow. The aim of a cortisone injection is to relieve pain. Your health care practitioner may also use a freezing agent along with the cortisone to relieve the discomfort of the injection as well as to aid in the diagnosis of your pain – as the structure injected will no longer be painful when re-tested.
There are some risks involved with having an injection and it is important to discuss the use of cortisone with your healthcare provider before deciding if it is right for you.
Frozen shoulder – what is a frozen shoulder and what can I do about it?
Frozen shoulder, also known as adhesive capsulitis, is an inflammatory process in the soft tissue structures that surround the shoulder. Typically, frozen shoulder presents as progressive shoulder pain and loss of motion. A frozen shoulder can occur in the months following an injury or without a specific cause.
Some people are at more risk of a frozen shoulder than others; including people with diabetes, over or under active thyroid glands, tuberculosis, Parkinson’s disease or those whose shoulder has been immobile for an extended period of time.
If you have a frozen shoulder it is recommended that you complete regular exercises to maintain a healthy joint and soft tissues – see the shoulder exercise tab for more information.
I have been told I need a shoulder replacement, where can I find out more information?
In a small percentage of patients, a replacement of the joint surfaces is necessary to treat pain and loss of motion. Otherwise known as a shoulder arthroplasty, a shoulder replacement is an operation in which the joint surfaces of the shoulder are removed and replaced with metal and plastic components. Bony growth due to arthritis is also removed during the procedure.
You can find out more detailed information about your shoulder surgery at Total Shoulder Replacement – Orthogate.
Before proceeding with any surgery, make sure to discuss the risks and benefits relevant to your particular case.
Is the rotator cuff the source of shoulder pain?
Rotator cuff tears are the most common reason for referral to the ESP Shoulder and Elbow clinic, but are often not the primary pain generator.
Rotator cuff tears are a common occurrence and can be asymptomatic. So even when seen on Ultrasound or MRI, a rotator cuff tear should not be assumed to be the primary cause of pain.
When testing the rotator cuff muscles (insert images of positions) it can be uncomfortable for patients to provide resistance, and weakness of the muscle may be assumed when it is actually pain that is limiting contraction.
For an accurate assessment, be sure to distinguish between pain and weakness.
End of range pain in forward flexion is could also be the Acromioclavicular Joint, so make sure complete the three essential tests (insert pictures of ACJ palpation, bell van riet and X-body adduction) to make sure it is the rotator cuff that is causing pain.
Is the acromioclavicular joint the cause of pain?
The ACJ is one of the most under recognized pain generators in the shoulder.
ACJ pain can occur in a variety of patients and the pain pattern can be misleading, often being mistaken for rotator cuff or cervical spine pain.
Patients at risk for ACJ pain:
- Older patients with arthritic changes
- Patients with previous separations at the ACJ
- Young patients who over-exert the ACJ with weightlifting or repetitive strain
Typical pain patterns for the ACJ:
- Tenderness over the joint itself
- Referred pain to the scapular, cervical spine and distal upper extremity.
- Pain at night time
- Holding weight at arm’s length
- Reaching across the body
Is the labrum the cause of shoulder pain?
Labral injuries are common amongst patients with a history of overhead sports or trauma to the shoulder.
Typical pain patterns for labrum injuries:
- Symptoms are often deep within the joint itself
- Patients often describe a transient ‘dead arm’ feeling after throwing or sporting activities
- Pain can often present the following day and be described as a deep, dull ache
- The posterior capsule is often tight due to persistent micro tearing, so compare internal rotation at 90 degrees abduction on both sides.
Two key assessment techniques for the labrum:
Insert pictures O’Briens and dynamic labral shear test
Is osteoarthritis of the glenohumeral joint the cause of pain?
In the older patient (>65), or in patients with a history or trauma to the shoulder (including fracture or dislocations) it is important to review the glenohumeral joint (GHJ) for OA.
It is not uncommon for patients to present with concurrent rotator cuff tears, labral tears and bursitis, so make sure to rule out OA before referring for treatment of secondary pathologies.
The key to a diagnosis of GHJ OA is in the use of medical imaging. In most cases of shoulder pain, and in-particular with OA, a simple radiograph is adequate.
If GHJ OA is present on X-ray, make sure you examine for crepitus and limited range of motion with end range pain to confirm if OA is the pain generator.
A long history of mild shoulder pain with an increase in symptoms over a period of weeks or months is typical for shoulder OA.
In the presence of moderate to severe OA on radiograph, a diagnosis of Adhesive Capsulitis can be ruled out with reasonable certainty.
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Extended Scope Practitioner (ESP) Clinics is an enhanced model of care in which orthopaedic surgeon supervised inter-professional allied health care teams of Extended Scope Practitioners (Physiotherapists/Advanced Clinician Practitioners) provide patients with musculoskeletal (MSK) joint and spine pain with assessment, education, and evidence-based treatment plans emphasizing personalized self-management strategies.
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