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The shoulder consists of three bones: the scapula, or shoulder blade, the clavicle, or collarbone, and the humerus, or upper arm bone. The glenoid is the shallow socket where the upper arm rests in the shoulder, and the humerus is stabilized by a glenoid labrum, which also serves as an attachment point for several muscles and tendons. The rotator cuff is a covering over the top of the humerus comprised of four muscles which holds the humerus in place and allows the arm to move and rotate. A shoulder tear is a lesion in any of the shoulder components.
A rotator cuff injury is the most common shoulder tear. This can occur as a result of an acute injury and is usually accompanied by a large snapping sound and sudden, acute pain. More frequently, however, rotator cuff tears are a result from repetitive shoulder movements, such as repeated throwing and lifting in athletic endeavors, or simple wear and tear injuries appearing after the age of 40. Symptoms of a gradual rotator cuff shoulder tear usually include increasing pain when lifting or lowering the arm, atrophy of the shoulder muscles and a reduction in the arm’s range of motion.
Non-surgical treatment of rotator cuff tears includes resting the arm in a sling for a period of time, steroid injections, anti-inflammatory medications and rehabilitative exercises. If these methods fail, then surgery may be necessary. Surgical options are arthroscopic surgery, mini-open surgery, and open surgery, depending upon the location and severity of the tear. Post-operative treatment involves stabilizing the arm in a sling for a period of weeks followed by physical therapy.
A shoulder tear may also occur along the glenoid labrum, or the rim around the shoulder socket. A tear in the upper part of the labrum is called a SLAP lesion, while a tear of the lower rim is known as a Bankurt lesion. In the past, these injuries were extremely difficult to diagnose because the labrum is made of soft tissue and cannot be seen with a traditional X-ray. Diagnosis is now made with an arthroscopic television camera which can take pictures of the inside of the joint. Non-surgical treatment includes stabilization of arm, treatment of inflammation and therapy, though in some cases, arthroscopic surgery may be required.
A shoulder tear may also occur in the labrum. The labrum is a thick cuff of cartilage which forms a cup and circles the shoulder socket. While labral tears can occur from blunt trauma injuries, they are usually a result of age and wear, since the cartilage becomes brittle over time. Symptoms may include aching within the shoulder and a catching sensation when the shoulder moves.
Tendons attach muscles to the bones. The bicep is attached to the shoulder through two tendons. The longer tendon attaches on top of the glenoid, or shoulder socket, and the shorter tendon attaches to a bump on the shoulder blade called the cortacoid process. A shoulder tear of the bicep tendon is most likely to start with a fray and then gradually increase in size. A hard fall or lifting a heavy object can cause tears, though most are likely to occur over time and with repeated use.
Symptoms of a bicep tear may include a sharp popping sound accompanied by sudden pain, the inability to turn the hand from palm up to palm down, bruising in the middle arm near the elbow, and weakness. A complete tear is usually easy to diagnose because the bicep will bunch up like a “Popeye” muscle. Partial tears are more difficult to see, but are indicated when a person experiences pain when trying to flex the bicep muscle. If no damage has occurred to any other shoulder component, then this type of shoulder tear is usually treated with ice, anti-inflammatory medication, rest and physical therapy. Surgical repair is less likely, though may be an option if the patient has an occupation that requires complete recovery at full strength.