Shoulder Cartilage and Tendon Injuries
Overview
The shoulder is the meeting place of these 3 bones:
- Shoulder blade
- Arm bone
- Collar bone
The main shoulder joint is a ball-and-socket joint. It’s formed by the round end of the bone at the top of the arm fitting into a cup-shaped socket in the shoulder blade.
The shoulder is your most flexible joint. It allows you to raise, twist, and bend your arms in many directions. This can result in injury and overuse.
Most shoulder problems are caused by muscles, tendons, and ligaments, instead of bones. Tearing a tendon (tendinitis) is a common injury, including tears to the:
- Rotator cuff
- Biceps tendon
Many people with shoulder pain have problems with several structures in their shoulder. For example, people with bursitis or tendinitis may also have a tear in the cartilage called a labrum tear.
PMR - The Anatomy of the shoulder joint - Healthwise
The structures that make up the main shoulder (glenohumeral) joint
Types
Rotator cuff injury or tear
The rotator cuff moves and stabilizes the shoulder. It has 4 muscles and 4 tendons that attach the muscles to the bones. They form a cuff over the ball-and-socket joint of the shoulder.
Rotator cuff problems can be mild or severe. Your rotator cuff can become inflamed or torn. In severe cases it can separate from the bone.
Most of these injuries involve the tendon at the top of your shoulder. It can get pinched between the ball of the upper arm and part of the shoulder blade. This is called impingement and can happen when you raise your arm up or out to the side.
There are 2 types of impingement:
- Tendinitis, or inflammation of the rotator cuff tendons.
- Bursitis, or irritation of the bursa, a sac of tissue between the bone and the tendon.
Shoulder cartilage tear
The ball at the top of the upper arm bone rests in a socket in the shoulder blade. This socket is lined with a ring of cartilage and tissue that holds the ball of the upper arm bone inside it. After a shoulder dislocation, or simply use over time, this can tear.
Some of these tears are:
- Small and affect only the rim.
- Large enough to damage the biceps tendon.
- Severe enough to separate the biceps tendon.
Biceps tendinitis
The biceps tendon connects the biceps muscle to the shoulder blade. Biceps tendinitis is inflammation of this tendon.
Symptoms
Rotator cuff injury or tear
The rotator cuff can tear a little, or it can separate completely from the bone. You may feel mild pain and weakness, or severe pain that restricts your movement. In many cases rotator cuff injuries cause no symptoms.
When a rotator cuff problem causes symptoms, they include:
- Disruption in your sleep caused by pain. This is more likely if you lie on the affected shoulder.
- Pain in the front of your shoulder and down the side of the arm.
- Weakness in your arm.
- Difficulty raising your arm.
- Pain when reaching or throwing overhead.
- Pain, even though the shoulder moves normally.
Unlike other shoulder problems, people with rotator cuff injuries can still move their arms. In some cases, the arm may be too weak so they can’t do this by themselves, although a doctor can lift and move it. With other types of shoulder injuries, range of motion is severely limited.
Shoulder cartilage tear
A cartilage tear can cause symptoms that include:
- Pain when you raise your arm over your head.
- Pop or clicking sensation when you move your arm in certain ways.
- Pain at night.
- Loss of strength and range of motion.
- Instability of the joint.
Biceps tendinitis
The symptoms of biceps tendinitis can vary. They include:
- Pain in the upper arm.
- Pop or snapping sound when you move your arm or shoulder.
- Difficulty turning the arm palm up or palm down.
- Bulge in the upper arm above the elbow. This is called a "Popeye" deformity and occurs only if there is a complete tear.
Diagnosis
We’ll examine you and ask about the history of your shoulder problems, particularly when and how your problems developed.
We’ll also consider whether pain in the shoulder may be referred (or originate) from elsewhere in your body. For example, neck problems can irritate nerves in the shoulder.
We’ll do a physical exam to:
- Look at your shoulder and compare it with your other shoulder.
- Assess your ability to move your shoulder in various directions.
- Touch your shoulder to assess any tenderness and/or swelling.
- Check the strength of your shoulder muscles.
- Check the stability of your shoulder joints.
Additional tests may include:
- Shoulder X-ray. This can be useful if we suspect your symptoms are caused by a problem with the bones, such as arthritis, a fracture, or a tumor.
- MRI (magnetic resonance image).
- Ultrasound. We may do this test to examine the tendons and other structures of your shoulder.
Causes and Risk Factors
Rotator cuff tear
Rotator cuff injuries can be caused by:
- Injury, such as from a fall.
- Overuse during sports activities or work requiring overhead reaching, lifting, or throwing.
- Wear and tear over time. For example, this can create bone spurs at the top of the shoulder blade, which can rub on and tear the rotator cuff.
Shoulder cartilage tear
Some activities can injure the shoulder cartilage in the joint, such as:
- Repetitive forceful overhead movements.
- Activities that involve high stress overhead movements. For example, athletes and weightlifters are more likely to have a cartilage tear.
- Shoulder dislocation. This can tear the cartilage.
Biceps tendinitis
Most biceps tendinitis is caused by wear and tear that gradually weakens the tendon over time. Some cases can be caused by an injury. Repetitive movements during regular swimming, tennis, or baseball make tendinitis worse.
You’re more likely to develop biceps tendinitis if you:
- Fall on an outstretched arm.
- Lift something too heavy.
- Pull forcefully, such as by tugging on a lawn mower starter.
- Lift items overhead frequently.
- Play tennis or swim regularly.
- Smoke.
You can also get biceps tendinitis if you use too much steroid medication. People who get many prednisone or cortisone injections are at increased risk for tendinitis.
Prevention
Many shoulder problems are difficult to prevent. However, there are things you can do to avoid them or prevent a problem from getting worse.
It’s important to:
- Stretch and warm up before using your shoulder.
- Quit smoking, if you smoke. Smoking impairs blood supply to the tendons, increasing your risk of tendon and muscle tears. We have many resources to help you quit.
- Maintain good posture and stand up straight. This opens the shoulder up, creating more space between the ball of the upper arm bone and the shoulder blade.
You should avoid:
- Lifting heavy objects.
- Repetitive overhead movements, such as weight lifting, for prolonged periods.
Sudden jerking motions like pulling on a lawn mower starter.
Treatment
Nonsurgical treatments
If your symptoms are mild and you can still use your shoulder, we’ll recommend nonsurgical treatments first.
These may include:
- Rest. Avoid lifting, reaching, and overhead motions. Depending on the severity of your injury, you may need to limit the way you move your arm for a few weeks or months.
- Rehabilitative exercise. We can help you use exercise and other methods to repair and strengthen the muscles in your shoulder and arm. This can help reduce inflammation and pain.
We’ll monitor your progress to evaluate when you can resume your normal activities.
Over-the-counter (OTC) pain medications
We may recommend OTC nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve). They reduce pain, inflammation, and muscle spasms, and help you sleep. Read the directions carefully on the package so you take the correct dosage.
OTC NSAIDs aren’t right for everyone. They can interact with other medications. They can also cause problems for people with some medical conditions.
Talk to us about these medications if you:
- Have a complex medical condition.
- Are pregnant or trying to get pregnant.
- Have been taking OTC NSAIDs and they don’t relieve your symptoms. We can recommend alternatives.
Corticosteroid injections
Inflammation and pain may affect your ability to move your shoulder and do physical therapy. If so, we may recommend a corticosteroid injection directly into the shoulder joint. This is a medication used to reduce inflammation and relieve pain.
We prescribe corticosteroid injections for short-term inflammation only, not for chronic (ongoing) shoulder pain. Too much corticosteroid can make it more likely that you’ll develop:
- Tendon damage
- Osteoporosis
- Eye conditions, including glaucoma and cataracts
- Bone tissue death
These injections can also cause high blood sugar levels. If you have diabetes, talk to your doctor if your blood sugar level becomes elevated.
Surgery
We’ll discuss surgery if nonsurgical approaches haven’t worked. Although complications are rare, all surgery has risks, including:
- Infection
- Bleeding
- Nerve damage
- Loss of function
Recovery and rehabilitation can take many months. Surgery may be the best option if you have a physically demanding job or hobby that requires strenuous shoulder motion.
Shoulder arthroscopy
Arthroscopy uses very small incisions so we can look inside your shoulder and repair damage. It usually takes between 1 and 2 hours, and you’ll be able to go home the same day. We use general anesthetic so you’re asleep during the surgery.
During surgery we will:
- Make a small incision in the back of your shoulder.
- Inject saline solution into the joint, which lets us see inside your shoulder clearly.
- Insert a scope with a camera attached.
- Identify any debris or bone spurs.
- Assess any tears to the rotator cuff or cartilage.
- Make 2 or 3 small additional incisions into your shoulder and insert surgical instruments.
- Remove bone spurs or cartilage and clean out inflammation.
You’ll need to arrange for someone to bring you to the hospital and drive you home.
Shoulder joint/cartilage tear repair
How we repair the cartilage tear will depend on the location and whether other structures are involved.
- Small tears. For a small tear on the rim, we can usually remove it. Torn tissue can catch in the other structures in the shoulder causing pain. Removing it can resolve your symptoms.
- Large tears. Some tears can make the shoulder joint unstable. For example, a tear at the top can extend into the biceps tendon and separate it from the joint. If so, extensive surgery may be needed to repair the cartilage and reattach the tendon.
Rotator cuff repair
If we see a large tear to your rotator cuff when we look inside your shoulder, we may make 1 larger incision, rather than 2 small ones.
To repair it we will:
- Drill small anchors into the top of the arm bone.
- Reattach the tendon to the anchors in the upper arm bone using stitches. These stay in place long enough for the tendon to heal. They slowly dissolve and don’t need to be removed.
If the injury is old and the tendon has shrunk too far back, we may not be able to repair the tendon.
Shoulder replacement
We may recommend replacing the shoulder joint. This can be the best option if:
- The tendon has shrunk too far away from the shoulder joint and can’t be reconnected.
- Other treatments haven’t worked.
- You’re in severe pain.
- You’re losing the ability to use your shoulder.
Lifestyle Recommendations
If you have a shoulder cartilage or tendon injury, there are things you can do to protect your joint. These include:
- Hold heavy items close to your body when lifting.
- Use light weights in the gym. Lift up only to the level of your shoulders.
- Try swimming. It’s an ideal exercise for all your joints. To protect your shoulder use sidestroke or breaststroke. Avoid the front crawl.
- Don’t throw balls overhand or serve overhand when playing tennis.
- Don’t do exercises that require you to push with your shoulder. Avoid shoulder press and push-up exercises.
- Use good ergonomics. When you’re working at a computer, keep your shoulder blades down and back. Take regular breaks to move and stretch.
Additional References
Related Health Tools
Disclaimer
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.