Elbow to Shoulder

Oakland Regional Hospital Orthopaedic Surgeons that can improve your lifestyle:
 
Jerome V. Ciullo, M.D.
Mark J. Milia, M.D.
Nilesh Patel, M.D.
 
Shoulder injuries are frequently caused by athletic activities that involve excessive, repetitive, overhead motion, such as swimming, tennis, pitching, and weightlifting. Injuries can also occur during everyday activities such as cleaning the house, hanging pictures, and gardening.
 
Shoulder Injury Warning Signs
If you're having pain in your shoulder, you should ask yourself these questions:
  • Is your shoulder stiff? Can you rotate your arm in all the normal positions?
  • Does it feel like your shoulder could pop out or slide out of the socket?
  • Do you lack the strength in your shoulder to carry out your daily activities?
ELBOW
Elbow injuries occur most commonly during:
  • Sports or recreational activities.
  • Work-related tasks.
  • Work or projects around the home.
  • Falls.
Sudden (acute) injury
  • Bruises from a tear or rupture of small blood vessels under the skin.
  • Injuries to ligaments, the ropey fibers that connect bones to bones around joints.
  • Injuries to tendons that connect muscles to bones.
  • Injuries to joints sprains that stretch or tear the ligaments.
  • Pulled muscles strains caused by overstretching muscles.
  • Muscle tears or ruptures, such as your biceps or triceps in your upper arm.
  • Broken bones fractures of the upper arm bone (humerus) or the forearm bones (ulna or radius) at the elbow joint.
  • Dislocations of the elbow joint (out of its normal position). See a picture of a dislocated elbow
Overuse injuries
  • Bursitis. Swelling behind the elbow may be olecranon bursitis (Popeye elbow).
  • Tendinosis, which is a series of microtears in the connective tissue in or around the tendon.
    • Soreness or pain felt on the outside (lateral) part of the elbow may be tennis elbow (lateral epicondylitis). This is the most common type of tendinopathy that affects the elbow and most often is caused by overuse of the forearm muscles. This overuse may occur during sports, such as tennis, swimming, golf, and sports involving throwing; jobs, such as carpentry or plumbing; or daily activities, such as lifting objects or gardening.
    • Soreness or pain in the inner (medial) part of the elbow may be golfer's elbow. In children who participate in sports that involve throwing, the same elbow pain may be described as Little Leaguer's elbow.
  • Pinched nerves, such as ulnar nerve compression, which is the pinching of the ulnar nerve near the elbow joint. This usually occurs with repeated motions.
  • An infection of the elbow may cause pain, redness, swelling, warmth, fever, chills, pus, or swollen lymph nodes in the armpit on that side of your body. "Shooter's abscess" is an infection commonly seen in people who inject illegal drugs into the veins of their arms.
Tennis elbow
Tennis elbow or lateral epicondylitis is an extremely common injury that originally got its name because it is a frequent tennis injury, appearing in a large proportion of tennis players. Nevertheless it commonly manifests in a vast proportion of people who do not play tennis at all.
 
Golfers / Throwers elbow
Golfer elbow is a similar injury to tennis elbow only it affects the inside of the elbow instead. Golfer elbow is more common in throwers and golfers hence the 'nicknames'. Also known as flexor / pronator tendinopathy this elbow pain is seen in tennis players who use a lot of top spin on their forehand shots.
 
Elbow Dislocation 
Can be a complete dislocation or a subluxation of either the Radius, Ulna or both! Elbow dislocations are the second most common dislocations in adults, behind shoulder dislocations. The elbow is a very stable joint and so it requires a lot of force to dislocate it.
 
Broken Elbow
An elbow fracture is a break in one of the bones which form the elbow joint. There are three bones which could be broken. These are the Humerus (upper arm bone), Ulna and Radius (two forearm bones).
 
Ulna Fracture
An Ulna Fracture is a break in the Ulna bone, which is one of the two bones in the forearm. A fracture may occur from a sudden, direct trauma or impact, or a strong muscle contraction - known as an avulsion fracture.
 
Olecranon Fracture
The Olecranon process is part of the Ulna (forearm bone) which can be felt as the large bony prominence at the back of the elbow. There is very little protection in this area and so it can easily be fractured from a direct impact on fall onto the bent elbow.
 
Radial Head Fracture
A fracture of the head of the Radius.
 
Entrapment of the radial nerve
The symptoms of radial nerve entrapment are very similar to those of tennis elbow. The radial nerve divides into two branches at the elbow. These are the superficial radial nerve and the posterior interosseous nerve (PI nerve). It is the PI nerve that may become entrapped in the forearm.
 
Cubital tunnel syndrome / Ulnar nerve entrapment
Compression of the Ulna nerve within the 'cubital tunnel' on the inside of the elbow- also known as ulnar nerve compression.
 
Median nerve injury
Damage to the median nerve at the elbow may occur with injuries to the inside of the joint. Injury to the median nerve at the elbow may cause symptoms to appear in the forearm, wrist and hand.
 
SHOULDER
 
Sudden (acute) injury
Injuries are the most common cause of shoulder pain.
A sudden (acute) injury may occur from a fall on an outstretched arm, a direct blow to the shoulder, or abnormal twisting or bending of the shoulder. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. If nerves or blood vessels have been injured or pinched during the injury, the shoulder, arm, or hand may feel numb, tingly, weak, or cold, or may look pale or blue. Acute injuries include:
  • Bruises (contusions), which occur when small blood vessels under the skin tear or rupture, often from a twist, bump, or fall. Blood leaks into tissues under the skin and causes a black-and-blue color that often turns purple, red, yellow, and green as the bruise heals.
  • Injuries to the tough, ropelike fibers (ligaments) that connect bone to bone and help stabilize the shoulder joints (sprains).
  • Injuries to the tough, ropelike fibers that connect muscle to bone (tendons).
  • Pulled muscles (strains).
  • Injuries to nerves, such as brachial plexus neuropathy.
  • Separation of the shoulder, which occurs when the outer end of the collarbone (clavicle) separates from the end (acromion) of the shoulder blade because of torn ligaments. This injury occurs most often from a blow to a shoulder or a fall onto a shoulder or outstretched hand or arm.
  • Damage to one or more of the four tendons that cover the shoulder joint (torn rotator cuff), which may occur from a direct blow to or overstretching of the tendon.
  • Broken bones (fractures). A break may occur when a bone is twisted, struck directly, or used to brace against a fall.
  • Pulling or pushing bones out of their normal relationship to the other bones that make up the shoulder joint (subluxation or dislocation).
Overuse injuries
You may not recall having a specific injury, especially if symptoms began gradually or during everyday activities. Overuse injuries occur when too much stress is placed on a joint or other tissue, often by overdoing an activity or through repetition of an activity. Overuse injuries include:
  • Inflammation of the sac of fluid that cushions and lubricates the joint area between one bone and another bone, a tendon, or the skin (bursitis).
  • Inflammation of the tough, ropelike fibers that connect muscles to bones (tendinitis). Bicipital tendinitis is an inflammation of one of the tendons that attach the muscle (biceps) on the front of the upper arm bone (humerus) to the shoulder joint. The inflammation usually occurs along the groove (bicipital groove) where the tendon passes over the humerus to attach just above the shoulder joint.
  • Muscle strain.
  • A frozen shoulder, which is a condition that limits shoulder movement and may follow an injury.
  • Overhead arm movements, which may cause tendons to rub or scrape against a part of the shoulder blade called the acromion. This rubbing or scraping may lead to abrasion or inflammation of the rotator cuff tendons (also called impingement syndrome).
Other causes of shoulder symptoms
Overuse and acute injuries are common causes of shoulder symptoms. Less common causes of shoulder symptoms include:
  • Muscle tension or poor posture.
  • Pain that is coming from somewhere else in your body (referred shoulder pain).
  • Breakdown of the cartilage that protects and cushions the shoulder joints (osteoarthritis).
  • Calcium buildup in the tendons of the shoulder.
  • An irritated or pinched nerve or a herniated disc in the neck.
  • Infection in the skin (cellulitis), joint (infectious arthritis), bursa (septic bursitis), or bone (osteomyelitis).
  • Invasive cancer that has spread to the bones of the shoulder or spine.
  • Abuse. Any shoulder injury (especially a dislocated shoulder) that cannot be explained, does not match the explanation, or occurs repeatedly may be caused by abuse.
Fracture of the Neck of the Humerus
The Humerus is the bone at the top of the arm which fits into the glenoid or socket of the shoulder to form the glenohumeral joint. The neck of the humerus is at the top of the bone. A fracture is a break in the bone.
 
AC Joint Separation (Acromioclavicular Joint)
The AC joint is short for the acromioclavicular joint. Separation of the two bones forming this joint is caused by damage to the ligaments connecting them. It is sometimes also referred to as a shoulder separation injury.
 
Shoulder Dislocation
Shoulder dislocation is a very common traumatic injury across a wide range of sports. In most cases, the head of the humerus (upper arm bone) is forced forwards when the arm is turned outwards (externally rotated) and held out to the side (abducted). This causes an anterior dislocation, which make up approximately 95% of all shoulder dislocations.
 
Deltoid Strain or Rupture (Tear)
The deltoid muscle is the big muscle on the shoulder. It has three parts - the front (anterior), middle and back (posterior). The muscle lifts the arm up sideways. The front part helps to lift the arm up forwards (flexion) and the back part helps to lift the arm up backwards (extension).
 
Rotator Cuff Injury
The rotator cuff is a group of muscles which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control the joint during rotation (hence the name).
 
Impingement syndrome (Swimmer's shoulder / Thrower's shoulder)
Impingement Syndrome, which is sometimes called Swimmer’s shoulder or Thrower’s shoulder, is caused by the tendons of the rotator cuff (supraspinatus, infraspinatus, teres minor and subscapularis muscles) becoming 'impinged' as they pass through a narrow bony space called the Subacromial space – so called because it is under the arch of the acromion. With repetitive pinching, the tendon(s) become irritated and inflamed.
 
Rupture of the supraspinatus muscle / tendon
The supraspinatus muscle runs along the top of the shoulder blade and inserts at the top of the arm (humerus bone). It is one of the four rotator cuff muscles. This muscle is used to lift the arm up sideways and is also important in throwing sports as it is the muscle that holds the arm in the shoulder joint when you release what you are throwing.
 
Rupture of the long tendon of the biceps muscle
The biceps muscle splits into two tendons at the shoulder. A long one and a short one. The long tendon runs over the top of the humerus bone (upper arm) and attaches to the top of the shoulder blade. A rupture of this tendon is rare in young athletes but more common in older ones.
 
When is Total Joint Replacement necessary? 
An arthritic or damaged joint is removed and replaced with an artificial joint, called a prosthesis.
 
The goal is to relieve the pain in the joint caused by the damage done to the cartilage. The pain may be so severe, a person will avoid using the joint, weakening the muscles around the joint and making it even more difficult to move the joint. A physical examination, and possibly some laboratory tests and X-rays, will show the extent of damage to the joint. Total joint replacement will be considered if other treatment options will not relieve the pain and disability.
 
For further information about total joint replacement, please visit A.A.O.S