The shoulder (shown in video) is a ball and socket joint. The ball is formed by the head of the humerus (upper arm bone) and the socket is called the glenoid fossa, which is part of the shoulder blade (scapula). This is the larger of the two joints that form the shoulder and is called the glenohumeral joint. Each joint surface is covered by a layer of cartilage called articular cartilage. There is also a smaller joint between the collar bone and another part of the scapula which is called the A-C (acromioclavicular) joint. From an anatomic standpoint the shoulder joint has sacrificed less stability in exchange for more mobility compared to another ball and socket joint – the hip, which is a weight bearing joint. A shallow socket is what allows the shoulder joint to be more mobile and is also what causes it to be less stable. Around the outer edge of the socket there is a rim of cartilage that allows the socket to be deeper (Imagine a race track with very high banked curves). This cartilage socket rim is called the glenoid labrum. There are four rotator cuff tendons that originate from shoulder blade (scapula) muscles and they attach to the ball part of the ball and socket joint. They are responsible for coordinating movements to keep the ball aligned, as ideally as possible, within the shallow socket part of the joint through all the many motions achievable by the highly mobile shoulder joint. A large tendon from the biceps muscle also passes under the rotator cuff tendons in the shoulder. A “sack” called a bursa is strategically positioned in various locations to provide lubrication to all of these tendons. There are also larger muscles surrounding the joint that perform the major motions of the shoulder as well as add strength and stability to the joint. Shoulder problems and neck problems often overlap because both regions share muscles that connect them.
As a result of the shoulder’s higher degree of mobility and lower degree of stability, there are certain characteristic injuries that are common to this joint and can involve any of the anatomic structures listed above. Injuries to the rotator cuff tendons (shown in video) are the most common shoulder conditions and can occur from either repetitive overuse or from a specific injury (such as landing on an outstretched arm). Bursa sacks can become inflamed and cause bursitis. In the case of repetitive overuse, tendinitis develops, but in chronic cases recurrent tendinitis can evolve into tendinosis and eventually into rotator cuff tendon tears. The biceps tendon can also experience injury is the same fashion and in many cases biceps tendon and rotator cuff tendon injuries coexist. Because the biceps tendon (long head) is continuous with the labrum, injuries to both structures often coexist as well. Degenerative changes from osteoarthritis (shown in video below) can also occur in the larger ball and socket (glenohumeral) joint of the shoulder as well as the smaller A-C (acromioclavicular) joint. All of these injuries can be painful and cause functional problems in different ways.
Commonly Treated Shoulder Pain Diagnoses: Rotator Cuff Tendinitis, Rotator Cuff Tear, Shoulder Bursitis, Shoulder (glenoid) Labrum Tear, Biceps Tendinitis, Biceps Tendon Tear, A-C (acromioclavicular) Joint Separation, A-C (acromioclavicular) Joint Arthritis, Shoulder (glenohumeral) Joint Arthritis, Shoulder (glenohumeral) Joint Instability and Subluxation
Depending on the magnitude of degenerative change, the extent of tendon or labrum tear and of course the degree to which a person prioritizes avoiding a surgical intervention, Regenerative Medicine treatments can be considered for any of the shoulder injuries listed above. Call the Regenerative Spine & Joint Center today to find out if you are a candidate for Regenerative Medicine interventions for your shoulder pain. After discussing your shoulder history with you, performing a detailed physical examination and reviewing available imaging studies (x-ray, MRI, etc.) Dr. Terebuh will be able to give you his specific recommendations regarding whether or not Bone Marrow Cell Therapy or Platelet Rich Plasma (PRP) Therapy will help you accomplish the goals you have for your shoulder.