[Press]6 Characteristics & Treatments of Common 'Shoulder Joint' Diseases / Prof. Rhee Sung-min, Dept. of Orthopedic Surgery

The shoulder is the joint with the largest range of motion in our body. This is why we can perform various tasks with our arms. However, recently, the number of patients with shoulder joint diseases is rapidly increasing due to the aging population, sports activities, and the use of smartphones and PCs.

Diseases affecting the shoulder joint range widely from rotator cuff tears to frozen shoulder and calcific tendinitis, with varying symptoms and characteristics. If you suspect any shoulder joint disease, it is crucial not to neglect it but to seek early medical attention to avoid surgery. We have summarized the 6 most common shoulder joint diseases based on the advice of Professor Rhee Sung-min of the Department of Orthopedic Surgery at Kyung Hee University Hospital.

1. 'Rotator Cuff Tear': A Tear in the Shoulder

The most common shoulder joint disease is a rotator cuff tear. It is mostly a degenerative disease that occurs with age. Among the four tendons that make up the rotator cuff—supraspinatus, infraspinatus, subscapularis, and teres minor—the supraspinatus is the most frequently damaged and torn. A tear does not necessarily cause pain immediately. However, it can be accompanied by muscle weakness as well as pain.

For partial tears, conservative treatment is administered while monitoring the condition via ultrasound or MRI every 6 months to a year. However, patients complaining of severe pain may undergo arthroscopic rotator cuff repair. In the case of full-thickness tears due to degenerative changes, conservative treatments such as medication, injection therapy, and stretching are primarily attempted for 3 to 6 months. If pain does not improve or the tear size increases thereafter, surgical treatment is considered.

2. 'Shoulder Dislocation' Caused by External Impact

The shoulder joint looks like a golf ball sitting on a golf tee. While it has a large range of motion, it is relatively unstable compared to other joints.

Shoulder dislocation is mostly caused by direct external impact. When dislocation occurs for the first time, it can be treated conservatively by strengthening the surrounding muscles. However, habitual dislocation is often accompanied by a tear of the anteroinferior labrum, potentially requiring arthroscopic labral repair. Also, if bone loss in the glenoid is severe due to dislocation, other bones around the shoulder (coracoid process) may be harvested and grafted onto the defect site.

3. 'Superior Labrum Anterior to Posterior (SLAP) Lesion' from Excessive Exercise

A SLAP lesion, which Major Leaguer Ryu Hyun-jin suffered from, can be caused by excessive shoulder exercise or injury. It usually occurs in baseball players during the throwing motion or when the arm is suddenly pulled.

Pain occurs when applying force to the shoulder or bending it backward, but since it is not easy to distinguish from other shoulder diseases, diagnosis by a specialist is required. Steroid injections into the joint cavity are sometimes used to improve symptoms, but if pain persists, arthroscopic labral repair is performed.

4. 'Frozen Shoulder (Adhesive Capsulitis)' Affecting Various Ages

Frozen shoulder is a condition where the shoulder hurts and joint movement is severely restricted even without injury. It is often called "Fifty-year shoulder" (Oshipgyun) because it frequently occurs around the age of 50. However, recently, the name "Fifty-year shoulder" is becoming unsuitable as it occurs across various age groups.

Frozen shoulder develops when the joint capsule, which connects the upper arm and shoulder and facilitates smooth movement, becomes inflamed, causing related tissues to adhere to each other. For this reason, patients often complain of pain at night and cannot turn over onto the affected shoulder. Complete recovery can mostly be expected with non-surgical treatments such as medication, injection therapy, and rehabilitation. However, in very rare cases where recovery is not achieved, surgery to release the adhered capsule via arthroscopy is performed.

5. 'Calcific Tendinitis' Causing Pain due to Calcium Deposits

Calcific tendinitis is a disease where pain occurs due to stone-like calcium deposits building up around the rotator cuff, the four muscles surrounding the shoulder joint. Acute cases cause severe pain, whereas chronic worsening leads to persistent aching pain as the enlarged calcium deposits pressure tendons and surrounding tissues. This gradually reduces the range of motion, causing it to be confused with symptoms of frozen shoulder.

The cause of calcific tendinitis has not yet been clearly identified. Treatment generally involves using anti-inflammatory painkillers or prescribing steroid injections to reduce inflammation caused by calcium. In addition, extracorporeal shock wave therapy (ESWT) is used to increase blood flow to eliminate the cause. Ultrasound is also used to stimulate the calcium deposits with a needle to accelerate absorption. If the calcium deposit is very large and causes pain by compressing the surroundings, arthroscopic decompression and calcium removal are performed.

6. 'Shoulder Impingement Syndrome' with Clicking Sounds

Shoulder impingement syndrome is a disease where inflammation occurs due to friction between the rotator cuff surrounding the humeral head and the acromion located above it. It causes pain within a certain range when lifting the shoulder, and sometimes a 'click' or 'pop' sound is heard when moving the shoulder.

Most cases are treated conservatively with anti-inflammatory painkillers, but if the pain is severe and interferes with daily life, arthroscopy is used to remove the bursitis causing the pain and perform acromioplasty.