shoulder

Anatomy of the shoulder – the most mobile joint

The shoulder consists of several partial joints and a finely coordinated interaction of bones, cartilage, capsule, ligaments, tendons and bursa. This complex unit allows a large range of movement, but requires stability from muscles and ligaments.

• Glenohumeral joint: Ball joint between the head of the humerus and the socket of the scapula articular surface
• Acromion with acromion and AC joint between clavicle and acromion
• Rotator cuff: tendons of supraspinatus, infraspinatus, subscapularis and teres minor for dynamic stabilization
• Labrum: cartilaginous joint lip to increase the socket surface and provide stability
• Biceps tendon: long biceps tendon in the groove of the humerus and on the upper labrum
• Bursa: Bursa like the subacromial bursa to reduce friction
• Capsule-band device: provides guidance and final position control

The scapulohumeral rhythm is important for pain-free movement: around a third of the arm elevation is achieved by moving the shoulder blade on the chest. Disturbances in this coordination often lead to impingement complaints.

Common shoulder diseases at a glance

• Subacromial pain syndrome and impingement: tightness under the acromion with irritation of tendons and bursa
• Tendinopathies of the rotator cuff: painful overloading of the tendon without or with partial tears
• Rotator cuff tear: partial or complete tendon tear, acutely traumatic or degenerative
• Biceps tendon problems and SLAP lesions: Inflammation, instability or labral tears at the upper socket
• Calcified shoulder: Calcium deposits in tendons, often with periods of severe pain
• Adhesive Capsulitis Frozen Shoulder: inflammatory frozen shoulder in typical phases
• Osteoarthritis of the shoulder Omarthrosis and AC joint arthrosis: Cartilage wear with pain under strain and at rest
• Bursitis: subacromial or subdeltoid bursitis
• Shoulder instability and dislocations: recurrent dislocations, often with accompanying labral and bony lesions
• Proximal humerus fracture and other injuries: bony damage after a fall or accident

Depending on the findings, the treatment strategy and healing process differ significantly. A thorough diagnosis is therefore crucial.

Causes and risk factors

• Repetitive overhead work and sports with overhead loading such as swimming, tennis, volleyball, throwing disciplines or CrossFit
• One-sided office or craft workloads, unfavorable ergonomics and posture problems
• Age-related tendon and cartilage changes, reduced tissue quality
• Metabolism and blood circulation factors such as diabetes or smoking
• Anatomical variants that can narrow the subacromial space
• Accidents, falls or direct trauma resulting in tears or dislocations
• Muscular imbalances and impaired shoulder blade control

Often several influencing factors come together. The individual anamnesis helps to identify triggers and treat them effectively.

Typical symptoms – when should they be clarified?

• Pain on the outside of the upper arm when lifting, turning or lying on the shoulder
• Night pain, especially when lying on your side
• Restricted movement, stiffness or feeling of blockage
• Loss of strength during overhead or rotational movements
• Snapping, rubbing or cracking when moving
• Swelling and warming in inflammatory processes
• Feeling of insecurity or dislocation after dislocation

Warning signs that should be clarified by a doctor promptly: severe pain at rest, acute deformity after an accident, pronounced redness and overheating, fever, feelings of numbness or paralysis.

Diagnostics in practice

We start with a structured history and a careful clinical examination. Functional tests help to narrow down affected structures and identify differential diagnoses.

• Clinical tests: Jobe, Hawkins-Kennedy, Neer, Lift-off, Speed, O’Brien, Apprehension and Relocation
• Sonography Ultrasound: dynamic assessment of tendons, bursae and effusions
• X-ray: assessment of bones, joint space, calcium deposits and acromion shape
• MRI if the findings are unclear, there is suspicion of a tear, labral lesions or irritation of deep structures
• Rarely CT 3D for bony defects or preoperative planning
• Laboratory only if inflammatory or systemic causes are suspected

The findings are explained transparently in order to jointly determine the targeted therapy plan.

Conservative therapy – our first step

The majority of shoulder problems can be successfully treated without surgery. The aim is to reduce pain, address the cause and restore function sustainably.

• Information and activity adjustment: dose the load, temporarily avoid painful end positions
• Physiotherapy: Rotator cuff strengthening, scapulathoracic stability, posture training and mobility
• Manual techniques and targeted exercise program for the scapulohumeral rhythm
• Thermotherapy, cold or heat depending on the phase; additional taping
• Short-term medical pain therapy as needed and tolerated
• Ultrasound-guided injections if there is a clear indication, for example subacromial for inflammatory pain peaks
• Shock wave therapy ESWT for suitable calcified shoulders as a conservative option
• Viscosupplementation hyaluronic acid for osteoarthritis selected and after informed consent
• Autologous blood products such as PRP for tendinopathies in individual cases; Evidence depends on indication

Regenerative procedures are offered individually and after a transparent benefit-risk assessment. A promise of healing is not given.

Surgical options – when conservative is not enough

Operations are considered when conservative measures do not achieve the desired result or structural damage needs to be clearly addressed. The decision is made individually and often in collaboration with specialized centers.

• Arthroscopic rotator cuff suturing for suitable tears
• Arthroscopic calcific debridement for therapy-resistant calcified shoulder
• Biceps tendon tenotomy or tenodesis for persistent biceps pain
• Stabilizing procedures after Bankart dislocation or bony procedures such as Latarjet for pronounced defects
• Interventions on the AC joint for persistent osteoarthritis symptoms
• Shoulder endoprosthetics for advanced osteoarthritis by cooperating clinics

After surgical measures, consistent rehabilitation is crucial for the functional result. We accompany the conservative phases before and after the procedure.

Prevention and self-help in everyday life

• Optimize ergonomics: monitor at eye level, rest your forearms, relax your shoulders
• Regular movement breaks and mobilization exercises
• Technique training for overhead sports and slow increase in load
• Balanced strengthening of external rotators and lower trapezius muscles
• Warm up before exercise, cool down and stretch in moderation
• Vary your sleeping position, avoid lying on your side on the side of pain, use a pillow to support your arms
• Lift and carry loads close to your body, avoid jerky end positions

Mild complaints often improve with adjusted stress and targeted exercises. If pain persists or increases, you should seek medical advice.

Rehabilitation and course

Shoulder regeneration follows a process that is adapted to the respective diagnosis. Patience and continuity are important success factors.

In frozen shoulder, the disease typically progresses in a stiffening, stiffening and loosening phase; The therapy depends on the clinical phase.

Your shoulder consultation in Hamburg-Winterhude

In our practice at Dorotheenstrasse 48, 22301 Hamburg, we take time for anamnesis, examination and a clear explanation of the findings. We prefer conservative, evidence-based treatment paths and plan the therapy together with you – transparently and realistically.

• Short distances: ultrasound and x-ray clarification organized
• Individual exercise programs and physiotherapy recommendations
• Ultrasound-guided infiltrations if indicated
• Cooperation with specialized clinics if an operation makes sense

This is how your appointment works

Further topics on the shoulder

• Muscles, tendons, ligaments of the shoulder - from the rotator cuff to the biceps tendon
• Joint structures, cartilage and capsule – labrum, cartilage wear, bursa
• Instabilities and dislocations – when the shoulder dislocates

Use the in-depth pages for detailed information on the causes, diagnosis and therapy of the respective subtopics.