Shoulder pain is a common orthopedic complaint, but may not always be caused by a shoulder condition. Conditions such as gallstones, peptic ulcers, and even heart conditions may refer pain to the shoulder, as may problems with the neck. While the orthopedic medical transcriptionist might expect to encounter only shoulder injuries such as rotator cuff tears and fractures in the orthopedic clinic setting, she should be knowledgeable of inter-related medical terminology and prepared for a variety of complaints and conditions in addition to the basics below.
Anatomy – Shoulder Muscles, Bones, and Tendons
The two major bones that form the shoulder joint are the humerus and the scapula. The scapula has three distinct parts: the glenoid, acromion, and coracoid process. Where the humerus meets the glenoid, we have the glenohumeral joint, a ball-and-socket joint. This joint is cushioned by articular cartilage and stabilized by the labrum. The clavicle, particularly where it meets the acromion (the acromioclavicular joint or AC joint) is also considered part of the shoulder. The SC joint or sternoclavicular joint is where the clavicle meets the sternum.
The major shoulder muscles include supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles make up what is commonly referred to as the rotator cuff. This is because all four attach to the scapula as a unit with a single ligament and attach anteriorly to the greater tuberosity of the humerus. A complete tear of the rotator cuff disengages the muscles from the bone.
Shoulder Injuries, Conditions, and Diagnoses
Orthopedists obviously see many fractures (broken bones). In the shoulder, potential fractures include the humerus, scapula, and clavicle. Bony injuries might also include subluxation or dislocation of the shoulder joint.
Soft tissue injuries of the shoulder are more common than bony injuries. Muscles, ligaments, and tendons suffer strains, sprains, tears and ruptures. Common soft tissue injuries to the shoulder include:
- acromioclavicular sprain
- labral tear
- subacromial bursitis
- bicipital tendonitis
- rotator cuff strain
- adhesive capsulitis
Due to its flexible nature, the shoulder joint is also subject to impingement syndromes such as supraspinatus impingement, coracoid impingement, and even thoracic outlet syndrome.
Orthopedic examination of the shoulder involves varied shoulder tests that depend on the patient’s history. This history gives the physician (and the experienced transcriptionist) clues to the likely differential diagnoses. These orthopedic tests and maneuvers for the shoulder make up the bulk of the orthopedic shoulder examination.
Sources:
- American Academy of Orthopaedic Surgeons. “Rotator Cuff Tears”. (Accessed February 21, 2011).
- Gulick, Dawn. Ortho Notes: Clinical Examination Pocket Guide. ISBN 10: 0-8036-1350-4.
- Southern California Orthopedic Institute. “Anatomy of the Shoulder”. (Accessed February 21, 2011).
Jennifer Groepl - Living the good life in beautiful Cape Coral, Florida, Jennifer Groepl is currently working on her YA fiction projects. An intrinsically ...
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