The shoulder is the most mobile and complex joint of the entire musculoskeletal system, which makes it very vulnerable to pathologies.

• What is the orthopaedic examination of the shoulder?

This is a professional assessment, performed by a specialist orthopaedic and traumatology doctor who is experienced in the treatment of pathologies affecting the entire shoulder district. The visit is essential to identify any problems, identify their causes and find the most suitable and effective solution.

We will now see what to expect during an orthopaedic shoulder visit and how to prepare for optimal results.

• When to request the visit

The first objective of the orthopaedic examination of the shoulder is to confirm the causes of the discomfort. It is essential to understand whether pain, movement limitations and other symptoms of the patient are actually caused by the shoulder joint, or from a related cervical problem or inflammation or injury in another adjacent area

During the visit, in the thermal rehabilitation area of Bibione Thermae we try to understand which are the most common problems based on the symptoms of the patient and the functional evaluation tests performed. In this way, a diagnosis is made and a personalized treatment or rehabilitation path defined

• What are the main symptoms?
  • shoulder pain;
  • general night pain;
  • movement difficulties;
  • loss of strength with functional impotence 
  • Paraesthesia (tingling)
  • Joint stiffness

These symptoms help the orthopaedic doctor to identify pathological conditions and establish their causes

• What are the main pathologies that cause pain?
  • injuries to the rotator cuff; 
  • tendinopathy;
  • adhesive capsulitis (or frozen shoulder);
  • subacromial conflict syndrome
  • results of humerus/clavicle/scapula fractures;
  • long head injury of the biceps (CLB);
  • gleno-humeral dislocation of the head;
  • scabial-humeral arthrosis;
  • instability
  • bursitis

Damage to the rotator cuff, tendon calcification and adhesive capsulitis are the most frequent pathologies that can cause disabling consequences. Let’s see them in more detail:

• Injury of the rotator cuff

The rotator cuff consists of 4 tendons that wrap around the head of the humerus just like a cuff. These tendons, which have the function of stabilizing the shoulder joint, allowing movement of the joint on all planes of space, are

• subscapular
• supraspinatus
• infraspinatus
• teres minor

In the vast majority of cases, the supraspinous tendon is more affected than the others because it can be compressed between the humerus head and the acromion (a bone structure that is part of the scapula). This phenomenon of tendon crushing, which is accentuated when you hold the arm in a raised position, can become painful and goes under the name of sub-acromial conflict (or "impingement").

The mechanical stresses resulting from repetitive and heavy movements reach their maximum intensity at the level of the rotator cuff, causing various problems. Some sports can be cause of suffering of the tendons of the rotator cuff too, especially throwing sports (tennis, volleyball, basketball).

Another key factor is age. About 70% of people over the age of 70 have a lesion of one or more hamstrings, but this can remain asymptomatic. This is due to a reduced blood supply of nourishment of the tendon structures.

Finally, metabolic diseases such as diabetes or unhealthy lifestyle habits, like smoking, also play a major role in the development of pathologies affecting the rotator cuff.

• Tendinopathy due to calcification

Calcified shoulder tendinopathy is a fairly frequent painful condition characterized by the presence of calcium deposits especially at the level of the insertion of the rotator cuff. The tendon, degenerated and worn out by calcification, loses much of its functionality and becomes more sensitive to external stresses. Symptoms may also be associated with muscle spasms, inflammation of the sub-acromial sac, tendinopathy of the long head of the biceps, secondary adhesive capsulitis and massive injury of the rotator cuff. As a result, a local inflammatory reaction may occur, which can be more or less intense and cause a lancinating pain that prevents any activity of daily life.

The main risk factors are:

• female gender
• between 30 and 60 years of age
• diabetes or thyroid disease
• practice of an occupational or sporting activity that is strenuous and repetitive for the shoulder joint

• Adhesive capsulitis

Adhesive capsulitis is an inflammation of the articular capsule of the shoulder that can occur either spontaneously or as a result of trauma. It manifests itself with a progressive loss of joint capacity and mainly affects women aged between 40 and 60 years.

Risk factors for adhesive capsulitis, or frozen shoulder, can be different:

• diabetes mellitus;
• arthritis
• outcomes of trauma or surgery
• Parkinson's disease;
• depression;
• hypo or hyperthyroidism;
• hypercholesterolemia

• How is the shoulder orthopaedic examination performed?

The visit is carried out by a doctor specialized in the diagnosis and treatment of pathologies of this joint. Three stages are provided

• Anamnesis

The anamnesis serves the doctor to find the greatest number of information about the patient: clinical history, type of pain, any previous trauma, age, other pathologies, use of medicines and all other information that allows to create a complete picture of the patient’s situation

• Physical examination

The orthopaedic surgeon, through a series of clinical trials, determines which tendons are affected. It also performs a visual postural check of the affected area (presence of redness, swelling, swelling). This diagnosis will then be confirmed, if necessary, through imaging investigations (Ultrasound, Rx, RM)

• Ultrasound evaluation

If necessary, the orthopaedist uses an ultrasound to directly observe the joint and the structures of the shoulder. In this way the diagnostic hypotheses formulated in the previous steps are verified

Other tests, such as X-rays, magnetic resonance imaging or CT scans may be required if necessary

• Conclusions

At the end of the visit, the orthopaedic surgeon is able to establish a possible diagnosis and make a decision on the most suitable treatment. Depending on the diagnosis, conservative treatment or, in severe cases, surgical treatment may be considered. The treatment is agreed with the patient. 

• Follow-up

The doctor will then decide on a follow-up plan for each patient. The plan that may include periodic check-ups to monitor the progress of therapy and rehabilitation

• How long is the visit?

Due to the anatomical and biomechanical complexity of the shoulder joint, the visit lasts a minimum of 20 - 30 minutes

• How to prepare for the orthopaedic shoulder visit

No specific preparation is required, but it is useful to carry any medical reports and previous test results. Wearing comfortable clothes will make it easier to move around during the exam.

Ultimately, an orthopaedic shoulder examination is essential to diagnose and treat pathologies that can compromise the quality of life of patients. With the guidance of experienced specialists, you can identify the problem and start a targeted care path for the recovery of function and wellbeing.

BOOK YOUR VISIT WITH DR. ANDREA TOMASI, Specialist in ORTHOPAEDICS and TRAUMATOLOGY here at Bibione Thermae: Tel. 0431 441757