Shoulder pain can make daily life uncomfortable and even miserable. If you’re suffering from shoulder pain, you should get your shoulder evaluated by a specialist. Dr. J. Michael Bennett is a Shoulder Specialist, and he created this video to help you understand possible causes of your shoulder pain. If you’d like to make an appointment with Dr. Bennett, please call our Sugar Land office at 281-633-8600 or our Houston office at 713-234-3152. Don’t delay in seeing a shoulder specialist, because it could worsen your condition and make your treatment more difficult.
I’m Dr. J. Michael Bennett, and I’m a Board-Certified orthopedic surgeon who specializes in sports medicine and minimally invasive surgery of the shoulder, elbow, and knee. Welcome to the Whiteboard Series.
Today, we’re talking about shoulder pain and shoulder popping. A lot of patients come into our office complaining of painful popping and clicking within the shoulder joint. So I wanted to go over some of the likely causes of painful popping and clicking in the shoulder joint.
First off, it’s key to understand that shoulder popping and clicking is normal, potentially, in a majority of patients, particularly if you have it on both sides. A lot of patient’s shoulders pop and click on a daily basis, just like your knees pop and click.
The key difference here is whether or not it’s painful. If it is painful and it is a new onset, you should get your shoulder checked. Perhaps your shoulder pain started a month ago after sliding and falling down on your shoulder. That’s a little bit more of a serious situation, which needs to be evaluated by a specialist.
If it’s just popping and clicking that you’ve had as long as you can remember, then I wouldn’t worry about it. So if there is any question either way, please seek a professional for further evaluation or recommendations.
The first thing we want to discuss today is a painful pop in the shoulder particularly brought on by a traumatic incident. Perhaps the injury happened when you fell or you that grabbed something heavy. That patient will usually present with a painful pop, pain in the shoulder as well as inability to raise their arm above their head, and significant pain when sleeping at night.
So the first thing you want to think of with that particular scenario is a rotator cuff injury. These are some basic drawings of the shoulder. The shoulder consists of the ball, which is the humeral head and the glenoid, which is the cup.
Surrounding this humeral head is a series of muscles called the rotator cuff musculature. There’s the supraspinatus muscle up top, supraspinatus, subscapularis in the front, and then there’s the infraspinatus in the back, and the teres minor. When they all come together, they form a cuff around the ball and socket mechanism. These are the rotator cuff muscles and tendons all converging around this ball, which is the humeral head. So this is the cuff.
What we’re going to talk about today is a painful pop after a fall from an outstretched extremity, or after lifting something heavy, and the inability to raise their arm above their head. So what that usually means is that this tendon may be involved.
This is the supraspinatus tendon. You can have a tear in that tendon where it inserts right there at the bone. And when that happens, the rotator cuff can act almost like a rubber band, because there is elasticity in those muscles, so those muscles want to go back, they want to go backwards and retract.
Once that muscle and tendon detaches from the bone, your ability to raise his arm up above your head is significantly diminished. So it’s significantly painful and weak. Sometimes patients will present with a drop arm where they can just barely bring it up and it drops down to their side. That is definitely an indication of a possible rotator cuff injury, and it’s recommended that you get it evaluated.
The second possibility is grabbing something heavy and feeling a pop in the shoulder, and then maybe noticing some swelling or bruising, and maybe even a little bit of deformity in the arm. This deformity in the arm is some fullness of the biceps, we call this a Popeye deformity.
That usually means that you might have an injury to the biceps tendon, particularly a rupture of the biceps tendon. And when we say the biceps tendon, we talk about the long head of the biceps tendon, which is this long tendinous structure that inserts at the top of the cup. So the tendon actually comes there in the front of the shoulder and inserts right here, at the top of the cup here.
So this is what it looks like, it forms to the top of the labrum, which is this little bumper around the cup itself, surrounds that glenoid, and the biceps inserts right at the top. Now what can happen is over time, we can get some weakness and some tendinosis and some degeneration of that biceps tendon, and it gets very weak.
Then if you grab something, it’s excessive stress on that bicep that pulls, and then you get a rupture right down there. When that happens, this retracts, like I mentioned before, muscles retract like a rubber band, and then you get a fullness here in the biceps muscle, and we call that a Popeye deformity.
Depending on your work, your status activity-wise, your age, and your expectations, determines what the treatment method is. A lot of times, you can be completely functional with a biceps rupture, particularly the long head of the biceps.
Distal biceps is different. You end up to have a significant weakness of the distal biceps rupture and that needs to be addressed, most of the time, surgically. The long head of the biceps can be addressed nonoperatively if that patient is willing to accept the deformity in their biceps. That is something to consider and have evaluated by an orthopedic surgeon. So please, if you have any of these symptoms, go see somebody and have it evaluated.
The last thing that you need to worry about regarding popping, or locking of the shoulder joint, is a cartilaginous injury to the shoulder. It could be through the labrum, which is this little ring around the glenoid, which is the cup, and you see it here on this view.
This is looking top down from up down on the shoulder, there’s the ball and the socket, the labrum surrounds that socket, and sometimes the labrum can actually be torn and disrupted. If that happens, you can have instability of that ball. The ball can actually dislocate, and that’s actually a labral tear.
The mode of treatment depends on your activity, your age, your activity level, and expectations. A lot of our athletes that have instability of the shoulder will have to get this fixed. And the way we fix it is reattaching the labrum back down to the bone with some anchors. And that gives you back stability of the shoulder.
Another possibility is that you can always have, whenever you have an injury to the shoulder, you can have a little defect of the cartilage which can create a flap of cartilage as well, which can either get dislodged, or can become dislodged and floating in the joint as well and create what’s called a loose body. That can, once again, be either evaluated on plain x-ray, or with an MRI, which actually shows body in the joint.
The problem with that is that this loose body is knocked around in there like a ping pong. It actually can wear down the joint even further and create even more arthritis in the shoulder joint.
So these are some just really basic possibilities when it comes to shoulder painful popping and symptoms associated with shoulder and painful popping. If you do have any of these symptoms, please get evaluated by an orthopedic specialist, and if you would like to contact our office, our office is at 281-633-8600. Thank you very much.
If you have a shoulder injury that causes you pain, you should see a specialist like Dr. Bennett. Trying to tough out the pain can make your injury worse and require more extensive treatment. Call for an appointment in Sugar Land at 281-633-8600 or in Houston at 713-234-3152.
For more information about the causes of shoulder pain and treatments for shoulder injuries, please see our library of patient education videos for shoulder pain and shoulder injuries.