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Inside the Shoulder: A New Look at an Old Problem

Amazing things are happening in the world of orthopedics. Technology continues to improve, helping doctors find the tiniest tears in tendons and joint surfaces. When MRI (magnetic resonance imaging) doesn't show any problems, arthroscopy may give a clearer picture. The arthroscope is a tiny TV camera that can be inserted into a joint through a very small incision.

The shoulder is an area where arthroscopy has helped tremendously. Many people develop a shoulder problem called impingement. This occurs when part of the soft tissue around or inside the shoulder gets pinched. This tissue could be a tendon or bursa (soft sac to cushion the shoulder).

Different kinds of impingement occur in different groups of people. The most common or "classic" case happens in middle-aged, nonathletic individuals. In this case, a bursa and tendon in the front of the shoulder get pinched by a bony arch that crosses over them. A second type of impingement can occur in younger athletes. Most of these individuals do a lot of throwing and develop shoulder pain and impingement. This is most likely to happen when a tendon tears a little and starts to fray. The frayed edges get pinched against the rim of the shoulder joint when the arm is in a certain position.

Using arthroscopy, doctors have found a third kind of impingement. This kind usually doesn't show up in MRIs. It happens in younger adults who are not athletes. Although it looks like classic impingement, the arthroscope shows a very small area where the labrum has started to fray. This is the cartilage around the rim of the socket where the shoulder bone inserts.

Earlier and more specific treatment can be provided as more and more doctors identify the exact damage inside the shoulder with arthroscopy. The smallest of tears can cause significant pain and difficulty moving the arm. Finding the exact cause of the problem may keep small tears from becoming big ones.

References: Steven Struhl, MD. Anterior Internal Impingement: An Arthroscopic Observation. In Arthroscopy. January 2002. Vol. 18. No. 1. Pp. 2-7.

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