Shoulder

Rotator Cuff Tear

The rotator cuff is the group of tendons in the shoulder joint that provide support and enable a wider range of motion. One of the most common causes of shoulder pain in middle-aged and elderly adults is due to injury of these tendons. This condition is known as a rotator cuff tear.

Causes

A rotator cuff tear results from pressure on the rotator cuff from part of the shoulder blade known as the scapula, as the arm is lifted. It may occur with repeated use of the arm for overhead activities, while playing sports or during motor accidents.

Symptoms

Rotator cuff tear causes severe pain, weakness of the arm, and a cracking sensation upon moving your shoulder in certain positions. There may be stiffness, swelling, loss of movement and tenderness in the front of the shoulder.

Diagnosis

Your surgeon will diagnose a rotator cuff tear injury based on a physical examination, X-rays, and other imaging studies. This may include a MRI, as it provides the best imaging of a rotator cuff tear.

Conservative treatment options

• Rest
• Shoulder sling
• Pain medication injection of a steroid (cortisone) and an local anaesthetic in the subacromial space of the affected shoulder to help decrease the inflammation and pain
• Certain exercises

Surgery

Rotator cuff repair may be performed by open surgery or arthroscopic procedure. In an arthroscopy procedure, space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery you may be advised to practice motion and strengthening exercises.

Shoulder Impingement

Shoulder impingement is the condition of inflammation of the tendons of the shoulder joint. It is one of the most common causes of pain in the adult shoulder. The shoulder is a ‘ball-and-socket’ joint. A ‘ball’ at the top of the upper arm bone (humerus) fits neatly into a ‘socket’ (glenoid) which is part of the shoulder blade (scapula). Shoulder impingement is also known as swimmer’s shoulder, tennis shoulder or rotator cuff tendinitis.

Causes

Impingement occurs when the shoulder blade (scapula) puts pressure on the rotator cuff as the arm is lifted. It is more likely to occur in young and middle-aged people who engage in physical activities that require repeated overhead arm movements. The pain may be due to a “bursitis” or inflammation of the bursa overlying the rotator cuff or a “tendonitis” of the cuff itself. In some circumstances, a partial tear of the rotator cuff may cause impingement pain.

Symptoms

Individuals with shoulder impingement may experience severe pain at rest and during activities, weakness of the arm and difficulty in raising the hand overhead.

Diagnosis

Diagnosis involves physical examination by a doctor who will examine the range of movement in the affected shoulder. X-rays and MRI scans may be ordered to see the injury and associated inflammation.

Conservative Treatment Options

Shoulder impingement can be treated with rest, ice packs, anti-inflammatory drugs, and by avoiding activities that involve the shoulder. Physical therapy may be advised to strengthen the muscles and steroid injections may be given if pain persists.

Surgery

Arthroscopic surgery is recommended if the rotator cuff tendons are torn and to remove any bony spurs.

Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis is a condition characterized by pain and loss of motion in the shoulder joint. It is most common in older adults aged between 40 and 60 years and is more prevalent in women than men.

Causes

Frozen shoulder is caused by inflammation of the ligaments that hold the shoulder bones to each other. The shoulder capsule becomes thick, tight, and stiff bands of tissue called adhesions may develop.

Individuals at risk of developing frozen shoulder are those who:

• Have an existing shoulder injury
• Have previously undergone shoulder surgeries
• Have had their shoulder immobilized for an extended period of time
• Have other medical conditions such as diabetes, hypothyroidism, hyperthyroidism, Parkinson’s disease or cardiac diseases

Symptoms

Frozen shoulder may cause pain, stiffness and limit movement of the shoulder.

Diagnosis

Frozen shoulder condition can be diagnosed by the presenting symptoms and radiological diagnostic procedures such as X-rays or MRI scans.

Conservative Treatment

Conservative treatment options include:

• Non-steroidal anti-inflammatory drugs and steroid injections for pain
• Physical therapy to improve your range of motion
• Sometimes heat may be applied to reduce pain

Surgery

Your surgeon may recommend shoulder arthroscopy when conservative treatments do not work. During surgery, the scar tissue will be removed and any tight ligaments will be dissected. Following surgery physical therapy is recommended to ensure full range of motion and muscle strength.

Shoulder Instability

Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred as subluxation, whereas the complete separation is referred as dislocation.

Causes

The risk factors that increase the chances of developing shoulder instability include:

• Injury or trauma to the shoulder
• Falling on an outstretched hand
• Repetitive overhead sports such as baseball, swimming, volleyball, or weightlifting
• Loose shoulder ligaments or an enlarged capsule

Symptoms

The common symptoms of shoulder instability include pain with certain movements of the shoulder and a popping or grinding sound that may be heard or felt. Swelling and bruising of the shoulder may be seen immediately following subluxation or dislocation. Visible deformity and loss of function of the shoulder occurs after subluxation. Sensation changes such as numbness or even partial paralysis can occur below the dislocation as a result of pressure on nerves and blood vessels.

Conservative Treatment

The goal of conservative treatment for shoulder instability is to restore stability, strength, and full range of motion. Conservative treatment measures may include the following:

• Closed Reduction: Following a dislocation, your orthopaedist can often manipulate the shoulder joint, usually under anesthesia, realigning it into proper position. Surgery may be necessary to restore normal function depending on your situation
• Medications: Over the counter pain medications and NSAID’s can help reduce the pain and swelling. Steroidal injections may also be administered to decrease swelling
• Rest: Rest the injured shoulder and avoid activities that require overhead motion. A sling may be worn for 2 weeks to facilitate healing
• Ice: Ice packs should be applied to the affected area for 20 minutes every hour

Surgery

When these conservative treatment options fail to relieve shoulder instability, your surgeon may recommend shoulder stabilization surgery. Shoulder stabilization surgery is performed to improve stability and function to the shoulder joint and prevent recurrent dislocations. It can be performed arthroscopically, depending on your particular situation, with much smaller incisions. Arthroscopy is a surgical procedure in which an arthroscope, a small flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat the condition. The benefits of arthroscopy compared to open shoulder surgery include; smaller incisions, minimal soft tissue trauma and less pain which equates to a faster recovery.

To find more shoulder conditions head to the orthopaedic connection website of American Academy of Orthopaedic Surgeons..

Unfortunately for those with stiff shoulder it is usually uncomfortable, even if the degree of stiffness is not great. Fortunately most stiff shoulders can be managed successfully by a simple exercise regime conducted by the patient at home.

This regime is the safest of all treatments for frozen shoulders and involves gently and gradually getting the shoulder moving again. Although it may take months of doing the exercises persistence is important. Even if arthritis is present, this program may help preserve and even improve the shoulder’s range and comfort. Please note that prior to beginning these exercises, you should consult your physician.

There are two components to the home program for stiff shoulders. The first is a series of stretching exercises and the second relates to regular participation in a fitness program.

Your opposite arm is a great therapist for your stiff shoulder. Your ‘therapist arm’ is always available to apply a gentle stretch in any direction of tightness. Each of these gentle stretches needs to be held up to a count of 100.

If other directions of stiffness are identified, they can be stretched with a similar approach. An important principle of the stretching exercise is to allow your muscle to relax so that the stretch can be applied to the soft tissues without muscle interference. Tissues of a tight shoulder do not like to be stretched suddenly, roughly or with a lot of force. Thus, the strategy is to apply a gentle stretch so that at most minimal soreness results. Any soreness should go away within 15 minutes after you stop the exercises.

The great thing about this exercise is that you are in control. You can adjust the vigour of the stretching to do what is most easily tolerated by your shoulder. The exercise program is ‘portable’ and can be performed in your home, car, office, bus, aeroplane or wherever you happen to be. This is important, because consistency in this exercise regime pays off. If pain results from this program, do not stop or alter the frequency of your exercise sessions, just reduce the vigour of the stretches so that they are comfortable.

• Forward Elevation – Lying
• Forward Elevation – Sitting
• External Elevation – Standing and Lying
• Cross Body Stretch – Cross Body

Shoulder Joint Replacement

Shoulder joint replacements are usually performed in order to relieve pain and when all non-operative treatments have failed.

Reverse Total Shoulder Replacement

Reverse total shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where the patient suffers from both shoulder arthritis and a rotator cuff tear.

Shoulder Hemiarthroplasty

Shoulder hemiarthroplasty, also called partial shoulder replacement, is a surgical procedure during which the upper bone in the arm (humerus) is replaced with a prosthetic metal implant, whereas the other half of the shoulder joint (glenoid or socket) is left intact.