Rotator Cuff Conditions (Tendinitis, Impingement, Tears):
The rotator cuff is a set of four muscle-tendon units around the shoulder, which serve as dynamic stabilizers of the shoulder, in order to keep the ball (humeral head) centered within the socket (glenoid). They can be damaged over time, or during one specific traumatic event. They can also be damaged when the shoulder is dislocated (comes out of socket). A majority of the time, these conditions can be successfully treated with anti-inflammatory medications, injections, and physical therapy. However, occasionally, patients require surgery. Most of the time this surgery is done arthroscopically (through small incisions and insertion of a camera into the shoulder), but occasionally, open surgery is needed.
Most commonly seen in younger patients who participate in collision sports (football, rugby, etc), when the ball (humeral head) is forced out of the socket (glenoid and surrounding labrum) the shoulder is referred to as dislocated. Usually it requires a reduction (put back in place) by a physician, although occasionally it will slide back in on its own. A single dislocation episode predisposes to further episodes of the same shoulder. Dependent upon one’s age, desired activity level and other considerations, rehabilitation is the first line treatment. If the shoulder continues to dislocate, surgery is usually recommended. This can be performed arthroscopically (through small incisions and insertion of a camera into the shoulder) or with open surgery to repair the damaged structures and “tighten” the shoulder to minimize the chance of further dislocations.
Superior Labrum Anterior-to-Posterior (SLAP) Tears frequently occur in younger patients who participate in overhead throwing activities. These tears often occur after a traumatic event or can occur with repetitive use, and often can be treated with rehabilitation. When conservative means are unsuccessful, arthroscopic repair is recommended. Depending on the age of the patient, and anatomic repair may not be possible and alternative means of repair may be necessary (see below)
The long head of the biceps tendon originates from the superior labrum, and is a frequent pain generator when damaged, from long-term degeneration or after a single traumatic event. Similar to SLAP tears, rehabilitation with anti-inflammatories is the initial treatment. Corticosteroid injections remain a secondary treatment option if initial measures are unsuccessful. Once all other means have failed, surgical treatment by either biceps tenodesis (securing the tendon to the upper part of the humerus (arm bone)) or tenotomy (cutting the tendon) is the primary options for alleviating biceps-related pain.
Acromio-clavicular (AC) separation occurs when a patient lands directly on the superior (upper) aspect of the shoulder. It is classified into six types, and the severity depends on the degree of injury to the three major ligaments which secure the AC joint. The three most common injuries all can be treated non-operatively, which requires a period of immobilization followed by physical therapy. The more severe cases require surgical stabilization and reconstruction. Several techniques exist to do this both with open and arthroscopic techniques.
Fractures around the shoulder, most frequently of the proximal humerus, can occur after an injury, such as a fall (which occurs in older patients) or after a high-energy injury such as motor-vehicle collision. Approximately 85% of proximal humerus fractures can be treated without surgery. For more complex injuries, repair of the fracture with plates and screws or rods, partial shoulder replacement, or reverse total shoulder replacement may be necessary.
The collar bone is a commonly-injured bone, especially in high-speed sports, such as cycling. Most of these breaks can be treated with immobilization and appropriate nutritional supplementation (calcium and protein) to optimize bone healing. Some fractures require surgical treatment, through either repairing the break with a plate and screws or a rod placed inside the bone.
While degenerative (wear-and-tear) arthritis more commonly effect the hip and knee, the shoulder can be affected, as well. Occasionally, a remote traumatic injury can predispose to developing symptomatic shoulder arthritis, while inflammatory conditions, such as rheumatoid arthritis can lead to symptomatic shoulder disease, as well. The mainstays of treatment include activity modification, anti-inflammatory medications and physical therapy. Corticosteroid injections can be given to decrease pain and improve function, as well. When all of the previously-mentioned measures no longer provide pain relief, total shoulder replacement is recommended.
Rotator Cuff Arthritis:
A specific kind of shoulder arthritis which occurs years after the rotator cuff is damaged, can be very debilitating and is often associated with pain and loss of shoulder function. Traditional conservative means, as outlined in the previous section, are initially employed, and are successful a majority of the time. When symptoms no longer respond to these measures, a specific type of shoulder replacement, the reverse total shoulder replacement can be recommended. It is called a reverse replacement, because what is customarily the ball is turned into the socket and vice-versa. It requires a functioning deltoid muscle (found on the lateral aspect of the shoulder) and can provide pain relief and improved range of motion. This procedure can also be used if previous shoulder replacements are not successful.
If you would like your symptoms diagnosed or evaluated, or would like to see if shoulder surgery is right for you, contact one of our physicians at a location near you.