Who Gets Shoulder Problems?
After age 25, most shoulder pain problems are caused by the effect of repeated overhead motions for a long period of time. Weekend athletes and do-it-yourselfers are especially vulnerable to overuse problems in the shoulder.
Under age 40, shoulder pain is usually either a traumatic rotator cuff injury or the result of instability. Instability means the ball slips out of socket.
Over age 40, shoulder pain is usually caused by repeated overhead motions for a long period of time, leading to degeneration of the rotator cuff tendon. A degenerated tendon may eventually tear. People over the age of 40 may also develop arthritis of the shoulder, although arthritis of the shoulder is uncommon.
The leading causes of shoulder pain are bursitis, tendonitis and irritated rotator cuff. This group of conditions is called shoulder impingement syndrome.
What is degeneration of the rotator cuff?
Repetitive overuse and / or age can lead to degeneration of the tendons similar to a rope becoming frayed. The tendons become weak and painful. If the degeneration progresses, the tendon can become so weak it ruptures, especially during a sudden activity such as swinging a golf club.
What is instability?
Instability means the humerus (ball) slips out of the glenoid (socket). This can occur from an injury and is then called a dislocation (dislocated shoulder). If the dislocation occurs repeatedly, it will lead to arthritis unless the instability is corrected. A less severe form of instability is called subluxation, where the ball slips part way out and then goes back in. Subluxation can be subtle but if untreated will usually lead to chronic strain on the rotator cuff tendon. Dislocation or sublaxation can also cause injury of cartilage in the shoulder.
Instability, degeneration and arthritis all cause dull achy shoulder pain which can become sharp and severe, particularly with overhead motion. Pain is frequently worse at night. A sudden increase in pain may mean a degenerative tendon has ruptured. A catching sensation may indicate torn cartilage.
What is impingement syndrome?
Impingement Syndrome is the name given to an irritated rotator cuff, either from repeated overuse or degeneration.
What is the treatment for shoulder impingement?
- Rest – Avoid strenuous activity, especially overhead motion or throwing.
- Ice – An ice pack can help ease pain and swelling from inflammation.
- Oral Medication – Anti-inflammatory medicines such as aspirin, ibuprofen, Aleve or Naprosyn may help the pain.
- Cortisone Injections – Cortisone is a very powerful medication and when injected into the area can be very effective in relieving pain and inflammation.
- Physical Therapy – Once the pain and inflammation are under control, a program of exercise, ice, heat, electrical stimulation, ultrasound and massage is used to help you regain motion. This also helps to maintain the rotator cuff strength.
When is shoulder surgery helpful?
Thanks to recent advances in arthroscopy, many of the problems that cause shoulder pain can be corrected using the same techniques that revolutionized the treatment of knee problems.
Shoulder Arthroscopy
Shoulder arthroscopy is a minimally-invasive outpatient procedure requiring small (less than 1 inch) incisions. This procedure allows the surgeon to see and work inside the shoulder joint. Problems that can be treated with arthroscopy include:
- Impingement Syndrome
- Instability
- Torn Cartilage
- Rotator Cuff Tears
Shoulder surgery such as arthroscopy is indicated if the shoulder problem cannot be satisfactorily treated with modification of activities, physical therapy or medication.
Rotator Cuff Repair
Rotator cuff repair can be performed either arthroscopically or through a 2-3 inch incision, depending on the size of tear and tissue quality. Arthritis of the shoulder, if severe and disabling, can be successfully treated with a total shoulder replacement. A total shoulder replacement usually requires one day in the hospital.
What kind of anesthesia is used?
Shoulder surgery can be performed under local or general anesthesia, whichever the patient prefers.
What is the length of recovery for a shoulder arthroscopy?
What is the length of recovery for a shoulder replacement?
A sling is worn for 7 days. Physical therapy for 6 weeks. Return to work in 3-6 weeks.
When the arm is raised repeatedly over the head, the tendons rub against the underside of the shoulder bone and become irritated. The tendons swell, leaving even less space between tendons and bone. The irritation creates more irritation. It is much like a rope being drawn again and again across a craggy rock. This is called tendonitis, a leading cause of shoulder pain.
Occasionally, injuries or infections can also lead to arthritis, although arthritis of the shoulder is less common than in the knee or hip. Arthritis in the shoulder causes a roughening of the joint from worn cartilage and loose fragments of bone.
- Rest – Avoid strenuous activity and any motion that causes pain. In some cases a shoulder sling is helpful to rest fatigued muscles and inflamed tendons.
- Ice – An ice pack on the affected shoulder can help ease inflammation when combined with gentle motion.
- Oral medicines – Anti-inflammatory medicines such as Motrin, Feldene, Voltaren, Naprosyn or Aspirin will help reduce inflammation.
- Cortisone Injections – Cortisone is a natural hormone and a very powerful medicine for inflammation. When injected directly into the inflamed area, it is very effective in decreasing swelling and inflammation that cause pain.
Problems that can be treated through arthroscopy include:
- Impingement syndrome
- Irritated rotator cuff
- Torn Cartilage
- Unstable Joint
In some cases, however, if the rotator cuff is severely damaged and leads to arthritis, the only option for pain-free motion is a shoulder replacement. Shoulder replacement requires a 4-5 day hospital stay.
On a Friday morning, Edna checked in for arthroscopy. She was given a general anesthesia, the doctor dimmed the lights and connected the television monitor. Through three tiny incisions (needing only one stitch each to close) in Edna’s shoulder, he smoothed an inflamed tendon and trimmed a small amount of bone in order to enlarge the space between the tendon and bone.
Edna took it easy for the next few days and then started physical therapy to strengthen her muscles and restore her shoulder motion. Six weeks later she was back playing golf, moving her shoulder easily and without pain.
