Joint
Center FAQs
Who gets shoulder problems?
After age 25, most 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. The leading
causes of shoulder pain are bursitis, tendonitis, and irritated
rotator cuff. This group of conditions is called shoulder
impingement syndrome.
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What is bursitis?
The bursa is a fluid-filled sac that cushions
the rotator cuff tendons from the shoulder bone. An irritated
bursa is caused by an inflamed rotator cuff. When irritated,
the bursa produces extra fluid, the sac expands, and the pressure
creates pain.
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What is tendonitis?
Deep in the shoulder are a group of
tendons and muscles called a rotator cuff. They help stabilize
the upper arm bone in the shoulder joint and rotate the
arm. The biceps tendon is also present in front of the shoulder.
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.
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What is an irritated rotator cuff?
Excessive wear on the rotator cuff can
lead to severe irritation, roughening, and eventually ulceration
and tearing of the cuff. An irritated rotator cuff is felt
as a clicking or popping in the shoulder from a ragged piece
of the cuff sliding under the shoulder bone, and arm weakness.
Occasionally, injuries or infections can all 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.
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What are the symptoms?
Bursitis, tendonitis, irritated
rotator cuff and arthritis are all inflammatory reactions
to overuse. With any of these problems, a continuous dull
ache in the shoulder can become a sharp pain when you try
to move your arm, especially over your head. The pain may
be worse at night after a heavy day of activities using
your shoulder.
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What is the treatment for shoulder impingement?
- 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 can be effective in
decreasing swelling and inflammation that cause pain.
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How can physical therapy help?
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.
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When is surgery helpful?
Thanks to recent advances in arthroscopy,
many shoulder problems can be corrected using the same techniques
that revolutionized the treatment of knee problems. Arthroscopy
is an outpatient procedure requiring three tiny incisions
closed with one stitch each. This procedure allows the surgeon
to see and work inside the shoulder joint.
Problems that can be treated through arthroscopy include:
- impingement syndrome
- irritated rotator
- 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 1-2 day hospital stay.
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What kind of anesthesia is used?
For maximum comfort, general anesthesia
is preferred. Regional anesthesia is an option for some patients.
Your surgeon will discuss which type is best for you.
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How long does it take?
Shoulder arthroscopies are performed
as an outpatient procedure. The time from check-in to discharge
usually is as little as two hours. Many people return to their
normal activities within four to five days. People with physically
demanding jobs can usually return to work in two to three
weeks.
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