Introduction

Rotator cuff tears are one of the most common causes of shoulder pain. They can occur in both younger patients typically due to trauma and in older patients with both degenerative and traumatic causes. There are 4 tendons that make up the rotator cuff: supraspinatus, infraspinatus, subscapularis, and teres minor. The most commonly torn tendon is the supraspinatus tendon.

Symptoms/Signs

The primary symptom of rotator cuff tears is pain. This pain is often worsened with activity but can also occur at rest. Weakness and limited range of motion are typically present as well. The ability to perform overhead activities including reaching into a cabinet and sporting activities that involve throwing or swinging can be affected. However, symptoms and signs vary considerably depending on the cause and size of the tear.

Evaluation

Your orthopaedic surgeon will review the history of your shoulder pain and perform a physical exam. X-rays are used to evaluate the bones of the shoulder and diagnose fractures, dislocations, and arthritis. Magnetic resonance imaging (MRI) and ultrasound can provide definitive diagnosis of a rotator cuff tear.

Treatment

Non-Operative Treatment
Many patients can be treated non-operatively with a period of rest and non-steroidal anti-inflammatory medications and allowed to resume normal activities as tolerated. Other patients may benefit from physical therapy to strengthen the shoulder and improve range of motion. A steroid injection to decrease inflammation and pain may be offered as well.

Surgical Treatment
Your orthopaedic surgeon will determine if surgery is indicated and discuss the risks and benefits with you. Surgery is typically performed in an ambulatory surgery center as an outpatient procedure. After the torn tendon is repaired, your shoulder is immobilized in a sling for several weeks to allow it to heal. When the rotator cuff tendon heals, physical therapy is commonly utilized to help patients regain their range of motion and strength. Most patients have excellent outcomes after surgical repair.

Introduction

Shoulder arthritis is a common cause of shoulder pain in adults. It typically occurs in older patients as a result of degenerative changes to the shoulder cartilage. However, there are many other causes of arthritis including trauma, rheumatic disease, and rotator cuff disease. The most common type of shoulder arthritis is osteoarthritis.

Symptoms/Signs

Most patients experience pain and limited range of motion.   Pain may be worsened with activity but also occurs at rest. Commonly, patients experience clicking and catching sensations with movement. The ability to perform normal activities may be affected including getting dressed and reaching into cabinets. Progressive worsening with time is typical.

Evaluation

Your orthopedic surgeon will review the history of your shoulder pain and perform a physical exam.  X-rays are the primary imaging technique used to evaluate the bones of the shoulder and diagnose arthritic conditions.  Loss of joint space and bone spurs are common findings of shoulder arthritis. Magnetic resonance imaging (MRI) and computed tomography (CT) may be ordered as adjunct imaging and can provide additional information related to your diagnosis and treatment.

Treatment

Non-Operative Treatment

The majority of patients can be treated non-operatively. Activity modification and non-steroidal anti-inflammatory medications are often prescribed. Physical therapy may help decrease pain and improve range of motion. Steroid injections into the shoulder joint may be considered to temporarily decrease pain and inflammation. Patients with rheumatic diseases are often prescribed disease-modifying medications.

Surgical Treatment

Your orthopedic surgeon will determine if surgery is indicated and discuss the risks and benefits with you.  Surgery can be performed either in the hospital setting or in an ambulatory surgery center depending on a patient’s general health. Surgery often involves replacing the worn out cartilage and is known as shoulder replacement (arthroplasty). Minimally invasive surgery is an option for some patients as well. After surgery, your shoulder is immobilized for a period of time in a sling to allow it to heal. Your doctor may prescribe physical therapy to aid in your rehabilitation. Most patients experience significant pain relief and improved function after surgery.

Introduction

A shoulder fracture is a broken bone. There are 3 bones that make up the shoulder: the clavicle, the humerus, and the scapula. The clavicle is the most commonly fractured shoulder bone. Fractures often occur due to significant trauma in younger patients including falls from a height, sporting injuries, and direct blows to the shoulder. Older patients typically describe lower energy injuries such as a fall from a standing height.

Symptoms/Signs

When a fracture occurs, patients experience severe pain, limited range of motion, swelling and often times bruising. Pain occurs with any shoulder motion and may be partially relieved with immobilization. Some patients notice deformity of the shoulder due to displacement of the bones from their normal position. The severity of symptoms can vary greatly depending on the type of fracture.

Evaluation

Your orthopaedic surgeon will review the history of your shoulder pain and perform a physical exam. X-rays are the primary imaging technique used to evaluate the bones of the shoulder and diagnose a fracture if present. Magnetic resonance imaging (MRI) and computed tomography (CT) may be ordered as adjunct imaging and can provide additional information related to your diagnosis and treatment.

Treatment

Non-Operative Treatment

The majority of fractures can be treated non-operatively. Sling immobilization is the most commonly utilized treatment. Non-steroidal anti-inflammatory medications are often prescribed to help with pain control. Sometimes, stronger pain medication is prescribed as well. Physical therapy can help patients regain their range of motion and strength after the fracture has healed.

Surgical Treatment

Some fractures do require surgical treatment and your orthopaedic surgeon will determine if surgery is indicated and discuss the risks and benefits with you. Surgery can be performed either in the hospital setting or in an ambulatory surgery center depending on a patient’s general health. Surgery involves setting the broken bones and often times using a plate and screws to stabilize the fracture. Minimally invasive surgery and joint replacement are potential options for some fractures as well. After surgery, your shoulder is immobilized for a period of time in a sling to allow it to heal. Physical therapy is commonly recommended after fracture healing occurs to rehabilitate your shoulder. Most patients are able to successfully resume their normal activities and even sports after surgery.

Introduction

Shoulder instability is recurrent separation of the ball-and-socket joint in your shoulder. A partial separation is called a subluxation. Complete separation is called a dislocation. Often times, patients experience a traumatic injury to the shoulder that may lead to recurrent instability. However, instability can also occur due to repetitive stretching of the shoulder ligaments. The most common direction of shoulder instability is towards the front of your body (anterior).

Symptoms/Signs

The primary symptoms of shoulder instability are pain and the sensation of the shoulder slipping out of the joint. The instability is typically associated with certain shoulder positions. Weakness and limited range of motion may occur during instability episodes. Some patients experience numbness and tingling as well. Symptoms can affect athletic participation and even normal activities of daily living depending on the severity.

Evaluation

Your orthopaedic surgeon will review the history of your shoulder instability and perform a physical exam. X-rays are used to evaluate the bones of the shoulder and diagnose subluxations, dislocations, fractures, and arthritis if present. Magnetic resonance imaging (MRI) and computed tomography are useful adjunct studies that can aid your doctor in diagnosis and treatment.

Treatment

Non-Operative Treatment

The first line of treatment for shoulder instability is non-operative care. This may include activity modification, non-steroidal anti-inflammatory medications, and physical therapy. If your shoulder is dislocated, your orthopedic doctor will attempt to realign the shoulder into the correct position. Most patients require sedation to help relax their muscles prior to performing the procedure. After the shoulder joint is back in place, a period of sling immobilization is necessary to allow the ligaments to heal.

Surgical Treatment

Your orthopedic surgeon will determine if surgery is indicated and discuss the risks and benefits with you. Surgery is typically performed in an ambulatory surgery center as an outpatient procedure. The injured structures are repaired and your shoulder is immobilized in a sling for several weeks to allow it to heal. After surgery, physical therapy is commonly utilized to help patients regain their range of motion and strength. Most patients have excellent outcomes after surgical repair.