Your shoulder is the most flexible joint in your body. This flexibility also makes your shoulder susceptible to instability and injury.
How the Normal Shoulder Works
The shoulder is a ball-and-socket joint. It is made up of three bones: the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle).
A sac-like membrane (bursa) between the rotator cuff and the shoulder blade cushions and helps lubricate the motion between these two structures.
Shoulder Problems and Treatments
Bursitis or Tendinitis can occur with overuse from repetitive activities such as swimming, painting or weight lifting. Initially, these problems are treated by modifying the activity which causes the symptoms of pain and with a rehabilitation program for the shoulder.
Impingement and Partial Rotator Cuff Tears
The conservative non-operative treatment is modification of activity, light exercise and occasionally, a cortisone injection. Non-operative treatment is successful in a majority of cases, but if it is not successful, surgery often is needed to remove the spurs on the underside of the acromion and to repair the rotator cuff.
Full Thickness Rotator Cuff Tears are most often the result of impingement, partial thickness rotator cuff tears, heavy lifting or falls. Non-operative treatment with modification of activity is successful in a majority of cases. If you continue to have pain, surgery may be needed. Surgery may be necessary to repair full thickness rotator cuff tears. Arthroscopic techniques allow shaving of spurs, evaluation of the rotator cuff and repair of some tears. Both techniques require extensive rehabilitation to restore the function of the shoulder.
Instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of sudden injury or from overuse of the shoulder ligaments. Patients with repeat dislocation usually require surgery. Open surgical repair may require a short stay in the hospital. Arthroscopic surgical repair is often done on an outpatient basis. Following either procedure, extensive rehabilitation, often including physical therapy, is necessary for healing.
Shoulder Replacement Shoulder replacement is recommended for patients with painful shoulders and limited motion. The treatment options are either replacement of the head of the bone or replacement of the entire socket. Your orthopedic surgeon will discuss with you the best option.
The orthopedic evaluation of your shoulder consists of three components:
- A medical history
- A physical examination to assess swelling, tenderness, range of motion, strength or weakness, instability and/or deformity of the shoulder.
- Diagnostic tests such as X-rays taken with the shoulder in various positions. An MRI (Magnetic Resonance Imaging) may be helpful in assessing soft tissues in the shoulder. A CT (Computerized Tomography) scan may be used to evaluate the bony parts of your shoulder.
Your orthopedic surgeon will review the results of your evaluation with you and discuss the best treatment. You and your doctor may agree that surgery is the best treatment option. He or she will explain the potential risks and complications that may occur. Some surgical procedures may require you to be hospitalized.
Types of Surgical Procedures
Arthroscopy allows the orthopedic surgeon to insert a pencil-thin device with a small lens and lighting system into tiny incisions to look inside the joint. The images inside the joint are relayed to a TV monitor, allowing the doctor to make a diagnosis. Other surgical instruments can be inserted to make repairs, based on what is seen with the arthroscope. Arthroscopy often can be done on an outpatient basis.
Open Surgery may be necessary and, in some cases, associated with better results than arthroscopy; open surgery often can be done through small incisions of just a few inches.
Recovery and rehabilitation is related to the type of surgery performed inside the shoulder, rather than whether there was an arthroscopic or open surgical procedure.
Prevention of Future Problems It’s important that you continue a shoulder exercise program with daily stretching and strengthening. In general, patients who faithfully comply with the therapies and exercises prescribed by your orthopedic surgeon and physical therapist will have the best medical outcome after surgery.