Shoulder Conditions & Treatment

One of the most essential parts of the shoulder, your rotator cuff, consists of muscles and tendons that hold the shoulder in place and allow you to lift your arm and reach up. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time due to repetitive activities. Rotator cuff injuries are common in people who play sports or have occupations requiring repeated overhead motions, such as painters or carpenters. 

Rotator cuff degeneration and tears may also be caused by aging. Rotator cuff tears are painful, and you may be unable to raise your arm or put weight on your shoulder. Signs of a torn rotator cuff may include:

• Pain when you lift or lower your arm
• Weakness when you lift or rotate your arm
• Crackling sensation when you move your shoulder in certain positions

Individuals who experience a rotator cuff injury may have a dull ache in the shoulder that disturbs their sleep or makes it difficult to brush their hair or reach behind their back, arm weakness, pain that radiates to the elbow, or pain that worsens with reaching motions, especially overhead. Chronic symptoms can also include muscle weakness, joint noise in the shoulder, and the inability to move the arm fully, especially forward or sideways from the body.

Experienced DMC orthopedic surgeons can use a minimally invasive technique, arthroscopic rotator cuff repair, to eliminate your pain while restoring strength and function to your shoulder. The advantages of arthroscopic rotator cuff repair are less pain, less scarring and a faster recovery.

Treatment

Surgical techniques that may be used to repair a rotator cuff tear include arthroscopy, open surgery, or a combination of both. The goal of rotator cuff repair surgery is to help restore the shoulder's function and flexibility and relieve pain that cannot be controlled by other treatments.

In some situations, joint resurfacing can be an alternative to total joint replacement surgery. This surgical procedure replaces only the diseased part of the joint instead of the entire joint, allowing you to retain much of your natural tissue. Shoulder resurfacing can often delay total shoulder replacement and may be a good option for younger, more active patients.

The procedure may be an option for patients with:

• Osteoarthritis
• Rheumatoid arthritis
• Fractures of the head of the humerus or upper arm bone
• Mild to moderate joint wear
• Loss of cartilage
• Stiffness
• Loss of function
• Pain that does not respond to other treatments

Called a “reverse shoulder replacement,” this procedure alters the mechanics of the shoulder by reversing the normal position of the ball and socket. Rotator cuff problems can occur due to injury or degenerative changes, resulting in tendon tears and arthritis. In cases where the tendon can’t be repaired surgically, a reverse shoulder replacement is a good alternative because it is the deltoid muscle instead of the rotator cuff that moves your shoulder. It increases your stability, restores motion and relieves pain. Reverse total shoulder replacement may be an option for people who have:

• Completely torn rotator cuffs
• The effects of severe arthritis (cuff tear arthropathy)
• Had a previous shoulder replacement that failed

Older people with significant pain and little to no shoulder movement are the best candidates. It is ideal for patients with chronic, longstanding rotator cuff tears and arthritis.

Treatment

The upper arm bone (humerus) ends in a ball shape in the healthy shoulder. This fits into a socket formed by the shoulder blade (scapula). Together, this ball and socket form the shoulder.

The reverse shoulder prosthesis “reverses” the way the shoulder works, with an implant in which the socket and metal ball are switched. The ball portion attaches to the scapula, and the socket connects to the humerus. Reversing the shoulder anatomy allows your deltoid muscle to lift your arm, instead of the rotator cuff. As a result, your range of motion will greatly increase, and your pain may disappear.

If you have arthritis of the shoulder joint, then total shoulder replacement surgery may be right for you. Arthritis affects the cartilage in your joints, causing it to wear away so there is no protective lining between your bones.

Total shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with an implant. During surgery, the ball is removed from the top of the humerus (long bone in the arm or forelimb that runs from the shoulder to the elbow) and replaced with a metal implant. The socket portion of the joint is shaved clean and replaced with a plastic socket cemented into the shoulder blade.

If you have tried the usual treatments for shoulder arthritis but have not found adequate relief, you may be a candidate for total shoulder replacement surgery. Other reasons for surgery include:

• Osteoarthritis (degenerative joint disease)
• Rheumatoid arthritis
• Post-traumatic arthritis
• Rotator cuff tear arthropathy (a combination of severe arthritis and a massive non-reparable rotator cuff tendon tear)
• Failed previous shoulder replacement surgery

Symptoms

X-ray evidence of joint damage aids doctors in deciding who should have this surgery. However, symptoms of pain and decreased mobility may also help doctors decide who may benefit. Symptoms may include:

• Severe pain during activity
• Pain walking or getting up from a chair
• Pain that prevents movement
• Pain that prevents sleeping

Treatment

In this operation, a surgeon replaces the shoulder joint with an artificial ball for the top of the humerus and a cap (glenoid) for the scapula. The operation's success often depends on the condition of the rotator cuff muscles before surgery.

Physical therapy is a critical part of recovery from shoulder replacement. Patients can start passive shoulder exercises, in which someone else moves the joint for them, soon after surgery and will continue physical therapy for up to 12 weeks. There may still be some pain in the two to three months after surgery; however, it's usually a different type of pain and will go away as the recovery period continues.

Adhesive capsulitis, or frozen shoulder, is a condition that causes the shoulder to feel stiff or “frozen.” It is more commonly referred to as frozen shoulder. Frozen shoulders can happen to anyone, but those with diabetes and thyroid conditions are at a higher risk of developing frozen shoulder.

Symptoms may include:

• Loss of movement
• Dull or achy feeling in the shoulder
• Pain when the arm moves

Treatment may include:

• Medication
• Injections
• Surgery