Conditions of the shoulder
Arthritis means inflammation of a joint. In the shoulder a joint is formed between
the ball of the arm bone, and the socket of the shoulder blade. Both osteoarthritis and rheumatoid arthritis cause shoulder pain. The first step in treatment of shoulder pain due to arthritis is anti-inflammatory medications, ultrasound, ice or heat, and strengthening exercises. If there is a postural problem, kinesiotape along with postural correction and restricted
movement may help correct it. Steroid injection can also help. Since arthritis is
caused by inflammation, and the strongest anti-inflammatories are steroids, we may
inject steroid into the shoulder to provide temporary relief. In severe cases with both pain and limited movement, the best option is to replace the shoulder joint entirely.
Arthroscopy means to put a scope in a joint. Debridement is cleaning out dead or
dying tissue. Arthroscopic debridement is cleaning out the shoulder through an
arthroscope. The procedure is minimally invasive and lasts about an hour. It is done as an outpatient, so a hospital stay is not necessary. Recovery is typically one week.
The shaft connected to the ball of the arm bone can break, causing shoulder pain.
Most heal with immobilization. Severe or complex breaks require surgery to place
hardware that fixes the broken bone in the proper position to heal.
BROKEN COLLAR BONE OR ACROMIOCLAVICULAR (AC) SEPARATION
These injuries are most common in children and are treated with a splint. In severe cases, a broken collar bone may warrant surgery to place hardware that fixes the broken collar bone in the proper position to heal.
BURSITIS OR TENDONITIS
The shoulder bursa is a lubricating sac for the rotator cuff tendons between the
muscles and bones below. Bursitis is inflammation of the bursa.
A tendon is a tissue that connects a muscle to bone; tendonitis is inflammation of a tendon.
Both conditions cause shoulder pain. The first step in treatment of shoulder pain due to bursitis or tendonitis is anti-inflammatory medications, ultrasound, ice or heat, and strengthening exercises. If there is a postural problem, kinesiotape along with postural correction or restricted movement may help correct it. Steroid injection can also help.
Dislocation occurs when the ball of the arm bone slips out of the socket of the shoulder blade. Initially shoulder dislocation is treated by reducing the ball back into the socket. Unfortunately, once the ball has been out of the socket, dislocation often happens again. If dislocation recurs or is severe, surgical
repair may be needed.
The labrum is a cuff of tissue around the socket that holds the ball and resists
dislocation. Arthroscopic surgery to fix the labrum to help prevent dislocation is called the Bankart repair. Movement may help correct it. Steroid injection can also help.
ROTATOR CUFF TEARS
Rotator cuffs can be torn completely or partially. A complete tear of a rotator cuff muscle or tendon often results from heavy lifting and falls; but they can also come on slowly due to partial tears and bone spurs wearing the tendons. Full rotator cuff tears are treated with activity modification. If that fails, arthroscopic surgical repair may be necessary.
Partial tears don’t go all the way through the muscle or tendon. They are often
followed by the development of painful bone spurs. Partial tears are usually treated non-surgically with activity modification, exercise, and steroid injection.
Your shoulder pain
Shoulder pain is a formidable foe.
First, let’s identify the issue.
Your doctor has already begun the process by hearing your story, examining you, and reviewing the X-ray of your shoulder to get an idea of what is causing your pain.
Now that your doctor has determined the diagnosis, the next step is to confirm it and begin initial treatment. We may need an additional X-ray and MRI to obtain more information about your shoulder.
After diagnosis, you’ll see your provider for:
At home exercises that can increase mobility and strength in the arm and shoulder.
- Ice packs
- Warm packs
- Ultrasound therapy
- Cold laser
Kinesiotape and restrictive movements are used to help correct posture and alignment.
My shoulder still hurts. What’s next?
Most of the time, initial treatment and conservative care are all that’s needed. If your shoulder still hurts, the next steps to consider are regenerative medicine or a shoulder replacement. These procedures are done in an outpatient setting with low risk of complication.
Arthritis is one of the most common causes of shoulder pain. In the early stages, it can be treated with steroid injections. Injections take just a few minutes. The skin on the side of your shoulder is numbed, then ultrasound is used to guide a needle to just the right place. You’ll feel some pressure in your joint during the injection, but most people don’t need sedation. You can go home afterward, and recovery is the same day.
During the procedure, your orthopedic surgeon places a small tube attached to a camera in your shoulder at the location of the injury. The surgeon can clean out damaged cartilage or repair a torn labrum. The procedure takes 30 to 45 minutes.
Most patients recover in a few days and are back to normal activity within a week.
Remember when you were young, and things healed in days—not weeks or months?
As we age, our body has fewer stem cells, making it harder to heal. Stem cell injection puts back what you’re missing. Doctors can use 2 regenerative strategies:
STEM CELL INJECTION
AMNIOTIC-DERIVED GROWTH FACTOR INJECTION
The only restriction is not to take anti-inflammatory medications for a few weeks.
While stem cell therapy is not covered by insurance, many hospitals have a program to make it more affordable.
Total Shoulder Replacement
In rare occasions, when all other treatment options have failed to give you relief, you may need a total shoulder replacement.
ANATOMIC TOTAL SHOULDER REPLACEMENT
An anatomic total shoulder replacement is performed on patients with end-stage arthritis and intact rotator cuff.
REVERSE TOTAL SHOULDER REPLACEMENT
For patients with rotator cuff tears, a reverse total shoulder replacement surgery is performed.