Rotator Cuff Tendinitis
Rotator cuff tendinitis occurs when the tendons are injured, usually as a result of repetitive overhead reaching, pushing, or lifting with outstretched arms (e.g. swimming and tennis). People with rotator cuff tendinitis typically complain of shoulder pain at the tip of the shoulder and the upper, outer arm. Reaching, pushing, pulling, lifting, positioning the arm above the shoulder level, or lying on the side often aggravates the pain. Tendinitis is usually treated with ice, anti-inflammatory drugs, and physical therapy. Most people will see improvement in pain and function after 6 to 12 weeks of rehabilitation.
Rotator Cuff Tears
The injury is typically caused by a fall, direct blow, or a rapid use of force. Conservative treatment is adequate in the majority of people, however younger and/or active people with a medium- to large-sized tear may be candidates for surgical repair (e.g. Arthroscopic surgery – “Key-hole” surgery that allows for faster healing and lesser pain). Surgery may also be recommended for older people who have significant pain related to a rotator cuff tear.
A small tear that is repaired early will generally do better than a large tear that has been left neglected for a long time. So it makes sense to see your doctor early if you have any doubts.
People with small- to medium-size tears usually improve with physical therapy exercises, stopping painful activities, and, sometimes injection of a steroid. If shoulder strength and function do not improve after completing 3 to 6 months of physical therapy, surgical repair may be considered. Symptoms of rotator cuff tear often include pain and weakness of the shoulder, although some people have few or no symptoms. Note that the severity of the tear does not necessarily correlate with the severity of a person’s pain.
Shoulder Impingement Syndrome
In shoulder impingement syndrome, there is inflammation of the rotator cuff tendons and surrounding bursitis. This may sometimes be made worse with a bone spur on the underside of the acromion (shoulder blade bone).
Patients often complain of shoulder pain when trying to raise their arms, especially with lifting activities. They may have difficulty reaching for items placed on the top shelf, bending their arms to reach their back pockets, or putting on undergarments or clothing.
A visit to the doctor is important for him to understand the condition of your shoulder. Once the diagnosis is made, our doctors at Island Orthopaedic Consultants will prescribe medications to improve the pain and reduce inflammation. Sometimes, an injection to the shoulder may be required. Our doctors will also work closely with your therapist to prevent stiffness of the shoulder from developing, and also to promote strengthening of the cuff muscles. Most patients with shoulder impingement syndrome do get better with non-operative treatment. In some situations, surgery may be required if the condition fails to improve. In the surgery, the inflamed bursal tissue will be removed, and the bone spur smoothened and leveled off.
Frozen Shoulder / Adhesive Capsulitis
Frozen should occurs when the joint capsule is thickened and inflamed, binding the joint tightly and preventing free movement of the shoulder. The shoulder generally feels stiff and painful. Depending on the degree of joint stiffness, this condition can seriously limit the function of the individual.
The initial treatment involves medication to settle the inflammation, and regular therapy sessions to regain flexibility of the shoulder joint. In most instances, this condition is self-limiting and it improves over time.
In certain situations whereby the condition is stagnant or worsening despite diligent efforts from the patient, surgery may be useful. During capsular release, the tight capsule of the joint is carefully divided to prevent injury to the other surrounding structures. Once the capsule is divided, the joint can be easily manipulated to regain motion and flexibility. Aggressive therapy usually follows to minimize the risks of recurrence of stiffness of the joint.
Acromio-clavicular Joint Osteoarthritis
The acromio-clavicular joint is located at the front of the shoulder, between the shoulder blade (acromion) and the collarbone (clavicle). The joint surface can undergo wear and tear, with thinning out of the joint cartilage. An arthritic joint will usually be painful, stiff and weak. This is especially so with movement of the arm above the chest level and when reaching across the chest.
Medications and injections to the joint can help with temporary relief of painful symptoms. In some situations, your doctor may propose surgery to resect the diseased joint for more permanent pain relief.
Recurrent Shoulder Dislocations
The shoulder joint is essentially a “ball-and-socket” joint consisting of the “ball” of the arm bone (humeral head) sitting in the “socket” of the shoulder blade bone (glenoid). This socket is deepened at the edges by a raised cartilage bumper called the labrum, thus preventing the humeral head from shifting out of the socket during shoulder movement.
The labrum can be damaged when the shoulder dislocates or shifts transiently out of joint. Once damaged, the restraint is lost and the shoulder becomes unstable. This feeling of instability can cause pain, especially when the arm is raised and put out to the side of the body.
Physiotherapy is generally useful to strengthen the surrounding muscles and regain some stability to the joint. With avoidance of certain risky maneuvers, most individuals are able to perform their daily activities without difficulties.
However, if you are a high-demand recreational or professional athlete, you may find that the shoulder is not stable enough to allow you to return to your sport of choice. In other instances, the shoulder is so unstable that it will dislocate even during simple actions such as reaching backwards with the outstretched arm, or even when sleeping! Under these circumstances, surgery can help to repair the labrum, and stabilize the shoulder joint.
Superior Labrum Anterior and Posterior (SLAP) Tear
A SLAP lesion happens when the upper labrum (superior labrum) is torn at or near it’s attachment with the biceps. It usually occurs with heavy forceful lifting, acute forceful traction movement of the arm (e.g. wakeboarding), repeated overhead activity (e.g. tennis, throwing) or a fall on the outstretched hand.
If symptomatic, the tear can be treated surgically using ‘key hole’ surgical technique (Arthroscopic surgery). Using special bone anchors (screws) and sutures, the torn labrum is attached back to its normal position. In cases where the tear is irreparable, it will be smoothed down (debrided) to a stable surface.
This keyhole operation is usually done through two or three 5mm puncture wounds. There will be no stitches only small sticking plaster strips over the wounds. The wound should be kept dry until healed (about 5 to 7 days).
After the surgery, our doctors at Island Orthopaedic Consultants will work closely with your physiotherapist to guide your road to recovery.
Surgeries of the Upper Limb
Similar to the lower limb, arthroscopic (minimally invasive) treatment is the most common type of surgical technique used at our clinic. The types of surgeries can again be broadly classified as reconstructive procedures (shoulder stabilization, elbow ligament reconstruction), debridement procedures (osteoarthritis, shoulder impingement), reparative procedures (rotator cuff repair, labral repair) and replacement procedures (shoulder and elbow).
AC Joint Sprain
This is where the clavicle (collar bone) meets the acromion process of the scapular. It is a bony bit on the top of the shoulder. This joint can be injured by falling onto the shoulder, elbow or an outstretched arm.
Fracture of the Clavicle
Fracture of Shoulder injury involving a fracture of the collar bone or clavicle. This bone is usually fractured as a result of falling badly onto an outstretched arm or onto the shoulder.
Glenoid Labrum Injury
Shoulder pain resulting from damage to the lining of the cavity the end of the upper arm bone sits in.
Inflammation of Muscle Attachments to the Clavicle
Pain along the front of the collar bone.
Inflammation of the Supraspinatus Tendon
The supraspinatus muscle runs along the top of the shoulder blade and inserts via the tendon at the top of the arm (humerus bone). This muscle is used to lift the arm up sideways and is also important in throwing sports.
Inflammation of the Subscapularis Tendon
The subscapularis muscle originates from the underside of the shoulder blade and inserts at the front of the upper arm (humerus). It is mainly throwers that injure this muscle. A partial rupture of the muscle is more common than a complete rupture but the partial rupture will often heal with inflammation.
Pectoralis Major Muscle / Tendon Strain
The pectoralis major muscle is a large powerful muscle at the front of the chest. It used to rotate the arm inwards, pull a horizontal arm across the body, pull the arm from above the head down and pull the arm from the side upwards. It is most likely to rupture at the point where it inserts into the arm (humerus).
Pectoralis Major Tendon Inflammation
The tendon where it inserts into the arm (humerus) can become inflammed. It is common in racket players, rowers, swimmers, throwers and weight trainers.
Rotator Cuff Injuries / Rotator Cuff Strain
The rotator cuff muscles control rotation of the shoulder.These muscles are put under a great deal of strain especially in throwing events and racket sports where your arm is above your head a lot.
Rupture of the Supraspinatus Tendon
The supraspinatus muscle runs along the top of the shoulder blade and inserts at the top of the arm (humerus bone). This muscle is used to lift the arm up sideways and is also important in throwing sports as it is the muscle that holds the arm in the shoulder joint when you release what you are throwing.
Rupture of the Long Head of the Biceps
The biceps muscle splits into two tendons at the shoulder. A long one and a short one. The long tendon runs over the top of the humerus bone (upper arm) and attaches to the top of the shoulder blade. A rupture of this tendon is rare in young athletes but more common in older ones.
Subacromial Bursitis
Over the supraspinatus tendon is a bursa (small sack of fluid used to help lubricate the moving tendon). This bursa can become trapped in the shoulder causing pain and inflammation. The athlete is more prone to this injury if they overuse the shoulder particularly if the arm is at or above shoulder level. Or if the athlete has had a rupture of the supraspinatus tendon.
Deltoid Muscle Strain (front)
The deltoid muscle is the big muscle on the shoulder. It has three parts – the front (anterior), middle and back (posterior). The muscle lifts the arm up sideways. The front part helps to lift the arm up forwards (flexion) and the back part helps to lift the arm up backwards (extension).
Deltoid muscle Strain (back)
The deltoid muscle is the big muscle on the shoulder. It has three parts – the front (anterior), middle and back (posterior). The muscle lifts the arm up sideways. The front part helps to lift the arm up forwards (flexion) and the back part helps to lift the arm up backwards (extension).
Dislocation of the Sterno-Clavicular Joint
The clavicle (or collar bone) connects to the sternum (or breast bone) in the middle of the chest at the top. If the shoulder is subjected to a hard impact this joint can become damaged.
Fracture of the Neck of the Humerus
A fracture to the neck of the humerus is often caused by falling onto an outstretched hand or direct impact to the shoulder. It is seen more often in young adults, adolescents and the elderly.
Inflammation of the Long Head of the Biceps
Inflammation of this tendon is a fairly common complaint especially with swimmers, rowers, throwers, golfers and weight lifters.
Winged Scapula
A winged scapula is a shoulder injury or condition in which the scapula or shoulder blade sticks out at the back, particular when pushing against something such as a wall.
Suprascapular Neuropathy
Aching or burning diffuse pain which may radiate through the arm.
|
No. |
Condition |
Common Signs & Symptoms |
|||||
|
Pain |
Swelling |
Stiffness |
Weakness |
Instability |
Locking |
||
|
1 |
AC Joint Sprain |
x |
|
x |
x |
x |
|
|
2 |
Dislocated Shoulder |
x |
x |
x |
x |
x |
|
|
3 |
Broken Collar Bone/Clavicle |
x |
|
x |
x |
x |
x |
|
4 |
Shoulder Bursitis (Shoulder Impingement Syndrome) |
x |
|
|
|
|
|
|
5 |
Rotator Cuff Injury (Shoulder Tendonitis) |
x |
|
|
x |
|
|
|
6 |
Frozen Shoulder |
x |
|
x |
x |
|
x |
Many patients ignore temporary minimal shoulder symptoms with few bad effects. In the case of an acute injury, if the pain is intense, you should seek medical care as soon as possible. If the pain is less severe, it may be safe to wait a few days to see if time will alleviate the problem. If symptoms persist, a Sports Doctor will provide timely diagnosis and treatment. Sports Doctors are specifically trained in the workings of the musculoskeletal system, including the diagnosis, treatment and prevention of problems involving muscles, bones, joints, ligaments and tendons.
Treatment for Shoulder Injuries
Treatment generally involves altering activities, rest and physical therapy to help you improve shoulder strength and flexibility. Medication may be prescribed to reduce inflammation and reduce pain. Injection of drugs may also be used to treat the pain.
Surgery may be required to resolve some shoulder problems such as recurring dislocation and some rotator cuff tears.
