Rotator Cuff Tears
The rotator cuff is a group of tendons that connect the four muscles of the upper shoulder to the bones. While the normal process of aging can create wear and tear on the rotator cuff, individuals who participate in sports like golf and tennis have an increased risk of injury. Symptomatic rotator cuff tears are believed to affect an estimated 4% and 32% of the population and appear to be more prevalent with increasing age. Symptoms can include shoulder pain and tenderness, especially when reaching overhead or behind the back, shoulder weakness, and reduced range of motion. Nonsurgical treatment includes painkillers and anti-inflammatory medications, physical therapy, and cortisone injections. Surgery may be required if the tear is associated with an acute injury and/or conservative treatment methods fail to alleviate pain and weakness.
Rotator Cuff Arthropathy
In a healthy shoulder, the rotator cuff helps the large deltoid muscle elevate your arm. When a person has both an arthritic shoulder joint and an irreparable massive tear of the rotator cuff, it is known as rotator cuff arthropathy, or pseudo-paralysis of the shoulder. Symptoms can include significant loss of function in the affected shoulder and the inability to lift the arm even to shoulder height.
According to the American Academy of Orthopedic Surgeons, the vast majority of shoulder dislocations are caused by trauma (96%). Most often, these are related to contact sports or when a person falls onto an outstretched hand. Only about 4% of dislocations are classified as atraumatic – the shoulder starts to partly slip out of the socket without trauma, causing limited shoulder movement in multiple directions. Positional dislocation is related to abnormal muscle patterning, in which the strong muscles around the shoulder joint are not functioning correctly, causing the shoulder to dislocate frequently and usually painlessly.
A literature review of shoulder dislocations published in the December 2014 issue of the Journal of the American Academy of Orthopedic Surgeons revealed the following insightful data:
- In 40% of shoulder dislocations, patients had an associated ligament or muscle injury.
- One of three shoulder dislocation patients also had a rotator cuff tear.
- Males ages 10 to 20 had the highest rate of shoulder dislocation.
- Recurrent dislocations were most likely to occur within two years after the initial dislocation, and impacted patients age 20 and younger more frequently.
- Following a dislocated shoulder, six of 10 younger patients developed instability during a two-year period, and seven of 10 did so over a five-year period.
- Men were more likely than women to have recurrent instability following a shoulder dislocation.
Common Symptoms of a Dislocated Shoulder
Symptoms of a dislocated shoulder include a visibly deformed or out-of-place shoulder, swelling or bruising, intense pain, loss of joint movement, and numbness, weakness, or tingling that radiates down the arm. After a dislocation injury, patients are advised to move their arms as soon as it is comfortable to do so. In some cases, patients are given a sling to wear for the first one to two days, but only when significant pain is present. Icing is recommended to help decrease swelling and reduce pain, generally for 20 minutes, three to four times a day. In chronic cases, a number of surgical approaches can be used, including arthroscopic procedures or the Latarjet procedure if there is glenoid bone loss.
Glenoid Labral Tears
The labrum reinforces and stabilizes the ball and socket joint of the shoulder, which is comprised of the glenoid and humeral head. Therefore, when the labrum tears, partial or complete shoulder dislocation can result. The two most common types of labral injuries are Superior Labrum from Anterior to Posterior (SLAP) lesions/tears and Bankart lesions/tears. SLAP tears occur at the front of the upper arm where the biceps tendon connects to the shoulder. Bankart tears may occur with shoulder dislocation when the head of the humerus either shifts toward the front of the body, (anterior), or the back of the body (posterior). Symptoms of both types of tears are aching pain and an impairment of normal shoulder movement. Patients with SLAP tears more typically experience pain at the front of the shoulder near the biceps tendon. Nonsurgical treatment includes painkillers and anti-inflammatory medications, physical therapy, and cortisone injections. If these treatment methods are ineffective, arthroscopic surgery is performed in which the orthopedic surgeon repairs the labrum and/or the biceps tendon.
The part of the scapula that comprises the top of the shoulder and connects with the clavicle is called the acromion. The acromioclavicular (AC) joint, where the acromion and the clavicle attach, is a common area for shoulder osteoarthritis to develop in middle age. Degeneration of the AC joint can be painful and can cause limitations in everyday activities involving the shoulder. Symptoms include pain and tenderness in the front of the shoulder around the joint, but this can spread to the entire shoulder, the front of the chest, and the neck. AC joint osteoarthritis can also occur after an injury, such as an AC joint separation.
Osteoarthritis is diagnosed using x-rays and sometimes arthrocentesis – a procedure in which a sterile needle is used to remove joint fluid to rule out gout, infection, and other causes of inflammatory arthritis. In most cases, nonsurgical treatment is administered before surgery is considered. Treatments may include anti-inflammatory medications, physical therapy, cortisone injections, icing, and moist heat. If conservative treatment options are ineffective, shoulder arthroplasty is an option, during which damaged parts of the shoulder are removed and replaced with artificial components. Surgical treatment of arthritis of the shoulder is generally very effective in reducing pain and restoring motion.