Shoulder Injuries & Treatments
Monday, March 31, 2008
Ed Glenn, MD, orthopaedic surgeon
SAINT THOMAS HOSPITAL
Minor shoulder problems, such as sore muscles and aches and pains, are common. Shoulder problems develop from everyday wear and tear, overuse, or an injury. They can also be caused by the natural process of aging.
Your shoulder joints move every time you move your arms. To better understand shoulder problems and injuries, you may want to review the anatomy and function of the shoulder. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), collarbone (clavicle), and shoulder blade (scapula). These bones are held together by muscles, tendons, and ligaments. The shoulder joint has the greatest range of motion of any joint in the body. Because of this mobility, the shoulder is more likely to be injured or cause problems. The acromioclavicular (AC) joint, which lays over the top of the shoulder, is also easily injured.
Shoulder problems can be minor or serious. Symptoms may include pain, swelling, numbness, tingling, weakness, or changes in temperature or color. Shoulder injuries most commonly occur during sports activities, work-related tasks, projects around the home, or falls. Home treatment often can help relieve minor aches and pains.
Sudden (acute) injury
Injuries are the most common cause of shoulder pain.
A sudden (acute) injury may occur from a fall on an outstretched arm, a direct blow to the shoulder, or abnormal twisting or bending of the shoulder. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. If nerves or blood vessels have been injured or pinched during the injury, the shoulder, arm, or hand may feel numb, tingly, weak, or cold, or may look pale or blue. Acute injuries include:
You may not recall having a specific injury, especially if symptoms began gradually or during everyday activities. Overuse injuries occur when too much stress is placed on a joint or other tissue, often by overdoing an activity or through repetition of an activity. Overuse injuries include:
Other causes of shoulder symptoms
Overuse and acute injuries are common causes of shoulder symptoms. Less common causes of shoulder symptoms include:
Treatment for a shoulder injury may include first aid measures, physical therapy, medicine, and in some cases surgery. Treatment depends on:
Rotator cuff repair
Surgery may be used to treat a rotator cuff disorder if the injury is very severe or if nonsurgical treatment has failed to improve shoulder strength and movement sufficiently.
The rotator cuff is a group of four tendons and the related muscles that stabilize the shoulder joint and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, ligaments, and the joint capsule. The rotator cuff helps keep the arm bone seated into the socket of the shoulder blade.
Surgery to repair a torn rotator cuff tendon usually involves:
In open shoulder surgery, a surgeon makes a large incision [2 in. to 3 in.] in the shoulder to open it and view the shoulder directly while repairing it. One open-surgery technique, sometimes called mini-open, allows the surgeon to reach the affected tendon by making a small incision to split the deltoid muscle. This method reduces your chances of problems from a deltoid injury.
Open-shoulder surgery often requires a short stay in the hospital.
Complete tears can sometimes be repaired with arthroscopic surgery.
What To Expect After Surgery
The arm may be protected in a sling for a defined period of time, especially when at risk of additional injury.
Physical therapy after surgery is crucial to a successful recovery. A rehabilitation program may include the following:
Why It Is Done
How Well It Works
What To Think About
Massive tears [greater than 2 in. or involving more than one rotator cuff tendon] often cannot be repaired. Grafting and patching procedures are possible, but they are not much better at restoring strength than debridement and decompression, which is less risky and requires less rehabilitation.
Less active people (usually those older than 60) with confirmed rotator cuff tears that do not cause pain, significant weakness, or sleep problems can safely go without surgery unless symptoms become worse.
Shoulder replacement surgery
In shoulder replacement surgery, doctors replace the ends of the damaged upper arm bone (humerus) and usually the shoulder bone (scapula) or cap them with artificial surfaces lined with plastic or metal and plastic. Shoulder joint components may be held in place with cement, or they may be made with material that allows new bone to grow into the joint component over time to hold it in place without cement.
The top end of your upper arm bone is shaped like a ball. Muscles and ligaments hold this ball against a cup-shaped part of the shoulder bone. Surgeons usually replace the top of the upper arm bone with a long metal piece, inserted into your upper arm bone, that has a rounded head. If the cup-shaped surface of your shoulder bone that cradles your upper arm bone is also damaged, doctors smooth it and then cap it with a plastic or metal and plastic piece.
Surgeons are now trying a newer procedure called a reverse total shoulder replacement for people who have painful arthritis in their shoulder and also have damage to the muscles around the shoulder. In this procedure, after the surgeon removes the damaged bone and smoothes the ends, he or she attaches the rounded joint piece to the shoulder bone and uses the cup-shaped piece to replace the top of the upper arm bone. Early results are encouraging.1