Shoulder Injuries, Conditions, Surgery and Treatment

If you have injured your shoulder, consult an orthopedic specialist for correct diagnosis and treatment of the problem, as this can make a big difference in the long run.

How does the shoulder work?

Your shoulder is made up of a ball-and-socket joint that has three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The top end of the humerus has a ball on the end that fits into a small socket of the shoulder blade. This is what forms the shoulder joint. The socket of the shoulder is surrounded by soft-tissue and the head of the arm bone has a smooth, durable surface. There is a thin inner lining of the joint called the synovium, and this allows for the smooth motion of the joint.

The upper portion of the scapula protects the shoulder joint. Your collarbone is attached to the shoulder blade by the acromioclavicular joint, often called the ‘AC joint’. The inner portion of the collarbone joins with the breastbone (sternum). Your rotator cuff is the group of tendons and muscles that attach your upper arm to your shoulder, and this structure covers the shoulder joint. You have many muscles that attach to the three upper arm bones and these enable you to lift your arm, throw a ball, swim, and reach over your head.

What are some common shoulder conditions?

Bursitis or Tendinitis

Bursitis or tendinitis occurs with overuse from repetitive activities like weight lifting, swimming, and throwing. These types of activities lead to a pinching and rubbing of the rotator cuff under the AC joint. The biceps tendon and rotator cuff will get irritated and inflamed with tendinitis and can lead to impingement syndrome and biceps tendon tears and/or rotator cuff tears. Sometimes, this condition can be treated by limiting the activity, but oftentimes, the pain starts after the damage has been done. If you have this condition and it is associated with isolated biceps tendon damage and pain, a procedure called ‘biceps tendoesis’ can be performed by a surgeon. This procedure relieves symptoms and prevents further damage to the joint.

Partial Rotator Cuff Tears

If the rotator cuff is partially torn, it is called a ‘partial thickness tear’. These are associated with chronic inflammation of the shoulder joint and the development of spurring under the AC joint. Sometimes, an orthopedic specialist will treat these with modification of activity, light exercise, as steroid injections. If these methods fail, surgery will be necessary to repair the rotator cuff and remove the spurs that have developed.

Full-Thickness Rotator Cuff Tears

When the rotator cuff is torn completely in two pieces, it is known as a full-thickness rotator cuff tear. This can occur from heavy lifting, a fall, or a car accident. Most of the time, surgery of the shoulder is necessary for full-thickness tears. Arthroscopic techniques allow our expert surgeons to shave the spurs, evaluate the rotator cuff, and repair the tear. If the tear is larger or significantly retracted or associated with other structural problems, the surgeon may have to perform open surgery on the shoulder.

Impingement Syndrome

Impingement syndrome develops when the bursa of the joint is inflamed and the bone and tendons are irritated from rubbing on the undersurface of the acromion or AC joint. Your orthopedic surgeon can treat this with an ‘arthroscopic subacromial decompression’ procedure. With this procedure, the doctor removes some of the bony prominence or spurs and the inflamed bursa to allow for more space for the shoulder structures.

Instability

When the head of the upper portion of the arm bone is forced out of the shoulder socket, instability occurs. This usually is the result of a sudden injury, but can occur from excessive laxity of the shoulder ligaments. The two forms of instability are subluxations and dislocations. Basically, a subluxation is an incomplete dislocation. With subluxation, the shoulder is partially out of the socket. A dislocation occurs when the head of the upper arm bone slips completely out of the socket and may result in chronic instability of the joint. If you have repeated dislocations, our orthopedic specialists can operate by means of arthroscopic or open surgical repair.

Frozen Shoulder

A frozen shoulder occurs when the structures of the shoulder joint become immobile and lose flexibility. This occurs from injury or ‘wear-and-tear’ or may develop spontaneously with no specific cause. An orthopedic specialist can treat frozen shoulder with many modalities including physical therapy, anti-inflammatories, injections and on rare occasions with manipulation under anesthesia or surgery to release the tight structures.

Fractured Collarbone and Acromioclavicular Joint Separation

Two common injuries for children and young adults who fall are a fractured collarbone and acromioclavicular separation. Most of these types of injures can be treated with splinting and arm slings, but often a serious displaced fracture or separation requires open surgical repair.

Fractures of the Upper Humerus or the Humeral Head

If you fall on an outstretched arm, you could suffer a fracture of the upper arm or humeral head. This type of fall is common in older people with osteoporosis. Open surgical repair is needed if the fracture is fragmented or displaced. Sometimes, the orthopedic specialist must put in an artificial joint called a prosthesis.

Osteoarthritis and Rheumatoid Arthritis

Arthritis can completely destroy the shoulder joint and its surrounding structures. Two forms of arthritis that do this are osteoarthritis (the most common type) and rheumatoid arthritis. These conditions may also cause deterioration and degeneration of the rotator cuff. If this happens, your orthopedic surgeon can surgically replace the shoulder joint with a metal and plastic joint to aid mobility and eliminate pain.

What are the types of shoulder surgeries?

Arthroscopy

Arthroscopy is a type of shoulder surgery that allows the surgeon to insert a small device inside the joint structure through a small incision to look inside. The images inside the shoulder joint can be viewed on a TV monitor that allows the orthopedic specialist to make a correct diagnosis. The surgeon can also insert small instruments inside the joint to make necessary repairs. Arthroscopy can usually be performed on an outpatient basis. The American Orthopedic Society for Sports Medicine reports that there are around 1.4 million shoulder arthroscopies done worldwide every year.

Open Surgery

Open shoulder surgery may be needed for some cases where there is an extensive injury or if the structures inside the joint are severely damaged. Open surgery can be done with a few small incisions. For some injuries, open surgery is associated with better results than arthroscopy. Open surgery technique uses larger incisions than arthroscopy to allow the surgeon to mobilize retracted tissues. Your orthopedic specialist will recommend the procedure that is best for you.

What are the possible complications of shoulder surgery?

After your shoulder surgery, some pain, stiffness, and tenderness are to be expected. There are some possible risks that could occur, however. These include infection, blood clots, and nerve damage.

How can I prevent future shoulder problems?

Once you have undergone a shoulder procedure, it is vital that you continue a shoulder exercise program that includes daily stretching and strengthening. Patients who follow their doctor’s therapies and instructions have the best medical outcome after shoulder surgery.

What can I expect during the recovery from shoulder surgery?

Your recovery really depends on the type of surgery that was performed. Most of the time, you will receive physical therapy for several weeks following surgery. It is critical that you only perform the activities your orthopedic specialist recommends.