shoulder pain treatment

Shoulder Replacement Surgery

  • Are you experiencing severe shoulder pain?
  • Does your shoulder pain interfere with your daily activities, such as reaching into a cabinet, dressing, toileting, and bathing?
  • Do you continue experiencing shoulder pain while resting and sleeping?
  • Have you experienced loss of motion or weakness in your shoulder?
  • Has your shoulder pain continued despite treatments such as anti-inflammatory medications, cortisone injections, or physical therapy?

You might be a candidate for partial or total shoulder replacement surgery. Shoulder replacement surgery is less common than knee or hip replacement, but it is just as successful in relieving joint pain. Shoulder replacement surgery is a safe and effective procedure to relieve pain and help you resume everyday activities.

Your shoulder is made up of three bones: your upper arm bone, your shoulder blade, and your collarbone. The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. This socket is called the glenoid. The muscles and tendons that surround the shoulder provide stability and support. These structures allow the shoulder to rotate through a greater range of motion than any other joint in the body. In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis.

In addition to severe trauma to the shoulder there are three types of arthritis that can cause chronic shoulder pain:

  • Osteoarthritis, which is typically age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older.
  • Rheumatoid arthritis, which is an inflammatory arthritis. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.
  • Post-traumatic arthritis, which can follow a serious shoulder injury such as a fracture.

There Are Several Types of Shoulder Surgery Available

Total Shoulder Replacement – The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.

Stemmed Hemiarthroplasty – Depending on the condition of your shoulder, your surgeon may replace only the ball. This procedure is called a hemiarthroplasty. In a traditional hemiarthroplasty, the head of the humerus is replaced with a metal ball and stem, similar to the component used in a total shoulder replacement. This is called a stemmed hemiarthroplasty.

Resurfacing Hemiarthroplasty – Resurfacing hemiarthroplasty involves replacing just the joint surface of the humeral head with a cap-like prosthesis without a stem. With its bone preserving advantage, it offers those with arthritis of the shoulder an alternative to the standard stemmed shoulder replacement.

Reverse total shoulder arthroplasty – a special type of shoulder replacement that is utilized in patients that have shoulder arthritis as well as a massive rotator cuff tear. The design of the shoulder replacement is such that the patient can regain functional motion and strength in the affected shoulder after surgery even though their rotator cuff is damaged beyond repair.

Rotator Cuff Tear

  • Do you experience shoulder pain at night, particularly if lying on the affected shoulder?
  • Does lifting and lowering your arm cause pain in your shoulder?
  • Do you notice weakness when lifting or rotating your arm?
  • Do you have a crackling sensation when moving your shoulder in certain positions?
  • Is it painful to lift your arm out to the side?

You may have a rotator cuff tear.

A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem. Tears that happen suddenly, such as from a fall, usually cause intense pain. You may experience a snapping sensation and immediate weakness in your upper arm. Tears that develop slowly due to overuse also cause pain and arm weakness. At first, the pain may be mild and only happen when you lift your arm over your head. Over time, the pain may become more noticeable at rest, and no longer goes away with medications.

A torn rotator cuff will weaken your shoulder to the point that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do. Your shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. Your arm is kept in your shoulder socket by your rotator cuff. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the upper arm bone.

There are two different types of rotator cuff tears:

  • Partial Tear – Partial rotator cuff tears damage the soft tissue, but does not completely sever it.
  • Full-Thickness Tear – Full thickness rotator cuff tears are also called a complete tear. It splits the soft tissue into two pieces. With a full-thickness tear, there is basically a hole in the tendon.

There are two main causes of rotator cuff tears:

  • Acute Rotator Cuff Tear – If you fall on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff.
  • Degenerative Tear – Most rotator cuff tears are the result of gradually wearing down the tendon. This degeneration happens naturally as we age.

Rotator cuff tears are more common in your dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder — even if you have no pain in that shoulder.

What Should I Do If I Tear My Rotator Cuff?

If you have a rotator cuff tear and you keep using it despite increasing pain, you may cause further damage. A rotator cuff tear can get larger over time. Good News! Approximately 50% of patients find that nonsurgical treatment relieves pain and improves function in the shoulder. Shoulder strength, however, does not usually improve without surgery. Here are some of the nonsurgical options to treat rotator cuff tears:

  • Rest. We may suggest rest and limiting overhead activities. We may also prescribe a sling to help protect your shoulder and keep it still.
  • Activity modification. Avoid activities that cause shoulder pain.
  • Over-the-counter anti-inflammatory medication like ibuprofen and naproxen can reduce pain and swelling.
  • Exercise. Strengthening exercises and physical therapy can restore movement and strengthen your shoulder. Your exercise program will include stretches to improve flexibility and range of motion. Strengthening the muscles that support your shoulder can relieve pain and prevent further injury.
  • Steroid injection. If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine.

If you have exhausted all the nonsurgical rotator cuff treatment options and are still experiencing significant pain, you may need one of the following surgical treatments.

Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of your humerus, which is your upper arm bone.

The Three Techniques Used for Rotator Cuff Repair

  1. Open Repair – An open surgical incision is often required if the tear is large or complex. The surgeon makes the incision over the shoulder and detaches the shoulder muscle (deltoid) to better see and gain access to the torn tendon. During this procedure your surgeon will remove any bone spurs.
  2. Arthroscopic Repair – During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments. Since arthroscope and surgical instruments are thin, your surgeon can use very small incisions as opposed to the larger incision needed for standard, open surgery. Arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.
  3. Mini Open Repair – The mini-open repair uses newer technology and instruments to perform a repair through a small incision. Once the arthroscopic portion of the procedure is completed, the surgeon repairs the rotator cuff through the mini-open incision. During the tendon repair, the surgeon views the shoulder structures directly, rather than through the video monitor.

Impingement and Bursitis of the Shoulder

  • Are you experiencing moderate to severe pain in your shoulder?
  • Do you find it painful to perform simple daily activities, such as combing your hair or getting dressed?

Shoulder Bursitis and Impingement are two of the most common causes of shoulder pain. Your shoulder is made up of three bones:

  • Upper arm bone, known as the humerus bone.
  • Shoulder blade, known as the scapula.
  • Collarbone, known as the clavicle.

The head of your upper arm bone fits into a rounded socket in your shoulder blade. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.

  • Shoulder Bursitis – Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.

Excessive use of the shoulder can lead to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful.

  • Shoulder Impingement – Shoulder impingement occurs when the top of the shoulder blade puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or “impinges” on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement. Severe impingement can even lead to a rotator cuff tear.

What Should I Do If I Have Shoulder Bursitis or a Should Impingement?

There are several simple nonsurgical options to treat shoulder bursitis and shoulder impingement:

  • Rest.
  • Limiting activities that cause the shoulder pain.
  • Physical therapy to help increase improve shoulder strength and flexibility.
  • Medication. We may prescribe medication to reduce inflammation and pain. We may also recommend injections of numbing medicines or steroids to relieve pain.

Ninety percent of patients respond well to the nonsurgical treatments. If you continue to experience shoulder pain after exhausting all nonsurgical treatment options, then you may need to consider shoulder surgery.

Shoulder surgery can involve arthroscopy to remove scar tissue or repair torn tissues, or traditional, open procedures for larger reconstructions or shoulder replacement.

Shoulder Joint Tear (Glenoid Labral Tear)

  • Are you experiencing shoulder pain when you lift your arms?
  • Have you noticed your shoulder catching, locking, popping, or grinding?
  • Does your shoulder hurt at night?
  • Does your shoulder feel less stable than normal?
  • Have you experienced a decreased range of shoulder motion?
  • Do you have a loss of strength in your shoulder when lifting?

Injuries to the tissue rim surrounding the shoulder socket can occur from trauma to your shoulder or through repetitive shoulder motion. Common causes of shoulder joint tear include:

  • Falling on an outstretched arm.
  • A direct blow to the shoulder.
  • A sudden pull, such as when trying to lift a heavy object.
  • A violent overhead reach, such as when trying to stop a fall.

Athletes can experience shoulder joint tears as a result of repetitive shoulder motion. Good news! There are several nonsurgical options to treat shoulder joint tears including:

  • Anti-inflammatory medication.
  • Rest.
  • Limiting activities that cause the shoulder pain.
  • Exercise. Rehabilitation exercises can strengthen the rotator cuff muscles. If these conservative measures are insufficient, your physician may recommend arthroscopic surgery.

If the nonsurgical treatment of your shoulder joint tear don’t relieve your pain then you may need to consider arthroscopic surgery.

During arthroscopic surgery, the doctor will examine the rim and the biceps tendon. If the injury is confined to the rim itself, without involving the tendon, the shoulder is still stable. The surgeon will remove the torn flap and correct any other associated problems. If the tear extends into the biceps tendon or if the tendon is detached, the shoulder is unstable. The surgeon will need to repair and reattach the tendon.

Shoulder Instability

  • Have you experienced repeated instances of your shoulder giving out?
  • Do you have a persistent sensation of your shoulder feeling loose, slipping in and out of the joint, or just hanging there?

You may be dealing with shoulder instability. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can be the result of a sudden injury or from overuse. Once your shoulder has dislocated, you are likely to have repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability. Shoulder dislocations can be partial or complete. With a partial shoulder dislocation the ball of your upper arm comes just partially out of the socket. This is called a subluxation. A complete dislocation means the ball of your upper arm comes all the way out of the socket.

Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Chronic shoulder instability is the persistent inability of these tissues to keep the arm centered in the shoulder socket.

Three Common Ways A Shoulder Can Become Unstable

  1. Shoulder Dislocation – Severe injury, or trauma, is often the cause of an initial shoulder dislocation. A severe first dislocation can lead to continued dislocations, giving out, or a feeling of instability.
  2. Repetitive Strain – Some people with shoulder instability have never had a dislocation. Most of these patients have looser ligaments in their shoulders. This increased looseness is sometimes just their normal anatomy. Sometimes, it is the result of repetitive overhead motion.
  3. Multidirectional Instability – In a small minority of patients, the shoulder can become unstable without a history of injury or repetitive strain. In such patients, the shoulder may feel loose or dislocate in multiple directions, meaning the ball may dislocate out the front, out the back, or out the bottom of the shoulder. This is called multidirectional instability. These patients have naturally loose ligaments throughout the body and may be what is commonly called double-jointed.

Good news! There are multiple nonsurgical options for treating should instability including:

  • Activity modification. You must make some changes in your lifestyle and avoid activities that aggravate your symptoms.
  • Medication. Anti-inflammatory medication like aspirin and ibuprofen can reduce pain and swelling.
  • Physical therapy. Strengthening shoulder muscles and working on shoulder control can increase stability.

If nonsurgical treatments don’t resolve your shoulder instability you may need to consider surgical treatment. Surgery is often necessary to repair torn or stretched ligaments so that they are better able to hold the shoulder joint in place. A common surgery for shoulder instability is:

  • Arthroscopy. Soft tissues in the shoulder can be repaired using tiny instruments and small incisions. This is a same-day or outpatient procedure. Arthroscopy is a minimally invasive surgery.

If you are dealing with shoulder instability call the Orthopaedic Center of Vero Beach at 772-778-2009 to schedule an appointment. We’ll conduct a thorough examination which may include X-Rays or an MRI, and discuss the best treatment options for you.