The Shoulder - An Amazing Joint!
Think about the wide range of motion permitted by the shoulder joint. The very fact that the shoulder is the most movable and flexible joint in the body also means it is one of the most fragile. Problems can arise from either chronic wear or sudden injury. These problems can be extremely painful and can be life-altering if left untreated.
Many chronic shoulder problems can be traced to over-use motions - typically repeated overhead movements that may be common in certain occupations. Weekend athletes and do-it-yourselfers can also be affected by the routine motions required to golf, play tennis, swim, lift weights or work on common construction projects.
The most likely causes of shoulder pain include tendonitis, bursitis and an inflamed rotator cuff. Collectively, this group of conditions is called shoulder impingement syndrome.
What is a Rotator Cuff?
The rotator cuff is a group of flat tendons that together wrap around the front, back and top of the shoulder. These tendons attach muscles that originate on the shoulder blade or scapula and allow the shoulder its wide range of motions. The passages that the tendons travel through can be quite narrow in some people and repetitive motions can cause the surrounding structures to become irritated and inflamed. An irritated rotator cuff can sometimes cause a feeling of clicking or popping as a ragged piece of the cuff slides under the shoulder bone.
What is Tendonitis?
When a tendon is constantly irritated, by repeated rubbing against the shoulder bone for example, it can become inflamed and swollen, leaving even less space between the tendons and the bone. Picture a rope being pulled along a craggy rock again and again. This inflammation of a tendon is called tendonitis.
What is Bursitis?
A bursa is a fluid filled structure that acts as a shock-absorber or cushion in many of the joints in the body. In the shoulder, they cushion the rotator cuff from the shoulder bone. If the rotator cuff becomes inflamed, it can irritate the bursa, causing the bursa to produce more fluid, pressure and pain.
Can Arthritis Affect the Shoulder?
Arthritis is less common in the shoulder than in the knee or hip, but it does occur. The cartilage surfaces on the bones can wear away over time or become damaged from an injury or infection. The arthritis can cause a roughening of the joint surfaces, resulting in pain and stiffness.
What are the Treatment Options?
There are a number of treatment options that may be effective for shoulder impingement syndrome including:
Cold and Heat Therapy
Ice on the shoulder for 15 to 20 minutes at a time can often reduce inflammation and pain. When the inflammation and discomfort have settled down, heat therapy in the form of a heating pad or hot packs can often soothe and relax sore muscles. As with cold therapy, limit heat applications to 20 minutes at a time.
Simply avoiding any movement or activity that causes discomfort can calm inflamed tissues and strained muscles. Wearing a shoulder sling can also offer support, providing relief while the irritated areas heal.
Oral, non steroidal anti-inflammatory medications, or NSAIDS, such as Motrin®, Voltaren®, Feldene® or aspirin can help reduce inflammation and provide relief. Cortisone injections directly into the inflamed areas can often be very effective at reducing inflammation and pain.
An exercise program designed by a physician or physical therapist may be recommended for some rotator cuff injuries. The exercises can improve flexibility and help heal an injured rotator cuff. Once pain and inflammation are reduced, other physical therapy treatments such as ice, heat, massage or even ultrasound may be effective to help you regain motion.
Shoulder surgery may be recommended for some shoulder problems including arthritis, shoulder instability or a torn rotator cuff. Thanks to recent advances in techniques and technology, many shoulder surgeries can be done arthroscopically. Arthroscopy allows the surgeon to see and work inside the joint through a few small incisions and is most often an outpatient procedure. Problems that can be treated with shoulder arthroscopy include rotator cuff tears, impingement problems and torn cartilage.
In some cases, such as with advanced arthritis of the shoulder, a shoulder replacement may be recommended. Shoulder replacement involves resurfacing the areas of the bones that meet in the shoulder joint. The ball-shaped end of the upper arm or humerus is replaced with a metal component, while the socket shaped glenoid cavity of the shoulder blade is relined with special plastic.
Shoulder replacement can offer improved strength and range of motion as well as reduce pain. With any surgery there are risks and these need to be fully discussed with your doctor. Shoulder replacement is usually performed at a hospital using general anesthesia, though regional anesthesia may be an option for some patients. Your doctor and anesthesiologist will discuss which option is best for you.
What if I Have Other Questions?
Just give us a call at 804-765-5652. We’ll be happy to answer any questions you may have. And be sure to ask us about our upcoming seminars on knee and hip pain – we’d love to see you!