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Joint and Spine Center
Who gets shoulder problems?
What is bursitis?
What is tendonitis?
What is an irritated rotator cuff?
What are the symptoms?
What is the treatment for shoulder impingement?
How can physical therapy help?
When is surgery helpful?
What kind of anesthesia is used?
How long does it take?
Anyone can get shoulder pain. Most problems are caused by the effect of repeated overhead motions for a long period of time. Weekend athletes and do-it-yourselfers are especially vulnerable to overuse problems in the shoulder. The leading reasons for shoulder pain are bursitis, tendonitis, and anirritated rotator cuff. This group of conditions is called shoulder impingement syndrome.
The bursa is a fluid-filled sac that cushions the rotator cuff tendons from the shoulder bone. An irritated bursa is caused by an inflamed rotator cuff. When irritated, the bursa produces extra fluid, the sac expands, and the pressure and inflammation create pain.
Deep in the shoulder are a group of tendons and muscles called the rotator cuff. They help stabilize the upper arm bone in the shoulder joint and rotate the arm. The biceps tendon is also present in front of the shoulder. When the arm is raised repeatedly over the head, the tendonsmay rub against the underside of the shoulder bone and become irritated. The tendons swell, leaving even less space between tendons and bone. The irritation creates more irritation.
Excessive wear on the rotator cuff can lead to severe irritation, roughening, and eventually ulceration and tearing of the cuff. An irritated rotator cuff may cause clicking or popping in the shoulder from a ragged piece of the cuff sliding under the shoulder bone. This is usually associated with pain, and, if the cuff tears, weakness.
Bursitis, tendonitis, irritated rotator cuff and arthritis are all inflammatory reactions to overuse. With any of these problems, a continuous dull ache in the shoulder can become a sharp pain when you try to move your arm, especially over your head. The pain may be worse at night after a heavy day of activities using your shoulder.
Rest — Avoid strenuous activity and any motion that causes pain. In severe cases, a shoulder sling is helpful to rest fatigued muscles and inflamed tendons.
Ice — An ice pack on the affected shoulder can help ease inflammation.
Oral Medicines — Over the counter a nti-inflammatory medicines such as ibuprofen, naproxen or aspirin will help reduce inflammation. Your doctor may also prescribe an anti-inflammatory.
Cortisone Injections — Cortisone is a natural hormone and a very powerful medicine for inflammation. When injected directly into the inflamed area, it can be effective in decreasing swelling and inflammation that cause pain.
Once the pain and inflammation are under control, a program of exercise, ice, heat, electrical stimulation, ultrasound and massage is used to help you regain motion.
Thanks to recent advances in arthroscopy, many shoulder problems can be corrected using this minimally invasive technique. Arthroscopy is an outpatient procedure requiring tiny incisions closed with one stitch each. This procedure allows the surgeon to see and work inside the shoulder joint.
Problems that can be treated through arthroscopy include:
- impingement syndrome
- rotator cuff tears
- torn cartilage
- unstable joint
In some cases, however, if the rotator cuff is incompetent for a long time, it may lead to arthritis. Sometimes, the only option for pain-free motion is a shoulder replacement. Shoulder replacement requires a 1-2 day hospital stay.
A combination of general anesthesia and regional anesthesia is preferred. Regional anesthesia, which makes the arm numb, is an option for some patients. Your surgeon will discuss which type is best for you.
Shoulder arthroscopies are performed as an outpatient procedure and most surgeries are completed in 1-2 hours. Many people return to their normal activities within 4-5 days. People with physically demanding jobs should plan to take more time to return to work.