The shoulder is made up of three bones:
- the scapula (shoulder blade)
- the humerus (upper arm bone)
- the clavicle (collarbone)
The rotator cuff, which connects the humerus to the scapula, is made up of the tendons of four muscles.
A variety of shoulder problems can arise, and the surgeons at Orthopaedic Physicians of Colorado will recommend an appropriate treatment for any shoulder problem you may be experiencing. Arthroscopy is sometimes the best solution.
Shoulder Instability: Sublaxation and Dislocation
Instability occurs when the top of the upper arm bone is forced out of the shoulder socket. This can happen as a result of sudden injury or from overuse of the shoulder ligaments. Subluxations and dislocations are two basic forms of shoulder instability.
- Subluxation is a partial or incomplete dislocation of a joint. If the shoulder is partially out of the shoulder socket, it eventually may dislocate. Even a minor injury may push the arm bone out of its socket.
- Shoulder dislocation means that the top of the arm bone (humerus) loses contact with the socket of the shoulder blade (scapula).
If the person with a dislocated shoulder can be taken to a hospital or clinic, that is the best immediate plan of action. This is because reducing a dislocated shoulder (putting the bones back in place) can involve complications that only trained medical personnel know how to treat.
Patients with repeat dislocation usually require surgery. Open surgical repair may require a short stay in the hospital, but arthroscopic surgical repair is usually done on an outpatient basis. After either procedure, extensive rehabilitation including physical therapy is necessary.
Impingement and Partial Rotator Cuff Tears
Partial thickness rotator cuff tears can involve chronic inflammation and the development of spurs on the underside of the acromion or the acromioclavicular joint.
Nonsurgical treatment is usually successful, and may include modification of activity, light exercise, and (sometimes) a cortisone injection. Sometimes spurs on the underside of the acromion are removed and the rotator cuff is repaired during surgery.
The socket of the shoulder joint is quite shallow and therefore less stable than the hip joint, for example. The shoulder has a kind of cartilage called a labrum that stabilizes the joint. If your shoulder has been injured, you may have a labral tear.
Your orthopaedic surgeon will determine what kind of tear has occurred and recommend a plan for treatment. Most labral tears don’t require surgery, but if your symptoms continue despite non-surgical treatment, surgery may be necessary.
Osteoarthritis In the Shoulder
Osteoarthritis of the shoulder can affect the two joints in the shoulder, the acromioclavicular joint and the glenohumeral joint. When osteoarthritis develops in the glenohumeral joint, it is usually the result of a previous injury. Osteoarthritis in the acromioclavicular joint becomes painful, and can eventually reduce the ability to do everyday tasks that involve reaching and lifting.
If other treatments recommended by your orthopaedic surgeon don’t reduce chronic pain and other symptoms, surgery is a last resort. The glenohumeral joint can undergo a total shoulder arthroplasty or a hemiarthroplasty. For the acromioclavicular joint, the common surgical procedure is a resection arthroplasty, which involves removing the last half inch of the clavicle.
Rotator Cuff Tears
Full-thickness rotator cuff tears are most often the result of impingement, partial thickness rotator cuff tears, heavy lifting, or falls. Nonsurgical treatment with modification of activity is successful in a majority of cases.
If pain continues, surgery may be needed to repair full-thickness rotator cuff tears. Arthroscopic techniques allow shaving of spurs, evaluation of the rotator cuff, and repair of some tears. Both techniques require extensive rehabilitation to restore the function of the shoulder.
Rotator Cuff Tendonitis
Rotator cuff tendonitis is an inflammation of a group of muscles in the shoulder, including an inflammation of the lubrication mechanism called the bursa. Bursitis is a symptom of rotator cuff tendonitis, which is often associated with throwing, raking, washing windows, and many other types of repetitive activities.
Rotator cuff tendonitis sometimes occurs because of an injury. Rotator cuff injuries are the most common cause of shoulder pain in people of all ages who participate in sports.
Shoulder Bursitis Or Tendinitis
Bursitis or tendinitis is typically caused by from excessive repetitive activities, swimming, painting, or weight lifting, for example. These kinds of activities can cause rubbing or squeezing (impingement) of the rotator cuff under the acromion and in the acromioclavicular joint. These problems are treated initiating by reducing activities that may be causing the pain, and by following a shoulder rehabilitation program.
Fractures — broken bones — usually involve the clavicle (collar bone), proximal humerus (top of the upper arm bone), and scapula (shoulder blade).
Fractures of the clavicle or the proximal humerus can be caused by a direct blow to the area from a fall, collision, or motor vehicle accident. Because the scapula is protected by the chest and surrounding muscles, it is not easily fractured. Therefore, fractures of the scapula are usually caused by high-energy trauma, such as a high speed motor vehicle accident. Scapula fractures are often associated with injuries to the chest.
Shoulder Joint Replacement
In shoulder joint replacement surgery, surgeons will replace the ends of the damaged upper arm bone and sometimes the shoulder bone, or they will cap them with artificial surfaces. Shoulder joint components may also be held in place with cement, or they will be made with material that will allow new bone to grow into the joint to hold it in the proper position.
The top end of your upper arm bone, which is shaped like a ball, is held against a cup-shaped part of the shoulder bone by muscles and ligaments. Surgeons usually replace the top of the upper arm bone with a long metal piece that has a rounded head, which will be carefully inserted into the upper arm.
Newer surgeries include a reverse total shoulder replacement for patients suffering from painful arthritis and who have damage to the muscles around the shoulder.
Doctors often use general anesthesia for joint replacement surgeries. In other cases, they choose to use regional anesthesia, which means you won’t be able to feel the area of the surgery, even though you are awake. The choice of anesthesia depends on your doctor, your overall health and to some degree, what you prefer.
Call Orthopaedic Physicians of Colorado at (303) 789-2663 to schedule an appointment at one of our locations in the Denver metropolitan area to discuss treatment of injuries to the shoulder.