Shoulder Conditions

Arthritis

Arthritis, which is loss of the normal cartilage, or smooth surfaces that line your shoulder joint, makes moving your shoulder and arm painful. In addition to pain, arthritis inflammation can cause swelling and joint damage. Types of shoulder arthritis include:

•    Osteoarthritis: The natural aging process can wear away at the cartilage between the bones at your shoulder joints, causing inflammation and shoulder pain.
•    Rheumatoid arthritis: This immune system dysfunction attacks and wears away the cartilage lining between the bones in your shoulder joint. The disease often affects multiple joints in your body.
•    Post-traumatic arthritis: This form of arthritis results from an injury or fracture to the shoulder.

Treatment options include

•    Non-surgical: NSAID’s, Activity modification, physical therapy.
•    Surgical: Shoulder resurfacing surgery, Total Shoulder Replacement & Reverse Total Shoulder Replacement

Frozen Shoulder

Frozen shoulder occurs when the capsule of connective tissue that surrounds the shoulder thickens and contracts, leading to stiffness and shoulder pain from restricted movement

Symptoms: Intense pain and restriction of pain followed by phase of minimal pain but restriction of movement followed by thawing phase. Delay in seeking treatment leads to capsular contracture, disuse atrophy and permanent reduction in movement.

Initial treatment includes pain management by medications and/or joint injections, followed by intense physical therapy protocol. If symptoms persist manipulation under anesthesia and/or arthroscopy adhesiolysis may be carried out.

Rotator Cuff Conditions

Three bones form the shoulder joint: the collarbone, the upper arm bone, and the shoulder blade. Together, these bones give the shoulder its wide range of motion. Attached to the shoulder is a group of muscles known collectively as the rotator cuff. These keep your arm in place while allowing it to move up and around. Rotator cuff disorders include:

Tendonitis and bursitis

Tendonitis and bursitis, both inflammatory conditions, are the most common causes of shoulder pain and stiffness. They can result from repetitive motion, such as in sports, or from a serious, sudden injury. The conditions are most common in adults older than 40, as the tendons have aged and are more susceptible to injury.

Rotator Cuff Tear

Rotator cuff tears are a common cause of shoulder pain and disability in adults and can seriously inhibit many daily activities, like combing your hair or getting dressed. This type of injury typically results from a wearing down of the tendon, which occurs slowly over time, but it can also be caused by a sudden trauma.

Treatment:

Non Surgical :

•   Rotator Cuff Therapy protocol with pain management

Surgical :

•    Arthroscopic Rotator Cuff Repair/ Mini Open Rotator Cuff Repair
•   Arthroscopic Superior Capsular reconstructions
•   Arthroscopic sub acromial decompression.

In the presence of severe cuff tear arthropathy Reverse Total Shoulder Arthroplasty is needed.

Dislocations

Because the shoulder joint is so mobile, it can be very easy to dislocate the bone from the socket. The top of the upper arm bone (humerus) can partially or completely come out of the socket (glenoid).

•   Partial: The bone moved partially out of the shoulder joint socket and returned on its own.
•   Total: The bone moved completely out of the shoulder joint socket and had to be returned to its proper position by an outside force.

Acromio-Clavicular Joint Dislocations:

This occurs when the outer (lateral) end of the clavicle (collar bone) seperates from the acromion (Part of shoulder blade). Depending on the nature of trauma the dislocation can vary from a mild to severe dissociation. Usually in the lower grades (types 1&2), non surgical therapy (Rest, medications, physical therapy) is needed. Surgical AC joint Reconstructions are done for the higher grades of injury or when non surgical treatment fails.

Fractures

Fractures are broken bones and those that affect the shoulder typically involve the

•   Clavicle (collar bone)
•   Proximal humerus (upper arm bone)
  •          Fractures of the clavicle or the proximal humerus often result from the force of a hard fall, collision, or motor vehicle accident.
•   Scapula (shoulder blade)
  •          The scapula is not as easily fractured because of the protection afforded by the chest and surrounding muscles. Therefore, scapula fractures are commonly the result of more severe traumas and are associated with injuries to the chest.

Shoulder Instability

Shoulder instability develops when your muscles and ligaments are not strong enough to hold the shoulder bones securely in the socket. This can lead to multiple painful shoulder dislocations or prevent you from using the shoulder or lifting your arm. Shoulder instability can develop as a result of:

•   Previous shoulder dislocations: The more often you experience shoulder dislocations, the less stable your shoulder becomes.
•   Loose ligaments: Ligaments are the tissues that bind bones together. Shoulder ligaments can either be naturally loose or become loose over time, especially if you repeatedly bring your arm up over your head, as in swimming or tennis.

Surgical Treatment for Traumatic Recurrent Shoulder Dislocations/Instability: Arthroscopy Bankart’s repair or Latarjet procedure.

For patients with habitual non traumatic dislocations, ligamentous laxity or muscle patterning disorders surgical treatments do not have positive outcomes and continuous physiotherapy and rehabilitation will be required.

Impingement Syndrome:

Condition caused by excessive rubbing of the shoulder muscles with the under surface of acromion. This leads to pain especially on activity. Treatment is focused on reducing inflammation and physical therapy. Arthroscopy procedures are useful in intractable impingement and in Type 2/3 acromion morphology.

SLAP Tear:

Injury to the labrum surrounding the glenoid is termed as a SLAP tear (Superior Labrum Anterior and Posterior). Cause of a SLAP tear can be traumatic in nature. It is also common in athletes engaged in repetitive overhead sports (eg throwing athletes). Many a times it can occur due to degeneration of the labrum. Symptoms: Pain ,especially with overhead activity, Reduced range of movement, difficulty throwing.

Treatments:

Non Surgical:

•   Activity restriction/modification, Physical therapy
Surgical:
•   Arthroscopic SLAP repair