Leigh Ann Curl, MD , head orthopaedic surgeon for the Baltimore Ravens
At the Sports Medicine and Shoulder Center at MedStar Harbor Hospital, we have a team of orthopaedic specialists dedicated to helping you regain the functionality of your shoulder and perform a full range of motion. Whether acute (from an injury) or chronic (due to long-term overuse), shoulder pain can be very debilitating. Many conditions affecting the shoulder can be treated non-surgically; however, shoulder surgery is an excellent option for those who have experienced a serious problem and need to regain mobility. MedStar Health shoulder specialists use a variety of treatment methods, including surgical and nonsurgical options. If you are experiencing shoulder pain that lasts longer than a few weeks or is severe, contact MedStar Harbor Hospital to meet with orthopaedic specialist. Learn more:
The shoulder is a complex joint built to allow movement in many directions: forward, backward, around in a circle, and away from the body. Muscles and ligaments help keep the shoulder stable and secure in your shoulder socket. We depend on our shoulders to support many of our most basic motions, including pushing, pulling, lifting, and throwing. Because the shoulder is a very flexible joint, it is highly vulnerable to injury. Whether you’re a competitive athlete or an active elder suffering from years of repetitive motion, our shoulder specialists are here to treat a wide variety of shoulder conditions. Learn more:
- Frozen Shoulder
- Rotator Cuff Conditions
- Shoulder Instability
- Shoulder Separation
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. There are many types of arthritis including the most common form, osteoarthris, which affects millions of people worldwide and occurs when the protective cartilage between bones wears down over time. Patients may also experience rheumatoid arthritis, an inflammatory disease that leads to painful swelling of the joints.
Shoulder arthritis symptoms generally include:
- Pain in the shoulder
- Redness or heat in the area
- Trouble raising your arm
- Clicking sound when you raise your arm
Treatment for shoulder arthritis usually depends on what specific type of arthritis you have, and how severe it is. Nonsurgical options may include:
- Resting your arm and avoiding painful activities
- Over-the-counter or prescription anti-inflammatory medications
- Applying heat or ice to the shoulder
- Steroid injections
- Physical therapy, including exercises designed to restore strength and range of motion in your arm and shoulder
The orthopaedic surgeons at MedStar are experienced in the most advanced and innovative surgical procedures for shoulder arthritis treatment, including:
Frozen shoulder, known in the medical field as adhesive capsulitis, occurs when the capsule of connective tissue that surrounds the shoulder thickens and contracts, leading to stiffness and pain from restricted movement.
The condition generally affects adults ages 40 to 60 and can be caused by diseases such as diabetes, hypothyroidism, hyperthyroidism, Parkinson’s, or cardiac disease. It can also result from immobilizing the shoulder too long after an injury, which is why a vital part of any shoulder recovery is physical therapy.
Physicians typically treat this condition with anti-inflammatory medication and physical therapy, which is successful in the majority of cases. For those who don't experience relief for two to three years, surgical options will be explored.
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.
- Tendonitis occurs when tendons in the rotator cuff become inflamed or irritated.
- Bursitis occurs when the fluid-filled sac that protects the space between tendons and bones becomes inflamed or irritated.
Treatment goals include reducing pain and inflammation. Rest, hot/cold compression and splinting usually are recommended. If those treatments are not successful, a physician may provide corticosteroid injections, recommend physical therapy, and in the most severe cases, perform surgery.
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.
Some common symptoms of rotator cuff tears include:
- Pain in the shoulder and arm
- Weakness and tenderness in the shoulder
- Limited range of motion and pain, especially when raising and lowering your arm
- Snapping or cracking sensation when moving the shoulder
- Inability to rest or sleep on the affected shoulder due to pain
Treatment for rotator cuff tears is usually very conservative: rest, sometimes in a sling, hot/cold application, and anti-inflammatory medications are recommended. In the most severe cases, surgery is necessary. Surgeons may perform an arthroscopic surgery or an open surgical repair.
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 and outside force.
Causes and Symptoms
Shoulder dislocations can occur from falls, car accidents, or strong contact during sports. Those with a dislocated shoulder can experience swelling, numbness, weakness, bruising, pain, instability, and even muscle spasms.
To treat a dislocated shoulder, a physician uses a process called closed reduction that places the upper arm back into the socket. Pain relief is almost immediate. Physicians typically recommend that, after treatment, the shoulder be immobilized in a sling or other device for a few weeks.
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 fractures may affect anyone but can be common in older adults when linked to osteoporosis. Children are more likely to fracture the clavicle, while adults fracture the proximal humerus more frequently. Some common symptoms of shoulder fractures include:
- Shoulder pain
- Swelling and bruising of the shoulder area
- Inability to move the shoulder without pain
- A bump or disfigurement at the site of the fracture
- Snapping or cracking sensation when moving the shoulder
Most shoulder fractures can be treated by setting the joint into place and using a sling or strap to immobilize it. After a period of healing, rehabilitation exercises are recommended to promote shoulder strength and motion. More severe cases, in which fracture fragments have been displaced from their normal position, surgery may be necessary to realign the shoulder.
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.
Most cases of shoulder instability respond well to conservative treatment involving intensive rehabilitation exercises and physical therapy to strengthen the muscles and help hold the shoulder in place. In cases where nonsurgical methods are unsuccessful, surgical options—such as coracoids transfer for shoulder instability—will be explored.
Shoulder separation often is confused with shoulder dislocation, but the two are very different injuries. Shoulder separation occurs when the connection between the shoulder blade and collarbone is disrupted. Typically, this injury occurs after a fall onto the shoulder (common in sports).
Symptoms depend on the severity of the separation, but most always include severe pain, swelling, bruising, and, sometimes, deformity.
Treatment also depends upon the severity of the injury. Physicians categorize shoulder separation into six levels. Depending upon the severity level of the separation, treatment can range from rest, ice, and a sling to surgical procedures.
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