| Shoulder Tendonitis
Shoulder Tendonitis
What is Tendonitis?
Tendons function like ropes connecting muscle to bone. When the muscle contracts it pulls on the tendon moving the bone. Tendonitis is an inflammation of the tendon. Over time inflammation can weaken the tendon and can result in tearing or failure of parts of the tendon.
Symptoms:
Symptoms usually include pain with some limitation of movement and weakness in the shoulder.
Causes:
Causes of tendonitis include repetitive use, overuse, post injury, and impingement.
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Shoulder Impingement
Shoulder Impingement
What is Shoulder Impingement?
Impingement occurs when a structure rubs on the tendon. The acromion is the outer edge of the shoulder blade. This can slope downwards and press on the tendon. The acromioclavicular, or AC joint, may swell or become enlarged after an injury or due to arthritis and can rub on the rotator cuff tendons as well.
Treatment:
Early on in the process rest, ice, and anti-inflammatory medication may be sufficient treatment. Frequently physical therapy and steroid injections can be necessary. If these measures don’t help and the tendonitis is due to impingement then arthroscopic surgery to shave the bone and alleviate the pressure on the tendon is necessary.
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Rotator Cuff Tears
Rotator Cuff Tears
What is the rotator cuff?
The rotator cuff is a group of four muscles and their tendons that connect the shoulder blade to the upper part of the arm. They elevate and rotate the arm. They also help keep the “ball” of the shoulder centered on the socket. There is one muscle/tendon on top (supraspinatus), one in front (subscapularis) and two in the back (teres minor and infraspinatus).
What is a rotator cuff tear?
The most commonly torn tendon is the supraspinatus. If this tears the patient usually has pain, weakness and difficulty raising the arm. The tear can vary in size and the tendon may or may not pull away from the bone leaving a gap (retraction).
Treatment:
Full thickness tears usually require surgical repair. This can be done with arthroscopic techniques with very small incisions. It takes about 6 to 8 weeks for the tendon to heal enough to begin lifting the arm without assistance. Physical therapy is helpful in regaining movement and strength. Full recovery can take up to 6 months or more.
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| Labral Tears
Labral Tears
What is the labrum?
The labrum is a circular piece of cartilage that goes circumferentially around the socket. The bicep tendon anchors to the upper part of the rim.
Causes and symptoms of a labral tear: Tears or detachments can cause pain, clicking, or instability (popping out of place). Tears in the front portion of the rim are associated with instability or dislocations. A displaced labrum can cause a popping or clunking sensation.
Treatment:
Labral detachment can be repaired utilizing small screw anchors with sutures. The anchors are inserted into the edge of the rim of the socket. The sutures are passed around the cartilage rim and tied.
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Shoulder Dislocation
Shoulder Dislocation
What is Shoulder dislocation?
Shoulder dislocation occurs when the ligaments and capsule that form a sheath around the ball and socket stretch or tear. This allows the ball to pop out of the socket (dislocate). They can be anterior (out the front) or posterior (out the back). About 90% of dislocations are anterior.
Treatment:
Initial treatment is manipulation of the ball back into the socket. This is followed by the use of a sling or immobilizer. The recommended time of immobilization is decreasing. After about 10 days or so gentle motion can be started. Extension coupled with overhead elevation is avoided. The younger the patient is at the time of their first dislocation the more likely it is they will dislocate again. The recurrence rate for an 18 year old with a traumatic dislocation is approximately 90%. This is due to the fact that it takes more force to tear a young persons ligaments than an older individual. Treatment for repetitive dislocations is surgical repair of the labrum if it’s detached and tightening of the ligaments/capsule sometimes.
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Arthroscopic surgery is a surgical procedure used to visualize, diagnose and treat problems inside a joint. A small incision about 1/4” is made to fit an arthroscope, which is a small, fiber optic medical device. The arthroscope enables orthopaedic surgeons to diagnose and treat problems such as ligament tears, arthritis and joint injuries quickly and effectively. Through the incision, various instruments can be inserted into the joint to trim, remove or repair damaged structures. 
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