Who Gets Shoulder Problems?
After age 25, 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 causes of shoulder pain are bursitis, tendonitis and irritated rotator cuff. This group of conditions is called shoulder impingement syndrome.
• What is bursitis?
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 creates pain.
• What is tendonitis?
Deep in the shoulder are a group of tendons and muscles called a 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 tendons 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. It is much like a rope being drawn again and again across a craggy rock.
• What is an irritated rotator cuff?
Excessive wear on the rotator cuff can lead to severe irritation, roughening and eventually ulceration and tearing of the cuff. An irritated rotator cuff is felt as a clicking or popping in the shoulder from a ragged piece of the cuff sliding under the shoulder bone, and arm weakness.
Occasionally, injuries or infections can also lead to arthritis, although arthritis of the shoulder is less common than in the knee or hip. Arthritis in the shoulder causes a roughening of the joint from worn cartilage and loose fragments of bone.
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What are the symptoms?
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.
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What is the treatment for shoulder impingement?
• Rest
Avoid strenuous activity and any motion that causes pain. In some 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 when combined with gentle motion.
• Oral Medicines
Anti-inflammatory medicines such as Motrin, Feldene, Voltaren, Naprosyn or aspirin will help reduce inflammation.
• Cortisone Injections
Cortisone is a natural hormone and a very powerful medicine for inflammation. When injected directly into the inflamed area, it is very effective in decreasing swelling and inflammation that cause pain.
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Can physical therapy help?
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.
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When is surgery helpful?
Thanks to recent advances in arthroscopy, many shoulder problems can be corrected using the same techniques that revolutionized the treatment of knee problems.
Arthroscopy is an outpatient procedure requiring three 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
• irritated rotator cuff
• torn cartilage
• unstable joint
In some cases, however, if the rotator cuff is severely damaged and leads to arthritis, the only option for pain-free motion is a shoulder replacement. Shoulder replacement requires a 4-5 day hospital stay.
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A Case History
Shoulder Arthroscopy at
The Florida Knee and Orthopedic Centers
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An avid golfer for many years, Edna Miller of Largo injured her shoulder swinging a golf club. After four weeks of pain and swelling, Edna came to The Florida Knee and Orthopedic Centers for an examination.
She and her surgeon decided a closer look was needed.
On a Friday morning, Edna checked into the Clearwater facility for arthroscopy. She was given a general anesthesia, the doctor dimmed the lights and connected the television monitor.
Through three tiny incisions (needing only one stitch each to close) in Edna’s shoulder, he smoothed an inflamed tendon and trimmed a small amount of bone in order to enlarge the space between the tendon and bone.
Edna took it easy for the next few days and then started physical therapy to strenghten her muscles and restore her shoulder motion.
Six weeks later she was back playing golf, moving her shoulder easily and without pain.
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What kind of anesthesia is used?
For maximum comfort, general anesthesia is preferred. Regional anesthesia is an option for some patients. Your surgeon will discuss which type is best for you.
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Where is shoulder arthroscopy performed?
Shoulder arthroscopies are performed at the Clearwater location of The Florida Knee and Orthopedic Centers. The time from check-in to discharge usually is as little as two hours. Most people return to their normal activities within four to five days. People with physically demanding jobs can usually return to work in two to three weeks.
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How can I schedule an evaluation?
An appointment can be made by calling (727) 446-5633, or 1-800-881-8485 if you are outside the Tampa Bay area. Your appointment will be scheduled at the office that is most convenient for you. Office hours are 8 to 5 Monday through Friday.
The Center accepts Medicare assignment and bills Medicare and secondary insurance. The Center also participates in most managed care plans including AvMed, PCA, Cigna, HIP, USA Health, Private HealthCare Systems, PruCare Plus and Principal.
Appointments for Workers’ Compensation patients are authorized and scheduled through adjusters for the compensation insurance companies.
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