Adhesive Capsulitis (Frozen Shoulder)
Adhesive capsulitis, also known as frozen shoulder, is a chronic inflammation of the shoulder capsule that causes abnormal tissue growth around the area, significantly restricting movement.
Other symptoms associated with this condition include pain and overall stiffness, often worsening at night and when it is cold. The cause of the condition is unknown, although some believe it may be linked to autoimmune complications. It occurs very rarely in individuals under the age of 40 and somewhat more frequently in those who exhibit risk factors such as:
- Connective tissue disorders
- Heart disease/previous stroke
- Lung disease
- Physical trauma to shoulder
Treatment for this condition varies widely from simple non-steroidal anti-inflammatory drugs (NSAIDs) and light physical therapy, to invasive surgery designed to release the excess scar tissue. The doctor may opt for manipulation under anesthesia (MUA) as a sort of middle ground to break up scar tissue without an invasive procedure. This also stimulates fluid circulation into the shoulder, which is very helpful in progressed cases of frozen shoulder.
Reverse Shoulder Replacement
Reverse shoulder replacement is a surgical intervention that aims to repair a condition known as rotator cuff tear arthropathy. This is different than total shoulder replacement because it switches the formation of the glenoid-humeral joint. Naturally, the “ball” of the joint exists as the terminal end of the humerus, but after this procedure the glenoid will be changed into a spherical object that the humerus head can articulate around. This allows the deltoid muscle to lift the arm instead of the torn rotator cuff.
Although this is a very effective method for relieving pain at the shoulder joint, it is normally the last option considered. It is still an invasive surgery that resurfaces the bones, which can be very risky, especially in patients most likely to require this surgery.
The bones of elderly individuals are continually weakening as they age, so it is important for doctors to take this into account when determining if the surgery is worthwhile. Additionally, the patient may no longer be able to lift their arm more than a 90 degree angle after this procedure.
Rotator Cuff Repair
The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury or overuse and can lead to pain, weakness and inflammation. Surgery is often needed to treat this serious condition.
Shoulder Instability (Dislocations)
A shoulder is deemed unstable when it frequently dislocates or slips partially out of joint (subluxation). People with unstable shoulders may experience pain and limited motion in the joint and feel that moving in the wrong way will cause their shoulder to dislocate.
One of the most common causes of shoulder pain, impingement occurs when the front of the shoulder blade rubs against the rotator cuff as a person lifts his/her arm. The rotator cuff is a group of muscles and tendons that stabilizes the shoulder and permits lifting and rotating movements. If the rotator cuff weakens or is injured, the bone of the upper arm (humerus) can lift up, pinching the rotator cuff against the shoulder blade. The muscles can then swell further, creating a vicious cycle of pain and weakness that will not improve without intervention.
In addition to rotator cuff injuries such as tendonitis and tearing, impingement may be the result of bursitis, an inflammation of the cushioning sac between the rotator cuff and the shoulder blade.
Impingement worsens over time. At first, you may feel mild pain in the shoulder, which may radiate from the front of the shoulder to the side of the arm. The pain may worsen when you lift your arm, reach for something, or throw or serve a ball while playing a sport. There may be some swelling and tenderness at the front of the shoulder as well. As impingement progresses, pain and stiffness worsen until you may not be able to lift or lower your arm. Eventually, if left untreated, the condition may severely limit arm motion to the point that the shoulder becomes "frozen."
People most at risk for developing impingement are athletes, especially those who swim or play baseball or tennis, and people whose occupations include repetitive lifting or overhead movements, such as painting and construction. Sometimes, impingement occurs after a minor injury, or even without a discernible cause.
Severe shoulder conditions with persistent symptoms that have not responded to conservative treatments may benefit from shoulder replacement surgery. Shoulder replacement surgery replaces the damaged joint with an artificial one that allows patients to enjoy painless motion and resume their regular activities.
Shoulder Separations (AC Separations)
A separated shoulder is a common injury that most often affects athletes in contact sports. This injury to the acromioclavicular (AC) joint is usually the result of a fall on an outstretched hand (FOOSH), severe lateral sheering-force, or a fall on the tip of the shoulder. It is important to note that this is not the same as a shoulder dislocation: a dislocation (subluxation) of the shoulder occurs exclusively in the glenohumeral joint.
Treatment and recovery varies greatly between the classes of shoulder separation, from a few weeks of bed rest with anti-inflammatory drugs to arthroscopic surgery requiring months of physical rehabilitation. The Weaver-Dunn Procedure is the most frequently used surgical technique for the repair of shoulder separation. This procedure allows stability in the joint to be maintained effectively by attaching the acromial end of the coracoclavicular ligament to the displaced clavicle bone, while replacing the aforementioned ligament with alternative connective apparatus or tissue.