• Shoulder

  • It has been estimated that more than 7 million people annually see a physician for shoulder pain. More than half of the visits are for rotator cuff issues. We also see patients with:

    • Tendonitis
    • Overuse Pain
    • Dislocated Shoulders
    • Unstable Shoulders
    • Shoulder Separation
    • Broken Collarbones

    Various factors contribute to shoulder pain or injury: sporting activities such as swimming, golf, or bowling; everyday activities such as painting walls or gardening; and repetitious tasks involving overhead motions.

    The shoulder is the most complex joint in the body and has the largest range of motion. The humerus (upper arm bone) is loosely joined to the scapula (shoulder blade) and held in place by muscles, ligaments and tendons. Broken bones are less common shoulder injuries than injuries of the soft tissue surrounding the bones.

    Shoulder problems are most often first treated with RICE (Rest, Ice, Compression, and Elevation):

    • Rest. Don't use the shoulder for 48 hours.
    • Ice. Put an ice pack on the injured area for 20 minutes, four to eight times per day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice wrapped in a towel
    • Compression. Put even pressure (compression) on the painful area to help reduce the swelling. A wrap or bandage will help hold the shoulder in place.
    • Elevation. Keep the injured area above the level of the heart. A pillow under the shoulder will help keep it up.

    If the pain persists, the injury may require medical treatments such as cortisone injections or physical therapy. Common shoulder injuries that typically resolve themselves without surgical treatment include separated shoulders, “frozen” shoulders, and tendonitis.

    Rotator Cuff Tear

    The rotator cuff is group of muscles and tendons that holds the shoulder joint together. Rotator cuff tears are common and some are small enough that they heal on their own with little or no pain. More extensive damage to the rotator cuff, however, can limit the ability to have a full range of motion in the shoulder and may require medical treatment.

    Rotator cuffs are most often injured through falls or sports. If you think you have damaged your rotator cuff but the pain is minor, try the home remedies listed above.

    You should see and orthopedic surgeon if:

    • You are experiencing intense pain.
    • Your shoulder motion is limited due to pai
    • Your shoulder feels loose like it will come out of the socket when you move i
    • You cannot engage in normal daily activities
    • You feel weakness in your shoulder

    Possible treatments for a severe rotator cuff tear that does not heal with rest and physical therapy include:

    • Decompression: Using a minimally invasive surgical procedure in the office, a surgeon will remove inflamed tissue and bone spurs from around the rotator cuff
    • Arthroscopic Surgery: the torn tendon is reattached to the arm bone using minimally invasive surgery. We perform this surgery at Littleton Adventist Hospital and patients typically go home the same day. Patients usually can return to work and activities within two weeks
    • Shoulder Replacement: In the most severe cases of long-term rotator cuff injuries, patients can develop arthritis in their shoulders and require surgery to replace the diseased joint with an artificial joint.

    Dislocated or Unstable Shoulder

    Dislocated shoulder is the general term for when the ball of the humerus pops out of the shoulder joint. Depending on the direction of this movement, a more specific term will be used in diagnosis. Anterior dislocation, where the humerus is in front of the joint, is the most common dislocation and happens when the arm is suddenly pulled backwards. Once a shoulder has been dislocated, the ligaments and tendons may become stretched, which will make the shoulder unstable and reoccurrences of dislocation likely.

    Common signs of the humerus being dislocated include:

    • A square appearance
    • Extreme pain
    • Swelling, bruising and tenderness around the collar bone

    Stabilize and seek medical attention for suspected dislocated shoulders as delays can permanently damage the tendons and ligaments.

    After the dislocated shoulder has been set, the pain will quickly stop. A sling may be used to reduce swelling and tenderness. Once the swelling has been reduced, exercises to strengthen and increase movement of the shoulder may be prescribed.

    Frequent bouts of dislocation can be treated with arthroscopic surgery to tighten stretched or torn tendons or ligaments. Specialists at the Center for Orthopedics perform minimally invasive arthroscopic shoulder surgery, which requires just small incisions to look inside and repair the shoulder. Patients typically go home the same day and return to full activities in several weeks.

    Shoulder Separation

    Different from a dislocated shoulder, separation occurs when the collarbone is moved out of position from the shoulder blade. This type of injury happens when a fall tears a ligament, causing the collarbone to move.

    A separated shoulder is usually treated with rest and a sling. If it doesn’t heal quickly, or the ligaments have been severely torn, surgery may be necessary. The specialists at Center for Orthopedics perform this surgery through minimally invasive techniques, typically allowing the patient to return to normal activities within two weeks.

    Broken Collarbone

    The collarbone, or clavicle, is a long bone connecting the arm to the ribcage. A broken collarbone is a common injury in small children and young adults. The most common cause of a broken collarbone is an automobile accident, but it also often occurs through sports accidents. The collarbone usually breaks either in the middle or close to the shoulder. Nerves and blood vessels run under the collarbone, but these are rarely damaged.

    Seek immediate medical treatment for a broken collarbone to determine the extent of damage. Typically, the broken bones can be aligned and a sling used for several weeks to aid in healing.

    Severely broken collarbones may require surgery to align the broken bones with plates, pins and screws. The orthopedic surgeons at the Center for Orthopedics provide on-call coverage to the Level II trauma center at Littleton Adventist Hospital and are specialists in traumatic orthopedic injuries, including broken collarbones.

    Total shoulder arthroplasty (TSA) can be a successful treatment option for patients who suffer with end stage arthritis or degenerative disease of the shoulder joint. Many patients aren’t familiar with shoulder replacement as an option and tolerate pain and restricted motion for a long period of time before seeking medical intervention.

    The shoulder is a ball and socket joint held in place by muscles, tendons and ligaments.  In TSA the upper arm bone (humerus) is replaced with a prosthetic implant that has a rounded metal head. The socket part of the shoulder joint (glenoid cavity) is replaced with a smooth plastic shell, held in place with special cement. The size of the shoulder replacement is customized to the patient and their lifestyle. The surgery itself takes between 1 – 3 hours and with normal use, most replacement shoulders last for at least 10 years.

    Once the postoperative therapy program is complete most TSA patients are pain-free, and able to return to their normal activities without any significant strength limitations.

    As when considering any surgical procedure, patients should talk with their doctor to determine if total shoulder replacement is appropriate for their condition. Ideal candidates for shoulder arthroplasty tend to be older with no prior history of large, inoperable rotator cuff tears. Athletes who play contact sports or heavy laborers are not typically good candidates for the surgery because of the long-term demands they place on the shoulder. Patients experiencing early osteoarthritis may consider more conservative management such as physical therapy, over-the counter medication, cortisone or steroid injections, or even a minimally invasive arthroscopic procedure before opting for total shoulder replacement.