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MMC Home | Orthopedics
Early Treatment Important
The main cause of shoulder injuries is overexertion. Participation in sports is a major factor, but people also sustain injuries while doing routine activities. All it takes is one quick movement or one wrong turn. Early treatment is important.
One of the most common shoulder problems is rotator cuff injury. The rotator cuff consists of muscles and tendons around the shoulder joint. Injuries to this structure generally occur as the result of repetitive motion, overhead work, or heavy lifting on the job, or participation in sports such as baseball, tennis or swimming. Pain can also begin for no apparent reason.
When inflammation or swelling occurs, a cycle of pain and loss of motion begins. The pain usually centers in the outer portion of the upper arm, but it also frequently radiates to the back of the shoulder. People may have trouble sleeping on the affected side and wake up frequently during the night because of the pain. They may have trouble getting dressed, reaching overhead cabinets, and brushing their hair.
There are three stages of injury:
- Stage I: Patients have swelling of the bursa, which is a small sac between a tendon and a bone. This stage usually occurs in people under age 40
- Stage II: Patients suffer from tendinitis and a partial tear of the rotator cuff. This stage often occurs in people between the ages of 40 and 55-60.
Stage III: Patients have a complete tear of the rotator cuff, a problem that usually occurs as a degenerative condition in people under age 60. It also may occur as the result of a fall or other trauma. The patient's physician may order an MRI scan or a type of X-ray called an arthrogram to confirm the diagnosis of a complete tear.
Treatment depends on the stage of the injury, as well as a patient's lifestyle, occupation, and involvement in sports. Stage I injuries usually improve significantly with rest, anti-inflammatory medicine, and exercises to strengthen the muscles and tendons at the shoulder joint. An injection of an anti-inflammatory steroid in the space between the top arm bone and the prominent shoulder bone may help speed up recovery.
One or two steroid injections, combined with rest, may relieve the recurrent pain and allow healing from Stage II rotator cuff injuries. Patients with Stage III injuries generally have constant pain and do not respond to steroid injections. They require aggressive treatment. Physical therapy may be helpful, but patients typically do not regain overall shoulder strength. Surgery is usually recommended.
The goal of surgery is to create more room, reduce compression, and decrease irritation to the rotator cuff. A surgeon accomplishes this goal by making a small incision and removing the inflamed bursa and bony undersurface of the shoulder blade. The surgery is a major procedure, and patients may be hospitalized for two or three days. Recovery takes several months.
Before patients leave the hospital, a physical therapist teaches them gentle range of motion exercises to prevent stiffness and formation of scar tissue. At home, patients should continue the exercises and abide by limitations recommended by their surgeon for best results.
Words of Advice
Prevention is always the best approach. Always stretch before and after exercising and participating in sports activities. Also, make strengthening exercises part of the exercise routine.
See an orthopedic specialist immediately if an injury occurs, constant pain develops, or there is loss of motion in the shoulder. When treated early, rotator cuff injuries should not cause serious damage.
Randall R. Robbins, M.D., is a board-certified orthopedic surgeon on the staff of Methodist Medical Center of Oak Ridge. He received his medical degree from Louisiana State University Medical Center and completed an orthopedic surgery residency at the University of Texas Southwestern Medical Center. Dr. Robbins also completed a specialized preceptorship in open and arthroscopic shoulder surgery. He is a member of the American Medical Association, Tennessee Medical Association, Roane-Anderson County Medical Society, American Board of Orthopaedic Surgeons, Tennessee Hand Society, and the Clinical Orthopaedic Society.
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