Common Shoulder Conditions
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Shoulder
Shoulder Surgery Sunshine Coast
We focus on managing a wide range of persistent shoulder issues, such as rotator cuff tears, shoulder arthritis, frozen shoulder, biceps injuries (including SLAP tears), and shoulder instability and dislocations. Additionally, we address various acute injuries, including fractures of the clavicle and humerus, as well as AC joint injuries.
Orthopaedic conditions of the shoulder
The shoulder, also known as the glenohumeral joint, is a ball-and-socket joint that offers the greatest range of motion in the body, enabling us to position our hands wherever necessary. This extensive mobility comes with a trade-off: the joint’s inherent instability, with the ball being significantly larger than the socket—about four times its size. The surrounding soft tissues play a crucial role in maintaining stability. Both sudden shoulder injuries and ongoing wear-and-tear of these supportive structures can result in shoulder pain.
AC joint pathology
AC joint pathology refers to conditions that affect the acromioclavicular (AC) joint, which is the small joint at the top of the shoulder where the acromion (part of the scapula) meets the clavicle (collarbone). Common AC joint pathologies include osteoarthritis, sprains, separations, and fractures. These conditions can result from acute injuries, such as a fall or direct impact, or from chronic wear and tear, particularly in athletes or individuals who perform repetitive overhead activities.
Symptoms typically include pain at the top of the shoulder, swelling, tenderness, and reduced range of motion. Treatment options vary depending on the severity of the condition and may range from conservative management, such as rest and physical therapy, to surgical intervention.
Non-Surgical Management
Rest
Cold Therapy
Medications
Physical Rehabilitation
Surgical Management
Surgery may be considered if pain continues or if you have a significant separation.
Recent advancements have focused on enhancing the surgical methods used to repair severe AC joint separations. A newer approach, designed to restore the AC joint’s anatomy, is called anatomic reconstruction. This technique aims to provide stable and secure joint function by anatomically reconstructing the joint. The procedure is often performed with arthroscopic assistance, involving a small open incision to place the graft.
During this surgery, the torn CC ligaments are replaced using allograft tissue. The graft is carefully positioned where the ligaments were torn and secured with biocompatible screws. Over time, the graft heals and helps to restore the shoulder’s natural anatomy. more>>
Shoulder Separation
What is shoulder separation?
Acromioclavicular joint (AC joint) dislocation or shoulder separation is one of the most common injuries of the upper arm. It involves separation of the AC joint and injury to the ligaments that support it. The AC joint forms where the clavicle (collarbone) meets the shoulder blade (acromion).
Causes of shoulder separation
It commonly occurs in young athletes and results from a fall directly onto the shoulder. A mild shoulder separation is said to have occurred when there is AC ligament sprain that does not displace the collarbone. In more serious injuries, the AC ligament tears and the coracoclavicular (CC) ligament sprains or tears slightly, causing misalignment in the collarbone. In the most severe shoulder separation injury, both the AC and CC ligaments tear, and the AC joint is completely out of its position.
Symptoms of shoulder separation
Symptoms of a separated shoulder may include shoulder pain, bruising or swelling, and limited shoulder movement.
Diagnosis of shoulder separation
The diagnosis of shoulder separation is made through a medical history, physical exam and X-ray.
Treatment of shoulder separation
Conservative treatment options
Conservative treatment options include rest, cold packs, medications and physical therapy.
Surgery
Surgery may be an option if pain persists or if you have a severe separation.
Anatomic reconstruction
Of late, research has been focused on improving surgical techniques used to reconstruct the severely separated AC joint. The novel reconstruction technique that has been designed to reconstruct the AC joint in an anatomic manner is known as anatomic reconstruction. Anatomic reconstruction of the AC joint ensures static and safe fixation and stable joint functions. Nevertheless, a functional reconstruction is attempted through the reconstruction of the ligaments. This technique is done through an arthroscopically-assisted procedure. A small open incision will be made to place the graft.
This surgery involves replacement of the torn CC ligaments by utilising allograft tissue. The graft tissue is placed at the precise location where the ligaments have torn and fixed using bio-compatible screws. The new ligaments gradually heal and help restore the normal anatomy of the shoulder.
Postoperative rehabilitation includes the use of a shoulder sling for 6 weeks, followed by which physical therapy exercises should be done for 3 months. This helps restore movement and improve strength. You may return to sports only after 5-6 months after surgery.
Frozen Shoulder
What is frozen shoulder?
Frozen shoulder, also called adhesive capsulitis is a condition characterised by pain and loss of motion in the shoulder joint. It is more common in older adults aged between 40 and 60 years and is more common in women than men.
Causes of frozen shoulder
Frozen shoulder is caused by inflammation of the ligaments holding the shoulder bones to each other. The shoulder capsule becomes thick, tight, and the stiff bands of tissue called adhesions may develop. Individuals with shoulder injury, shoulder surgeries, shoulder immobilised for longer periods, and having other disease conditions such as diabetes, hypothyroidism, hyperthyroidism, Parkinson’s disease and cardiac diseases are at a risk of developing frozen shoulder.
Symptoms of frozen shoulder
Frozen shoulder may cause pain and stiffness, and limit the movements of the shoulder.
Diagnosis of frozen shoulder
Frozen shoulder can be diagnosed by the presenting symptoms and radiological diagnostic procedures such as X-rays or MRI scans.
Treatment of frozen shoulder
Conservative Treatment
Conservative treatment options include:
- Non-steroidal anti-inflammatory drugs and steroid injections for pain
- Physical therapy to improve your range of motion
- Sometimes, heat to reduce pain
Surgery
Your surgeon may recommend shoulder arthroscopy when the conservative treatment does not work. During surgery, the scar tissue will be removed and tight ligaments, if any, will be dissected. Following surgery physical therapy will be advised to bring full range of motion and strengthen the muscles.
Shoulder Arthritis
Shoulder arthritis is a condition characterised by the inflammation and degeneration of the cartilage in the shoulder joint, which can lead to pain, stiffness, and reduced mobility. It typically results from wear and tear over time, known as osteoarthritis, or from inflammatory conditions like rheumatoid arthritis. As the cartilage breaks down, the bones in the joint may begin to rub against each other, causing discomfort and impacting daily activities.
Symptoms often include persistent pain, difficulty moving the shoulder, and stiffness, which can affect the quality of life and limit one’s ability to perform routine tasks.
Non Operative management
Arthritis cannot be cured, so be cautious of 'miracle cures.' Your doctor might prescribe anti-inflammatory medications and suggest occupational or physiotherapy, which could include exercises and heat therapy.
Surgical Management
In more serious cases, surgery might be considered. The specific type of surgery will depend on factors such as your age and the severity of the condition. For older individuals with advanced arthritis, joint replacement can be effective.
Common surgical options for treating shoulder arthritis include total shoulder arthroplasty or hemiarthroplasty, which involve replacing the damaged joint. more>>
Shoulder instability & dislocation
Shoulder instability occurs when the shoulder joint, which is inherently flexible to allow a wide range of motion, becomes excessively loose or prone to dislocations.
This condition can result from either acute injuries or chronic overuse, leading to the stretching or tearing of the ligaments and tendons that stabilise the joint. As a result, the shoulder may slip out of its normal position, causing pain, weakness, and limited movement. This instability can significantly affect daily activities and athletic performance, often requiring a comprehensive treatment approach to restore stability and function.
Non-Surgical Management
The primary aim of non-surgical treatment for shoulder instability is to regain stability, strength, and full mobility. Non-surgical options may include:
Manual Realignment
After a dislocation, your surgeon can often reposition the shoulder joint under anaesthesia to restore proper alignment. Depending on your specific condition, surgery might be required to fully restore function.
Medications
Over-the-counter pain relievers and anti-inflammatory drugs can help alleviate pain and reduce swelling. In some cases, steroid injections may be used to further decrease inflammation.
Rest
It’s important to rest the injured shoulder and avoid activities that involve overhead movements. Wearing a sling for up to two weeks can support the healing process.
Cold Therapy
Applying ice packs to the injured area for 20 minutes each hour can help minimise swelling and discomfort.
Surgical Management
When conservative treatments do not effectively address shoulder instability, your surgeon might recommend shoulder stabilisation surgery. This procedure is designed to enhance the stability and function of the shoulder joint and to prevent repeated dislocations.
Depending on your specific case, it may be performed arthroscopically, involving much smaller incisions. Arthroscopy is a surgical technique where a small, flexible tube equipped with a light and video camera is inserted into the joint to assess and treat the issue.
Compared to traditional open shoulder surgery, arthroscopy typically offers advantages such as smaller incisions, reduced soft tissue damage, less pain, and a quicker recovery. more>>
Arthritis of the Shoulder
What is arthritis of the shoulder?
The term arthritis means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Damage of the cartilage in the shoulder joint causes shoulder arthritis. Inflammation is the body’s natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.
The cartilage is a padding that absorbs stress. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually, the initial pain is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing against each other.
Types of arthritis of the shoulder
There are over 100 different types of rheumatic diseases. The most common are osteoarthritis and rheumatoid arthritis.
Osteoarthritis: Osteoarthritis is also called degenerative joint disease. This is the most common type of arthritis, which occurs often in older people. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, which is called a bone spur.
Osteoarthritis causes joint pain and can limit a person’s normal range of motion (the ability to freely move and bend a joint). When severe, the shoulder joint may lose all movement, making a person disabled.
Rheumatoid Arthritis: This is an autoimmune disease in which the body’s immune system (the body’s way of fighting infections) attacks healthy joints, tissues and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling and loss of function in the joints. When severe, rheumatoid arthritis can deform or change a joint.
Rheumatoid arthritis mostly affects the joints of the hands and feet, and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (both hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.
Causes of arthritis of the shoulder
Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time or due to other joint diseases, injury or deformity. Primary osteoarthritis is commonly associated with ageing and general degeneration of the joints.
Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.
Rheumatoid arthritis is often caused when the genes responsible for the disease is triggered by infection or any environmental factors. When triggered, the body produces antibodies, the defence mechanism of body, against the joint and may cause rheumatoid arthritis.
Symptoms of arthritis of the shoulder
There are several forms of arthritis and the symptoms vary according to each form. Each form affects the body differently. Arthritic symptoms generally include swelling and pain or tenderness in the joints for more than two weeks, redness or heat in a joint, limitation of motion of a joint, and early morning stiffness.
In an arthritic shoulder
- The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis.
- The capsule of the arthritic shoulder is swollen.
- The joint space is narrowed and irregular in outline; this can be seen in an X-ray image.
- Bone spurs or excessive bone can also build up around the edges of the joint.
Diagnosis of arthritis of the shoulder
Doctors diagnose arthritis with a medical history, physical exam and X-rays of the affected part. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.
Treatment options for arthritis of the shoulder
There is no cure for arthritis, so beware of ‘miracle cures’. Your doctor may prescribe anti-inflammatory medicine. They may recommend occupational therapy or physiotherapy, which includes exercises and heat treatment. In severe cases, surgery may be suggested. The type of surgery will depend on your age and severity of the disease. In the elderly with severe arthritis, joint replacement can give good results. Common surgery for treatment of shoulder arthritis arthroplasty (replacement of the damaged joint) may be total shoulder arthroplasty or hemiarthroplasty.
Surgical Management
Shoulder Replacement
Arthritis of the shoulder can cause pain, swelling and stiffness in the joint. The condition is treated by removing the damaged articulating parts and replacing them with prostheses. Total shoulder replacement surgery is performed to relieve symptoms of severe shoulder pain and disability due to arthritis. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses. Replacement of both the humeral head and the socket is called a total shoulder replacement.
Reverse Shoulder Replacement
Conventional surgical methods such as total shoulder joint replacement are not very effective in the treatment of rotator cuff arthropathy. Reverse total shoulder replacement is an advanced surgical technique specifically designed for rotator cuff tear arthropathy, a condition where you suffer from both shoulder arthritis and a rotator cuff tear.
Differences between conventional and reverse shoulder replacement
Conventional shoulder replacement surgery involves replacing the ball of the humerus with a metal ball and the glenoid cavity of the shoulder blade (scapula) with a plastic socket. If this surgery is used to treat rotator cuff arthropathy, it may result in implant loosening due to the torn rotator cuff. Therefore, a specifically designed surgery was developed called reverse total shoulder replacement to be employed in such cases.
In reverse total shoulder replacement, the placement of the artificial components is essentially reversed. In other words, the humeral ball is placed in the glenoid cavity of the shoulder blade (scapula) and the plastic socket is placed on top of the arm bone. This design makes efficient use of the deltoid muscle, the large shoulder muscle, to compensate for the torn rotator cuff.
Hemiarthroplasty
Depending on your shoulder condition, your surgeon may opt to replace only the ball of the joint, a procedure known as hemiarthroplasty. In this procedure, the surgeon substitutes the head of the humerus with a metal ball, similar to what is used in a total shoulder replacement.
Hemiarthroplasty is often recommended for cases where the humeral head is significantly fractured, but the socket remains intact. It may also be suitable for patients who have:
- Arthritis affecting only the head of the humerus, with healthy cartilage on the glenoid
- Insufficient or weakened bone in the glenoid
- Severely torn rotator cuff tendons along with arthritis
In some cases, the choice between total shoulder replacement and hemiarthroplasty may be made during surgery based on the findings. Research indicates that patients with osteoarthritis generally experience better pain relief from total shoulder arthroplasty compared to hemiarthroplasty.
Shoulder Instability
What is shoulder instability?
Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint.
Causes of shoulder instability
A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (socket) of the shoulder. A partial dislocation is referred to as a subluxation whereas a complete separation is referred to as a dislocation.
Risk factors for shoulder instability
The risk factors that increase the chances of developing shoulder instability include:
- Injury or trauma to the shoulder
- Falling on an outstretched hand
- Repetitive overhead sports such as baseball, swimming, volleyball or weightlifting
- Loose shoulder ligaments or an enlarged capsule
Symptoms of shoulder instability
The common symptoms of shoulder instability include pain with certain movements of the shoulder, popping or grinding sound may be heard or felt, and swelling and bruising of the shoulder may be seen immediately following subluxation or dislocation. Visible deformity and loss of function of the shoulder occurs after subluxation or sensation changes such as numbness or even partial paralysis can occur below the dislocation because of pressure on the nerves and blood vessels.
Treatment of shoulder instability
Conservative Treatment
The goal of conservative treatment for shoulder instability is to restore stability, strength, and full range of motion. Conservative treatment measures may include the following:
- Closed reduction: Following a dislocation, your surgeon can often manipulate the shoulder joint, usually under anaesthesia, realigning it into proper position. Surgery may be necessary to restore the normal function depending on your situation.
- Medications: Over-the-counter pain medications and NSAID’s can help reduce the pain and swelling. Steroidal injections may also be administered to decrease swelling.
- Rest: Rest the injured shoulder and avoid activities that require overhead motion. A sling may be worn for 2 weeks to facilitate healing.
Ice: Ice packs should be applied to the affected area for 20 minutes every hour.
Surgery
When the conservative treatment options fail to relieve shoulder instability, your surgeon may recommend shoulder stabilisation surgery. Shoulder stabilisation surgery is done to improve stability and function to the shoulder joint and prevent recurrent dislocations. It can be performed arthroscopically, depending on your situation, with much smaller incisions. Arthroscopy is a surgical procedure in which an arthroscope, a small flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat the condition. The benefits of arthroscopy compared to the alternative, open shoulder surgery are smaller incisions, minimal soft tissue trauma and less pain, leading to faster recovery.
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Rotator Cuff Tears
A rotator cuff tear is an injury to the group of muscles and tendons surrounding the shoulder joint, responsible for stabilising the shoulder and allowing a wide range of motion. This tear can occur due to acute injury, such as lifting something too heavy or falling on an outstretched arm, or from gradual wear and tear over time, particularly in activities involving repetitive shoulder movements.
Symptoms typically include pain, weakness, and a limited range of motion in the shoulder, often making it difficult to perform everyday tasks. Depending on the severity, treatment options may range from rest and physical therapy to surgical repair.
Non-Surgical Management
Rest
Shoulder sling for support
Pain relief through medication
Cortisone and local anaesthetic injections to reduce inflammation and pain
Physiotherapy to strengthen and restore movement
Surgical Management
Rotator cuff repair can be done through open surgery or minimally invasive arthroscopy. During arthroscopy, space for the rotator cuff tendons is expanded, and the tear is repaired using suture anchors.
These anchors help reattach the tendons to the shoulder bone. After the surgery, you may be recommended to engage in exercises to restore motion and strengthen the shoulder. more>>
Rotator Cuff Tear
What is a rotator cuff tear?
The Rotator cuff is the group of tendons in the shoulder joint that provides support and enables a wide range of motion of the shoulder. Major injuries to these tendons may result in tearing of these tendons, called as rotator cuff tears. It is one of the most common causes of shoulder pain in middle-aged adults and older individuals.
Causes of rotator cuff tears
Rotator cuff tears result from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. It may occur with the repeated use of the arm for overhead activities, while playing sports or during motor accidents.
There are two main causes of rotator cuff tears: injury and wear (degeneration).
- Acute tear: If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other injuries, such as a broken collarbone, a dislocated shoulder, or a wrist fracture.
- Degenerative (wear related) Tear: Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age and in most cases is relatively painless.
Symptoms of rotator cuff tears
A rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving the shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder.
Diagnosis of rotator cuff tears
Your surgeon diagnoses rotator cuff tears based on the physical examination, X-rays and imaging studies, such as MRI. A rotator cuff tear is best viewed on magnetic resonance imaging.
There are different types of tears.
- Partial tear. This type of tear does not completely detach the tendon from the bone. It is called partial because the tear goes only partially through the thickness of the tendon. The tendon is still attached to the bone, but it is thinned.
- Full-thickness tear. With this type of tear, there is detachment of part of the tendon from the bone.
- When only a small part of the tendon is detached from the bone, it is referred to as a full-thickness incomplete tear.
- When a tendon is completely detached from the bone, it is referred to as a full-thickness complete tear. With a full-thickness complete tear, there is basically a hole in the tendon.
Treatment of rotator cuff tears
Conservative treatment options
- Rest
- Shoulder sling
- Pain medication
- Injection of a steroid (cortisone) and a local anaesthetic in the subacromial space of the affected shoulder to help decrease the inflammation and pain
- Certain exercises
Surgery
There are a few options for repairing rotator cuff tears. Advances in surgical techniques for rotator cuff repair include less invasive procedures. While each of the methods available has its own advantages and disadvantages, all have the same goal: getting the tendon to heal back to bone.
Open Rotator Cuff Repair
A traditional open surgical incision (several centimeters long) is often required if the tear is large or complex. The surgeon makes the incision over the shoulder and detaches or splits part one of the shoulder muscles (deltoid) to better see and gain access to the torn tendon.
During an open repair, the surgeon typically removes bone spurs from the underside of the acromion (this procedure is called an acromioplasty). An open repair may be a good option if:
- The tear is large or complex
- Additional reconstruction, such as a tendon transfer, is needed
Open repair was the first technique used for torn rotator cuffs. Over the years, new technology and improved surgeon experience has led to less invasive procedures.
Arthroscopic Rotator Cuff Repair
During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays a live video feed on a monitor, and your surgeon uses these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are small and thin, your surgeon can use very small incisions (portals), rather than the larger incision needed for standard, open surgery.
All-arthroscopic repair is usually a day procedure and is the least invasive method to repair a torn rotator cuff.