TEAR OF THE ROTATOR CUFF TEAR OF THE ROTATOR CUFF
Bursitis probably the most common shoulder condition presenting to a doctor's office. When it does not respond to traditional simple measures such as a modification of activities or a trial of anti-inflammatory medicines (e.g. Motrin, Naprosyn, Volterin, etc., etc.), then many times it is appropriate to consider referral to an orthopedic surgeon for better delineation of the problem. The suffix "itis" in medicine refers to an inflammation (irritation). A "bursa" is a fibrous covering overlying a bone. Hence, bursitis is an irritative condition overlying the bones in the shoulder. Frequently an injection with a cortisone type preparation will be tried to see if the symptoms are alleviated. Many times, however, the focus of attention may be to determine if some other condition as listed below exists which might require more specialized treatment or even surgery.
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Next in the spectrum of shoulder disorders, impingement syndrome represents a pinching of the rotator cuff mechanism (principally the supraspinatus tendon) in an increasingly narrow space between the acromion bone and the humerus bone. Simple measures such as listed in bursitis can be tried, but many times will not give complete relief. A course of physical therapy may be in order. When these measures have been tried and are not successful, then if given sufficient time, an arthroscopic shoulder procedure may be indicated. I generally will have reviewed an MRI scan of the shoulder first to look for the potential problem of a rotator cuff tear. During an arthroscopy, the space between the bones would be visualized and several maneuvers performed to make more room in the shoulder. This might include such measures as filing the undersurface of the acromion bone and possibly dividing the corico-acromial ligament. It is sometimes necessary to make an open shoulder operation if arthroscopic techniques are not sufficiently meeting the goals. It is also distinctly possible that the surgeon may discover a tear of the rotator cuff which could have been missed in a pre-op MRI scan. If so, then the chance of a more open shoulder operation increases though the problem might still be treatable arthroscopically.
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Rotator Cuff Tear is a more severe condition of the shoulder which can be considered a worsening of the inflammatory conditions of the shoulder which have now brought about a frank tear usually in the supraspinatus tendon between the acromion and the humerus bones. Pain becomes more constant particularly at night. Many factors come into play in deciding whether the patient should go into surgery. Such things as the amount of pain, age, medical problems, ability to cooperate with a post-op rehabilitation program, etc., must all be taken into account. Although many times treatable arthroscopically, patients should be clearly prepared that there is considerable likelihood an open shoulder procedure will be needed to accomplish all the goals of rotator cuff surgery.
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Frequently confused with a shoulder dislocation, a shoulder separation usually refers to a traumatic tearing of the ligaments and capsule between the clavicle (collar bone) and the acromion. This can occur from a fall directly on the point of the shoulder. Many times the simplest and most successful treatment is no treatment at all. However, the patient may remain with a permanent bump on the shoulder. Surgical treatment and reconstruction is sometimes performed, though there should be a specific reason why it has been chosen over no treatment such as a particularly severe separation or some type of special cosmetic indications.
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This traumatic condition of the shoulder frequently presents in a dramatic way. It represents a total disruption between the articulation of the humerus bone with that of the cup of the shoulder blade (scapula). The first time this occurs in a patient (and many times it happens more than once), the pain is intense and they will frequently go to an emergency room. More times than not, it will be an emergency room doctor who puts the shoulder back into place. It may be several days before the patient comes to an orthopedic surgeon for evaluation. If this was the first time the dislocation occurred, then an extended period of time in a sling and swathe is commonly recommended although more attention is being given to primary surgical reconstruction to prevent future dislocations. However, when the story starts becoming that this was the second or third time the shoulder has dislocated, then strong consideration should be given to surgical stabilization. As with rotator cuff repairs, it is possible to perform some shoulder stabilizations arthroscopically, however the patient should be prepared with the understanding that an open shoulder procedure might be needed to meet all the goals of accurate and lasting stabilization.