Orthopedics - Shoulder & Elbow

Conditions

• Articular cartilage damage

  Overview:

  Articular cartilage is the soft cartilage that sits on the end of the bone to help the joint move smoothly. The rubbery tissue acts as a cushion between bones and can be found in many parts of the body, including the shoulder and elbow joints. Unfortunately, cartilage will not heal on its own due to the lack of blood supply and begin to break down over time, allowing the bone underneath to react.

  Symptoms may include:

  • pain
  • tenderness
  • warmth in the affected area
  • inflammation
  • stiffness
  • limited range of motion

  Treatment/procedure options:

  Conservative treatment includes rest, ice, physical therapy, anti-inflammatory medication, and injections. When a patient becomes unresponsive to conservative treatment, different surgical procedures may be considered depending on variables such as age, activity level of the patient, and how long ago the injury occurred.

• Bursitis

  Overview:

  Bursitis is inflammation of a bursa, which is a very thin sac-like structure filled with fluid generally located between where friction may occur, such as between tendons and bones or ligaments and bones. When too much friction occurs, the bursa can become injured causing stress to surrounding ligaments or tendons as well.

  Symptoms may include:

  • sharp or shooting pain
  • stiffness
  • swelling
  • redness on the skin at the sight of the affected area
  • limited range of motion

  Treatment/procedure options:

  Conservative treatment includes rest, ice, pain relieving and anti-inflammatory medications. Other treatment options include physical therapy, antibiotics if the bursa becomes infected, injections, and surgery if the bursa must be surgically drained.

• Collarbone (clavicle) injuries

  Overview:

  The collarbone, also known as the clavicle, is the long, thin bone that connects the arm to the body. Sitting below your neck and running horizontally to the front of the shoulder, the collarbone is susceptible to becoming fractured or breakage due to a fall, sports injury, or trauma.

  Symptoms may include:

  • Pain
  • Swelling
  • Tenderness
  • bruising
  • stiffness
  • deformity
  • crackling sound when you move your shoulder
  • limited range of movement

  Treatment/procedure options:

  To allow the bone to heal, immobilizing the collarbone with the use of a sling is recommended. The length of immobility depends on the severity of the injury and can take anywhere from two to six weeks to heal. Medication may be prescribed to manage pain for the first few days or as needed throughout the recovery period. Surgery is often beneficial if the bone has broken the skin or is broken in many places. If the collarbone has shortened, surgical repair may also provide better shoulder function compared to non-surgical treatment. Our surgeons are experienced with the use of low-profile repair devices to minimize complications.

• Frozen shoulder (adhesive capsulitis)

  Overview:

  Frozen shoulder, also called adhesive capsulitis, occurs when the capsule surrounding the shoulder joint becomes so thick and tight that movement is severely limited.

  Symptoms may include:

  Three stages of frozen shoulder are the freezing stage, the frozen stage, and the thawing stage.

  • Freezing stage - includes a relative time frame of several months when pain originally develops and slowly gets worse over time, particularly in the evenings.
  • Frozen stage - involves relief in pain but increase in stiffness in the joint and lasts about 4 to 12 months.
  • Thawing stage - includes 6 months to 2+ year stage of regaining motion back in the shoulder joint.

  Treatment/procedure options:

  Treatment options include pain and anti-inflammatory medications, physical therapy and injections. For patients who do not respond to non-surgical treatments, shoulder manipulation and surgical release of the capsule can provide improvement in symptoms.

• Rotator cuff repairs

  Overview:

  The rotator cuff consists of tendons and four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that are connected to hold your upper arm bone in your shoulder socket. A rotator cuff injury occurs when one of these tendons becomes partially or fully torn.

  Symptoms may include:

  • pain
  • shoulder weakness
  • decreased range of motion
  • difficulty with overhead activities
  • crackling sensation when engaging in specific movements

  Treatment/procedure options:

  Depending on the severity of the injury, conservative treatments such as rest, ice, and physical therapy can help aid recovery. However, if the conservative treatments have not reduced pain, steroid injections or surgery may be considered. Arthroscopic minimally invasive repair can be performed as a day surgery procedure.

• Separated shoulder

  Overview:

  Shoulder separation generally occurs during a direct blow to the point of the shoulder or fall on the shoulder that either stretch or tear the ligaments connecting the shoulder blade to the clavicle.

  Symptoms may include:

  • pain
  • swelling
  • bruising
  • tenderness
  • arm weakness
  • limited range of motion
  • a bump at the top of the shoulder

  Treatment/procedure options:

  With the assistance of pain medication, rest, applying ice to the injury, and physical therapy, a minor condition of shoulder separation may take a few weeks to a month to fully recover with the use of an assistive device such as a sling. Severe cases, however, may require surgery to repair ligaments and stabilize injured bones.

• Shoulder arthritis

  Overview:

  Common forms of arthritis in the shoulder, such as osteoarthritis and rheumatoid arthritis, cause one common symptom–inflammation. Either caused by normal “wear and tear,” a traumatic injury, or disease, arthritis in the shoulder leads to degeneration of the joints causing patients to experience intense pain if early signs and symptoms are ignored.

  Symptoms may include:

  • Inflammation
  • pain in the shoulder joint
  • stiffness
  • tenderness
  • redness at the sight of the affected area
  • reduced range of mobility

  Treatment/procedure options:

  Conservative treatment options include rest, applying ice to the affected area, anti-inflammatory medications, physical therapy, and injections. Surgery to smooth the inside of the joint or replace the joint altogether may be necessary if conservative treatments no longer provide relief for the patient.

• Shoulder dislocation

  Overview:

  Shoulder dislocation occurs when the upper arm bone leaves the cup-shaped socket of the shoulder blade and can be constituted as a partial or full dislocation depending on the severity.

  Symptoms may include:

  • severe pain
  • swelling
  • tenderness
  • numbness
  • bruising
  • limited mobility
  • deformity

  Treatment/procedure options:

  First time dislocation is usually treated with rest or physical therapy but may also require manipulation of the shoulder bones to return them back to their proper position. Manipulation of the shoulder bones, also known as a closed reduction, may require a muscle relaxer, sedative, or general anesthetic prior to this process depending on the severity of pain. The process would then be followed by immobilizing the shoulder for three days to a few weeks with the use of a sling or splint. If shoulder dislocation continues to occur, surgery can become necessary to stabilize the shoulder. Our surgeons are experienced with all types of shoulder stabilization ranging from minimally invasive arthroscopic repair to open surgeries such as the Latarjet procedure.

• Shoulder Sprains and Strains

  Overview:

  Although they affect different parts of the shoulder, strains and pains are painful and can be debilitating. A shoulder sprain is a tear in one or more of the ligaments in the shoulder joint whereas a shoulder strain involves tearing or stretching of a muscle or tendon in the shoulder joint.

  Symptoms may include:

  • pain
  • swelling
  • bruising
  • limited mobility and range of motion
  • stiffness
  • instability
  • feeling or hearing a pop in the joint when injury occurred
  • warmth, or redness of the affected joint
  • symptoms that differentiate the two conditions include bruising in a sprain and muscle spasm in a strain

  Although similar symptoms exist between the two injuries, aside from pain and swelling, a strain will also include cramping or muscle spasm.

  Treatment/procedure options:

  Treatment options for mild strains and sprains may include anti-inflammatory medications, rest, applying ice on and off for 20 minutes during the first 24-48 hours, compression to reduce swelling, and elevating the affected area above the heart. More severe cases may require assistive devices such as splint or cast. Severe cases may require surgery to repair torn ligaments and/or reattach muscles and tendons.

Conditions

• Cubital tunnel syndrome

  Overview:

  Cubital tunnel syndrome occurs when pressure increases on the ulnar nerve. The nerve travels down the back of the arm and passes through a cubital tunnel located on the inside of the boney bump of the elbow. Surrounded by ligaments, fascia, muscle, and bone, the nerve can become compressed or entrapped and become inflamed or even tear.

  Symptoms may include:

  • numbness
  • tingling
  • aching pain in the pinky, ring finger and inside of the hand
  • weakness in the hand or grip strength
  • loss of sensation in the hand

  Patients usually experience these symptoms more commonly at night or with prolonged bending of the elbow or resting on the elbow.

  Treatment/procedure options:

  Treatment options may include avoiding frequent bending or placing pressure on the elbow, using a brace or splint at night or anti-inflammatory medications. In severe cases, surgery can relieve pressure on the nerve by opening the constricted tunnel or moving the nerve to the front of the elbow.

• Elbow joint arthritis

  Overview:

  Elbow arthritis occurs when the cartilage in the elbow becomes damaged because of aging, repetitive activities, traumatic injury, or an autoimmune disease known as rheumatoid arthritis.

  Symptoms may include:

  • inflammation
  • pain
  • stiffness
  • tenderness
  • redness at the sight of the affected area
  • reduced range of mobility
  • grinding or popping in the elbow joint

  Treatment/procedure options:

  Treatment options include rest, applying heat to loosen up the joint and ice to ease swelling and symptom flare-ups. Anti-inflammatory medications, injections, immobilizing the joint with a brace, and physical therapy. If other forms of treatment are not effective, surgery may be necessary to remove bone, cartilage, or damaged tissues, smooth rough surfaces of the bone, or replace the elbow joint completely.

• Elbow Spurs

  Overview:

  Often found in between where two bones meet, elbow spurs are an overgrowth of bone resulting from wear and tear or early onset of arthritis.

  Symptoms may include:

  • pain
  • stiffness
  • muscle spasms
  • cramps
  • bumps under the skin
  • numbness or tingling should the bone spur place pressure on a nerve.

  Treatment/procedure options:

  Treatment options include rest, anti-inflammatory medications, injections, physical therapy, and surgery to remove the bone spur.

• Tendinitis

  Overview:

  Tendinitis occurs when the tendon, connecting muscle to bone, becomes inflamed or irritated commonly caused by overuse or sudden injury. Most likely to develop in the shoulder, knee, elbow, heel, or wrist, tendinitis can be caused by repetitive motion required to perform a certain task at a job or in sports such as tennis, golf, or basketball. In severe cases, tendinitis may lead to surgery due to ruptured tendon.

  Symptoms may include:

  • dull, aching pain that occurs during upon movement
  • tenderness
  • warmth, or redness of the affected area
  • mild swelling
  • a lump may develop along the tendon affected

  Treatment/procedure options:

  Treatment options include applying ice to the affected area, rest, anti-inflammatory medications, physical therapy exercises, injections, and assistive devices such as a brace to immobilize the muscles surrounding the injured tendon. If symptoms do not improve despite non-surgical treatment, our surgeons are experienced with minimally invasive tendon treatments that can be performed in the office without general anesthesia. Our surgeons also perform the entire spectrum of arthroscopic and open surgery for these conditions.