Health Talk: Shoulder woes can be very painful
by Dr. James
York
Injury and wear
and tear can cause parts of your shoulder to become damaged and painful.
The initial
treatment is nonsurgical. For pain that fails treatment or for a torn
rotator cuff, however, advanced arthroscopic treatment can be used to restore
function with less surgery than in the past.
The rotator cuff is a
combination of four muscles connecting the scapula (shoulder blade) to the
humeral head ("ball" of the shoulder joint). The rotator cuff keeps the humeral
head within the glenoid (socket) during normal shoulder function and also
contributes to shoulder strength.
Normally, the rotator cuff
glides smoothly under the acromion and over the humeral head. It is active when
lifting, reaching away from your body or throwing.
Around age 40, though, the
rotator cuff tendon begins to weaken and degenerate. Over time, partial
tears may begin to occur that can progress to full thickness tears with less
stress than it took at a younger age.
This "older" tendon is more
prone to become inflamed (rotator cuff tendonitis). The bone just above the
rotator cuff (acromion) can become thicker and develop downward-going bone spurs
from degeneration. This causes tightness over the tendon, also called
"impingement."
Impingement is one cause of
tendonitis and accelerates the wearing-out process. Repetitive lifting and
overhead activities also contribute to rotator cuff tendonitis and degeneration.
Patients with cuff tendonitis
and impingement have pain in the shoulder, which is worse with overhead activity
and sometimes severe enough to cause awakening at night.
Shoulder examination by your
doctor will help reproduce the symptoms and confirm the diagnosis. X-rays also
are helpful in evaluating the presence of bone spurs and/or narrowing of the
subacromial space. MRI (magnetic resonance imaging), a test that allows
visualization of the rotator cuff, is indicated if initial treatment is
ineffective and a rotator cuff tear is suspected.
Treatment
First, eliminate aggravating
causes or contributing factors. This may mean temporarily avoiding activities
like tennis, pitching, swimming or a job requiring repetitive lifting. Your
doctor may also recommend a non-steroidal anti-inflammatory medication. The
mainstay of treatment involves exercises to restore normal flexibility and
strength to the shoulder girdle. This is usually done under the care of a
physical therapist. An injection of cortisone may be helpful in treating
tendonitis.
Surgery is not necessary in
most cases of shoulder impingement. Surgery is indicated if symptoms persist
despite adequate non-surgical treatment or if there is a rotator cuff tear.
For impingement and
tendonitis, surgery involves debriding, or surgically removing tissue that is
irritating the rotator cuff.
A torn rotator cuff is
repaired by suturing it down to the bone where it belongs.
For many cases, we now use
advanced arthroscopic techniques for shoulder debridement and rotator
cuff repair instead of surgery with large incisions. Outcome is favorable in
about 90 percent of the cases.
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Dr. James York is an orthopaedic
surgeon at Baltimore Washington Medical Center and Chesapeake Orthopaedics and
Sports Medicine Center. He can be reached at 410-768-5555 or via
www.OrthopedicDoc.net
Published 09/07/05, Copyright © 2005
Maryland Gazette,
Glen Burnie, Md.
