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Description

Subacromial bursitis is inflammation of the bursa, which sits between the rotator cuff and the undersurface of the acromion. A bursa is a fluid-filled sac that sits between muscle and bone and acts as a cushion. When the bursa becomes inflamed, it swells and becomes thicker. Because the space needed for the rotator cuff to pass over the shoulder joint is already limited, a thickened bursa will increase the pressure on the rotator cuff tendons when the patient attempts to lift their arm. This leads to inflammation in the rotator cuff.

What are the causes?

Subacromial bursitis may result from an injury, but generally occurs as a result of overuse or repetitive motion. Patients with occupations that frequently require them to lift their arms over their heads, such as plumbers, painters, electricians and carpenters, are at risk. Athletes who play overhead sports, such as baseball, softball, volleyball and tennis will often develop impingement syndrome. Patients with curved acromions, or those with bone spurs, or arthritis in the shoulder are at risk for developing impingement.In some patients, subacromial bursitis will develop without any known cause.

What are the symptoms?

Patients will complain of pain in the outside portion of the shoulder, especially at night. They point to the anterolateral area of the deltoid muscle as the chief source of pain. Although the problem is deep inside the shoulder joint, the brain interprets the pain as coming from lower down in the arm. When the brain feels pain in a different location than the cause of the problem, it is called 'referred pain'. Patients will have pain with overhead lifting, or with rotating the arm internally, such as reaching for a wallet, or unhooking a bra strap. Patients may also complain of clicking or popping when moving the shoulder.

How is it diagnosed?

Your surgeon will ask questions about the location of your pain, and what makes it worse. On physical exam, the surgeon will move the arm and attempt to 'squeeze' the rotator cuff and bursa between the humeral head and the acromion. This should reproduce the patient's pain. X-rays of the shoulder may demonstrate a curved acromion or a 'bone spur' that narrows the space available for the rotator cuff. An MRI may be ordered if your surgeon thinks your rotator cuff might be torn.

How is it treated?

Non-operative

Non-operative treatment of impingement syndrome is usually successful. Your surgeon will recommend anti-inflammatory medicine (NSAIDS), physical therapy to strengthen the shoulder, and ice packs or cryotherapy to help reduce the pain and inflammation. A cortisone injection into the shoulder may help resolve the pain. Patients should be aware, however, that cortisone injections might make the pain worse for the first 48 hours, as a result of the body's reaction to the cortisone. This is called a 'flare' and can make the shoulder, hot, red and difficult to move. Multiple cortisone shots might lead to damage of the rotator cuff tendon.

Operative

If three months or more of non-operative treatment fails to relieve the pain, your surgeon may suggest an operation. Subacromial decompression can be performed through an open incision or arthroscopically. Decompression removes some bone over the top of the rotator cuff, giving it more space to function. The thickened, inflamed bursa is removed as well. After the surgery, physical therapy is restarted to restore motion and strength to the shoulder.

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Description

Subscapular bursitis is inflammation of the bursa, or fluid filled sac that sits between the shoulder blade and the rib cage.

What are the causes?

Subscapular bursitis may result from an injury, but generally occurs as a result of overuse or repetitive motion. Patients with occupations that frequently require them to lift their arms over their heads, such as plumbers, painters, electricians and carpenters, are at risk. Athletes who play overhead sports, such as baseball, softball, volleyball and tennis are at risk. Subscapular bursitis is commonly associated with rotator cuff impingement, or subacromial bursitis.

What are the symptoms?

Patients will complain of pain along the inside border of the shoulder blade and upper back. Clicking may be felt under the shoulder blade. Patients with rotator cuff inflammation will have pain at night and with some motions in the upper arm.

How is it diagnosed?

Your surgeon will examine the shoulder blades. Asymmetrical appearance or movement is an indication of shoulder blade dysfunction. One shoulder may appear to be lower than the other. This results from poor position of the shoulder blade, which causes the shoulder to slump forward. Slumping of the shoulder may cause tenderness to touch in the front of the shoulder. Scapular winging is when the shoulder blade appears to move away from the rib cage, and is often found in conjunction with bursitis. When rotating the arm, clicking may be felt under the shoulder blade.

How is it treated?

Non-operative

Non-operative treatment of subscapular bursitis is usually successful. Your surgeon will recommend anti-inflammatory medicine (NSAIDS), physical therapy to strengthen the muscles that move and support the shoulder blade, and ice packs or cryotherapy to help reduce the pain and inflammation. A cortisone injection under the shoulder blade may help resolve the pain. Patients should be aware, however, that cortisone injections might make the pain worse for the first 48 hours, as a result of the body's reaction to the cortisone. This is called a 'flare' and can make the shoulder, hot, red and difficult to move.

Operative

If non-operative treatment fails to relieve the pain, the surgeon will recommend excision of the bursa from underneath the shoulder blade. This can be done arthroscopically. Physical therapy is restarted following the procedure to restore motion and strength.

Description

The biceps tendon attaches in two places inside the shoulder and one in the forearm. Its function is to turn the palm of the hand face-up and assist in flexing or bending the elbow. It exits the shoulder just in front of the rotator cuff and passes through a groove in the humerus called the bicipital groove. Biceps tendonitis is inflammation of the tendon near its attachment in the shoulder or inside the groove. Inflammation of the biceps near its attachment in the elbow is termed Insertional Biceps Tendonitis.

What are the causes?

Biceps tendonitis occurs as a result of overuse of the shoulder or from an injury, such as a fall. Because the tendon is closely associated with the rotator cuff, injuries to the anterior cuff will place more stress on the biceps, leading to inflammation or injury.

What are the symptoms?

Patients with biceps tendonitis will have pain in the front of the shoulder, which may radiate into the arm. The biceps may be tender to the touch, especially inside the bicipital groove. They may have trouble turning doorknobs, using screwdrivers or lifting their arm over their head.

How is it diagnosed?

Your surgeon will press on the biceps tendon and perform an examination that stresses the biceps muscle. Tendonitis is confirmed if the exam reproduces pain. If obtained, an MRI will show partial tearing or inflammation in the tendon, and fluid surrounding the tendon.

How is it treated?

Non-operative

Physical therapy, anti-inflammatory medication (NSAIDS), and avoiding painful activities will usually resolve the symptoms. A cortisone injection can be given into the bicipital groove to reduce inflammation.

Operative

In severe cases, which do not improve with non-operative treatment, your surgeon will recommend one of two operations to relieve the pain. In the first, your surgeon will arthroscopically release the tendon from its attachment at the top of the shoulder socket. This provides pain relief and a quick recovery with no post-operative precautions. Because the tendon has a second attachment on the shoulder blade, there is no loss of function or strength. There may be, however, a cosmetic deformity, which occurs as the tendon slumps downward causing the muscle to bulge. This bulge occurs in the lower portion of the arm, and is called a 'Popeye Deformity' after the cartoon character.
Instead of cutting the tendon, your surgeon may reposition it from its attachment inside the shoulder joint, to a location outside of the joint in the bicipital groove. The surgeon shortens the tendon and reattaches it with a screw or anchors to the humerus. This provides relief of pain, with no cosmetic deformity. It can be accomplished either arthroscopically or with an open procedure.

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Description

A frozen shoulder is stiffness and pain in the shoulder.

What are the causes?

Frozen shoulders commonly occur after an injury, in which the patient is unable to move the shoulder for an extended period of time. The lining of the joint, or shoulder capsule, becomes stiff and limits movement. Scar tissue, known as adhesions, can form in the joint. Frozen shoulders can occur as surgical complications, and are more common in diabetic patients.

What are the symptoms?

Loss of motion in the shoulder, combined with pain or clicking and popping.

How is it diagnosed?

Your surgeon will perform an examination to evaluate shoulder motion. Loss of both active (when the patient lifts the arm on his own) and passive (when the doctor moves the shoulder without help from the patient) motion indicates a frozen shoulder. An MRI may show a tight capsule or pathology that might have caused the shoulder to freeze.

How is it treated?

Non-operative

Physical therapy to stretch the lining of the shoulder joint and break up adhesions is the key to successful treatment. Anti-inflammatory medication, cortisone shots and ice may assist in limiting pain.

Operative

Patients that do not improve with therapy may be candidates for surgery. Your surgeon will perform an arthroscopy to cut the lining of the joint, remove the adhesions, and then perform a 'manipulation under anesthesia', in which the arm is moved in various directions to break up scar tissue and regain motion. Manipulations performed without prior arthroscopy may be successful, but carry a greater risk of damage to the structures inside the shoulder, such as the rotator cuff. After the surgery, therapy is started immediately to maintain motion before scar tissue has an opportunity to form.