Tag Archive: shoulder pain

Options for Shoulder Impingement Treatment

Shoulder impingement syndrome is known by many names including painful arc syndrome, swimmer’s shoulder, and subacromial impingement and this condition occur when the tendons of the rotator cuff muscles become inflamed as they move through subacromial space. As a result, there is reduced the flexibility of the shoulder, and weakness and pain will usually be experienced too. Pain usually intensifies if the shoulder is moved to an overhead position or, at night, when the individual lays upon that shoulder. Restricted movement increases the sense of frustration experienced. Pain may manifest as a dull ache, gradually occurring, or, it may suddenly manifest and be acute. There may be a grinding motion or a popping sensation. Elevation of the arm is likely to be painful but will also occur when applying downward force too although this will ease. Seeking medical assistance for shoulder impingement treatment is paramount.

Although other options are likely to be considered first, a subacromial decompression may be required which helps to prevent the bones and tendons rubbing together. Subacromial simply means under the acromion which is a part of the shoulder blade helping to form the shoulder joint. This is usually done through keyhole surgery and a general anesthetic would be required. When there is subacromial impingement, this means that the actual space between the rotator cuff tendons and the shoulder blade is reduced, typically through swelling and irritation or, the development of bony spurs. Where the latter occurs, it’s often as a result of osteoarthritis. Treatment enables this space to be extended and any inflamed bursa or bony spurs can be removed.

Any surgery can be worrying and so, it’s important for good communication to be in place and to speak to specialists in the field such as the Orthopedic Center, Arizona who can explain the process reducing any fears about the procedure. Any surgical operation will be carried out by an orthopedic surgeon who will guide each person through the process as is relative to their case. As a general anesthetic is likely, fasting will be necessary prior to the operation. Any individual who smokes will be asked to stop as smoking increases the risk of infection. The procedure takes approximately one hour although this will vary on an individual basis and a local anesthetic may also be injected into the shoulder nerves to reduce any discomfort experienced following surgery. Pain management is important and there will be options to ease discomfort. The surgeon may also decide to repair any damaged tendons at the same time.

Shoulder impingement treatment does not always require surgery. There are various causes and symptoms which may not mean invasive treatment at all. Certainly, resting the shoulder joint and avoiding extensive movements can help and doctors may suggest non-steroidal anti-inflammatory medicines along with physiotherapy initially. Where necessary, steroid joint injections may be given. Note that subacromial decompression will only be recommended usually if other treatments have not helped. It can take up to four months for full recovery following surgery and most people will make a complete recovery.  Following up with physiotherapy is often beneficial to aid flexibility and to increase movement. It will also be important to build strength up in the shoulder joint too. Find out more by visiting OSPLarizona.com

Treatment Options for a Rotator Cuff Tear in Arizona

Rotator Cuff info from OSPI in Gilbert Arizona

 

A rotator cuff tear is a common cause of disability and pain. A torn rotator cuff can weaken your shoulder, causing problems performing simple daily activities, such as getting dressed or brushing your teeth.

How common are rotator cuff tears?

According to a study in 2008, around 2 million people visit their doctors due to a rotator cuff problem. In cadaver studies, researchers found that 39% of deceased individuals older than Rotator Cuff Tear60 years had full-thickness rotator cuff tears. The incidence in the general population is around 20% for partial and full tears.

What structures are affected by a rotator cuff tear?

The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). The shoulder forms a ball-and-socket joint, with the ball being the head of the humerus and the socket being a groove in the scapula.

The arm bone is held in the socket by the rotator cuff, which is a network of four muscles and several tendons that form a covering around the humeral head. This cuff attaches the arm bone to the shoulder blade, and it helps elevate and rotate the arm. The lubricating sac of the joint is called the bursa, and it lies between the acromion bone (at the top of the shoulder) and the rotator cuff

How does a rotator cuff tear occur?

If one of the rotator cuff tendons tears, the tendon can no longer attach to the humerus head. Most tearing occurs in the tendon or the supraspinatus muscle. A partial tear involves only soft tissue, and it is not completely severed into two pieces. A full-thickness tear involves splitting into two pieces of soft tissue. The causes of a rotator cuff tear are:

  • Injury – Includes a fall onto an outstretched arm, or from lifting something heavy in a jerking motion. This often occurs along with a dislocated shoulder or broken collarbone.
  • Degeneration – Most rotator cuff tears occur from wearing down of the tendon that occurs gradually over time. Degeneration is related to aging. The factors that contribute to degeneration include repetitive stress, lack of blood supply, and bone spurs.

What are the risk factors for rotator cuff tears?

Certain people have a greater chance of suffering a rotator cuff tear. Risk factors include:

  • Aging – Normal wear-and-tear occurs with aging, so people age 40 and older are at greater risk.
  • Certain activities – People who do overhead activities and repetitive lifting are at risk, including carpenters, painters, and laborers. In addition, athletes who use their arms/shoulders (tennis players and baseball pitchers) are also at risk.

What symptoms are associated with rotator cuff tears?

The most common symptoms are pain at rest, particularly at night with lying on affected shoulder, pain with lifting and lowering the arm, weakness when rotating the arm, and crackling sensations (crepitus) when moving the shoulder through certain positions.rotator cuff

How is a rotator cuff tear diagnosed?

The doctor will ask you questions about your activities, inquire about your symptoms, take a medical history, and conduct a physical examination. The doctor checks for deformities, tenderness, and range of motion. In addition, the doctor checks arm and muscle strength. Tests used to make the diagnosis include:

  • X-rays – Do not show soft tissues of the shoulder but show bony deformities and fractures.
  • Magnetic resonance imaging (MRI) scans – Used to show rotator cuff tears, and shows if the tear is old or new. Also, it can dhow the quality of the rotator cuff muscles.

How are rotator cuff tears treated?

The goal of treatment is to restore arm and shoulder function, as well as to relieve pain. In planning your therapy, the doctor will consider your activity level, general health, age, and grade of tear you have. Treatment options include:

  • Medications – Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen will reduce swelling and pain. Narcotic analgesics can be prescribed short-term for severe pain.

 

  • Physical therapy – Special exercises are used to strengthen the shoulder and restore movement. The exercise program involves stretches that improve range of motion and flexibility, and strengthening exercises that enhance strength of muscles that support the shoulder to prevent further injury.

 

  • Corticosteroid injection – The doctor can inject the shoulder with a corticosteroid, with or without an anesthetic. This anti-inflammatory drug relieves irritation and swelling. In a review of several clinical trials comparing steroid injection to placebo injection, studies found significant benefit of steroid injections.

 

  • Suprascapular nerve block – This involves injecting a long-acting anesthetic agent near the affected nerve. The doctor will use x-ray guidance (fluoroscopy) to assure correct needle placement. In a large clinical study, patients receiving this block were followed for 12 weeks. Statistically significant improvements in disability and pain scores were observed, along with improved range of motion scores.

 

  • Surgery – If pain continues and does not improve with nonsurgical efforts, surgery may be required. Surgery is a good option if your symptoms have persisted for 6-12 months, you have a large tear, your tear was caused by a recent, acute injury, and/or you have significant loss of shoulder function. The tendon is reattached to the humeral head if possible. If the tear is severe, a graft may be used to replace the tendon.

Orthopedic and Sports Performance Institute offers comprehensive treatments for all types of shoulder conditions including arthritis, rotator cuff tears, labral tears and more. OSPI offers pain management, physical therapy and orthopedic surgeons in Gilbert AZ as well! Call us today.

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