The Shoulder Center

Impingement

Impingement syndrome represents a common and often painful condition of the shoulder, typically arising from repetitive overhead activities. The root of this issue lies in the narrow anatomical confines allocated for the rotator cuff. Certain bony anatomical variations in the shape of the scapula may predispose individuals to develop shoulder impingement. Rotator cuff tendonitis or bursitis are commonly associated with shoulder impingement.

Symptoms commonly associated with impingement syndrome include pain over the outside of the shoulder or arm which occurs during arm elevation, particularly when lifting the arm to approximately 90 degrees or shoulder height. Although the discomfort can be significant, the preferred approach to treatment is often conservative or non-surgical, focusing on reducing inflammation and restoring function without direct intervention on the structures involved. This can often be accomplished with the use of NSAIDs, physical therapy and occasionally a cortisone injection. This strategy underscores the importance of addressing the underlying causes and managing symptoms effectively to avoid further shoulder issues.

Rotator Cuff Tear (RCT)

A rotator cuff tear is a common injury affecting the shoulder, often resulting from either acute trauma or cumulative overuse. Approximately 85% of all rotator cuff tears are degenerative or attritional, whereas 15% result from an acute traumatic injury. Among the muscles comprising the rotator cuff, the supraspinatus is the commonly torn rotator cuff tendon. Often, injuries to the biceps or labrum can occur with rotator cuff tears. Patients will often experience pain over the outside of the shoulder or arm that is worse with lifting, pushing or pulling. Sleep disturbances are one of the most common symptoms of a rotator cuff tear. If a rotator cuff tear is expected, a magnetic resonance imaging (MRI), is typically ordered to conclusively confirm the presence and extent of a tear.

Management of an RCT can be approached conservatively or through surgical intervention. Degenerative or attritional rotator cuff tears can usually be initially managed conservatively, whereas acute traumatic rotator cuff tears are often an indication for operative management. While conservative treatments focus on alleviating symptoms and improving function, it's important to note that the physical integrity of the torn tendons cannot be fully restored without surgical repair. However, if conservative management successfully resolves the symptoms to the patient's satisfaction, opting out of surgery may be a viable choice, emphasizing the tailored approach to treating rotator cuff injuries based on individual patient needs and desired outcomes.

Acromioclavicular (AC) Joint Injuries

An AC joint injury is commonly called a “shoulder separation” or “AC dislocation” and involves injury to the ligaments stabilizing the acromion – a projection of the scapula, and the clavicle, or collarbone. This joint is stabilized by a ligament complex that is richly supplied with nerves, making the area particularly sensitive to pain. Injury typically arises from direct trauma to the shoulder, leading to a slight separation between the acromion and clavicle. Such separations, while potentially minor in terms of displacement, can provoke significant discomfort due to the integrity of the nerves being maintained, thereby transmitting pain signals effectively.

In terms of treatment, most AC joint injuries can be managed through conservative approaches. These methods focus on alleviating pain, reducing inflammation, and gradually restoring the joint's function and mobility without resorting to invasive procedures. The primary goal is to support the healing process while minimizing discomfort and preventing further injury to the area. Certain high-grade injuries or those that are refractory to conservative management may require operative treatment to stabilize the AC joint.

Humerus Fracture

The humerus, the long bone in the upper arm, is susceptible to fractures at various points along its length, with each fracture site potentially requiring a distinct approach to treatment. These fractures commonly result from significant trauma, such as a fall, impacting areas like the

humeral head, neck, and shaft. The nature of the trauma can influence the fracture pattern, particularly in terms of how closely the fractured pieces are aligned. When these pieces remain close together and properly oriented – a condition referred to as being well approximated – conservative treatment methods may be sufficient.

In such scenarios, the patient may be fitted with a brace or sling to immobilize the area, thereby facilitating natural healing processes. During this period, careful monitoring is crucial to ensure the fracture is healing correctly and to assess the alignment of the bone fragments. Conservative management aims to promote healing while minimizing the need for surgical intervention.

However, if the fracture fails to heal properly or if alignment issues arise during the healing process, surgical options may be considered. These interventions aim to realign and stabilize the bone fragments, ensuring the restoration of the humerus’s integrity and function. Sometimes, a type of shoulder replacement called a Reverse Shoulder Replacement may be indicated for certain fractures of the proximal humerus. The decision between conservative and surgical treatment is made based on the specific characteristics of the fracture, the patient's overall health, and the anticipated outcomes of each approach.

Osteoarthritis

Osteoarthritis is a degenerative condition that affects various joints, including the shoulder joint. This can result in pain as well as limitations in motion and function. Arthritis is irreversible; however, several strategies exist to mitigate its symptoms and improve quality of life. Among these, gentle stretching, NSAIDs and cortisone injections are effective means to alleviate pain and improve symptoms.

For cases where osteoarthritis leads to severe pain and significantly impairs range of motion, and function, joint replacement surgery may be considered. This option offers substantial pain relief, improved motion, function, and quality of life. Decision-making regarding surgery is a collaborative process between the patient and their healthcare provider, carefully weighing the benefits and potential outcomes to determine the most appropriate timing for the procedure.

Labral Tear

The shoulder's stability and range of motion are significantly enhanced by a ring of soft tissue known as the labrum, which encircles the glenoid cavity. This cartilage-like tissue, present throughout the body in various joints, plays a crucial role in preventing dislocations by deepening the socket that accommodates the head of the humerus. Despite its resilience, the labrum can sustain tears, leading to symptoms such as pain and shoulder instability. Such tears are frequently the result of the humeral head moving abnormally within the glenoid fossa, often during a shoulder dislocation, causing the labrum to be pinched or torn. Another type of labral injury is a SLAP tear, an acronym for Superior Labral tear from Anterior to Posterior, specifically

refer to injuries affecting the upper part of the labrum, where it detaches from the back edge of the glenoid.

Management of labral tears can be approached either conservatively or through surgical intervention. Surgical repairs, known as Bankart repair or capsulorrhaphy, involve the reattachment of the torn labrum and capsule to the glenoid using sutures, aiming to restore the shoulder's normal anatomy and function. On the other hand, conservative treatment primarily involves physical therapy, focusing on strengthening the muscles around the shoulder to compensate for the torn labrum, thereby stabilizing the joint and reducing symptoms. The choice between conservative and surgical treatment options depends on the severity of the tear, the patient's physical activity level, and the degree to which symptoms affect daily activities.

At BBJI, our expertise in orthopedics allows us to provide comprehensive care tailored to each patient's unique needs, ensuring a swift and effective recovery from injuries and other orthopedic issues. Our dedicated team is committed to guiding you through the entire healing process, prioritizing open communication and collaboration with all parties involved. Our ultimate goal is to restore your quality of life, helping you return to daily activities with confidence and without pain.