Rotator Cuff Problem: Do You Need Surgery?

Article featured on WebMD, Reviewed by Tyler Wheeler, MD on May 16, 2021

Some rotator cuff problems are easily treated at home. But if yours is severe, or lingers for more than a few months, you may need surgery.

What Causes Rotator Cuff Problems

Your rotator cuff is a group of tendons and muscles in your shoulder. It helps you lift and rotate your arm. It also helps keep your shoulder joint in place. But sometimes, the rotator cuff tendons tear or get pinched by the bones around them. An injury, like falling on your arm, can cause this to happen. But wear and tear over time can take its toll on your shoulder, too. The pain can be severe.

Treatment

Home care can treat many rotator cuff problems. Your doctor will tell you to rest your shoulder joint and ice the area. Over-the-counter pain relievers can help ease your pain and swelling while your rotator cuff heals. Physical therapy will help restore your shoulder strength.

What About Surgery?

If you’re not getting any relief with these steps, surgery may be the next option for you.

You may need surgery if:

  • Your shoulder hasn’t improved after 6 to 12 months
  • You’ve lost a lot of strength in your shoulder and find it painful to move
  • You have a tear in your rotator cuff tendon
  • You’re active and rely on your shoulder strength for your job or to play sports

What Type of Surgery Do I Need?

Surgery can relieve your pain and restore function to your shoulder. Some are done on an outpatient basis. For others, you may need to stay in a hospital.

The most common types are:

Arthroscopic repair. After making one or two very small cuts in your skin, a surgeon will insert a tiny camera called an arthroscope and special, thin tools into your shoulder. These will let them see which parts of your rotator cuff are damaged and how best to fix them.

Open tendon repair. This surgery has been around a long time. It was the first technique used to repair the rotator cuff. If you have a tear that’s very large or complex, your surgeon may choose this method.

A large incision is made in your shoulder, then your shoulder muscle is detached so the surgeon has direct access to your tendon. This is helpful if your tendon or shoulder joint needs to be replaced. Both of these surgeries can be done under general anesthesia, which allows you to sleep through the whole thing. They can also be done with a “regional block,” which allows you to stay awake while your arm and shoulder stay numb.You can talk to your doctor ahead of time about the type of anesthesia you prefer.

Recovery

Recovery from arthroscopic surgery is typically quicker than open tendon repair. Since open tendon repair is more involved, you may also have more pain right afterwards.

No matter which surgery you have, a full recovery will take time. You should expect to be in a sling for about 6 weeks. This protects your shoulder and gives your rotator cuff time to heal. Driving a car will be off limits for at least a month.

Most people don’t get instant pain relief from surgery. It may take a few months before your shoulder starts feeling better. Until then, your doctor will advise you to take over-the-counter pain relievers.
Physical therapy will be a key part of your recovery. Your doctor will give you exercises to do every day or you can work with a physical therapist. The movements you learn will help you regain your shoulder strength and range of motion.While the recovery from rotator cuff surgery can be a challenge, most people are back to their normal routine within 6 months.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday

Frozen shoulder: What you need to know

Article on MedicalNewsToday, medically reviewed by William Morrison, M.D. — Written by Caroline Gillott on December 5, 2017

Frozen shoulder is a common condition in which the shoulder stiffens, reducing its mobility. It is also known as adhesive capsulitis.

The term “frozen shoulder” is often used incorrectly for arthritis, but these two conditions are unrelated. Frozen shoulder refers specifically to the shoulder joint, while arthritis may refer to other or multiple joints. It commonly affects people aged between 40 and 60 years, and it is more likely in women than in men. It is estimated to affect about 3 percent of people. It can affect one or both shoulders.

Exercises

Frequent, gentle exercise can prevent and possibly reverse stiffness in the shoulder.

The American Association of Orthopaedic Surgeons (AAOS) suggest some simple exercises:

Crossover arm stretch: Holding the upper arm of the affected side, gently pull the arm across in front of you, under the chin. Hold for 30 seconds. Relax and repeat.

Exercises should be guided by a doctor, an osteopath, or a physical therapist. Anyone experiencing stiffness in the shoulder joint should seek medical attention sooner rather than later to prevent permanent stiffness.

Harvard Medical School suggest the following exercises for relieving a frozen shoulder:

Pendulum stretch

Stand with the shoulders relaxed. Lean forward with the hand of the unaffected arm resting on a table. Let the affected arm hang down vertically and swing in a small circle, around 1 foot in diameter. Increase the diameter over several days, as you gain strength.

Towel stretch

Grab both ends of a towel behind your back. With the good arm, pull the towel, and the affected arm, up toward the shoulder. Repeat 10 to 20 times a day.

Symptoms

A person with a frozen shoulder will have a persistently painful and stiff shoulder joint. Signs and symptoms develop gradually, and usually resolve on their own.

Causes

The shoulder is made up of three bones: The shoulder blade, the collarbone, and the upper arm bone, or humerus. The shoulder has a ball-and-socket joint. The round head of the upper arm bone fits into this socket. Connective tissue, known as the shoulder capsule, surrounds this joint. Synovial fluid enables the joint to move without friction.

Frozen shoulder is thought to happen when scar tissue forms in the shoulder. This causes the shoulder joint’s capsule to thicken and tighten, leaving less room for movement. Movement may become stiff and painful. The exact cause is not fully understood, and it cannot always be identified. However, most people with frozen shoulder have experienced immobility as a result of a recent injury or fracture. The condition is common in people with diabetes.

Risk factors

Common risk factors for frozen shoulder are:

  • Age: Being over 40 years of age.
  • Gender: 70 percent of people with frozen shoulder are women.
  • Recent trauma: Surgery or and arm fracture can lead to immobility during recovery, and this may cause the shoulder capsule to stiffen.
  • Diabetes: 10 to 20 percent of people with diabetes develop frozen shoulder, and symptoms may be more severe. The reasons are unclear.

Other conditions that can increase the risk are:

  • stroke
  • hyperthyroidism, or overactive thyroid
  • hypothyroidism, or underactive thyroid
  • cardiovascular disease
  • Parkinson’s disease

Stages

Symptoms are usually classified in three stages, as they worsen gradually and then resolve within a 2- to 3-year period.

The AAOS describe three stages:

  • Freezing, or painful stage: Pain increases gradually, making shoulder motion harder and harder. Pain tends to be worse at night. This stage can last from 6 weeks to 9 months.
  • Frozen: Pain does not worsen, and it may decrease at this stage. The shoulder remains stiff. It can last from 4 to 6 months, and movement may be restricted.
  • Thawing: Movement gets easier and may eventually return to normal. Pain may fade but occasionally recur. This takes between 6 months and 2 years.

Over 90 percent of people find that with simple exercises and pain control, symptoms improve. A frozen shoulder normally recovers, but it can take 3 years.

Diagnosis

Doctors will most likely diagnose frozen shoulder based on signs, symptoms, and a physical exam, paying close attention to the arms and shoulders. The severity of frozen shoulder is determined by a basic test in which a doctor presses and moves certain parts of the arm and shoulder. Structural problems can only be identified with the help of imaging tests, such as an X-ray or Magnetic Resonance Imaging (MRI).

Treatment

The aim is to alleviate pain and preserve mobility and flexibility in the shoulder. In time and with treatment, 9 out of 10 patients experience relief. However, recovery may be slow, and symptoms can persist for several years. There are several ways to relieve pain and alleviate the condition.

Painkillers: Nonsteroidal anti-inflammatory drugs (NSAIDs) are available to purchase over-the counter, and may reduce inflammation and alleviate mild pain. Not all painkillers are suitable for every patient, so it is important to review options with the doctor.

Hot or cold compression packs: These can help reduce pain and swelling. Alternating between the two may help.

Corticosteroid injections: However, repeated corticosteroid injections are discouraged as they can have adverse effects, including further damage to the shoulder.

Transcutaneous electrical nerve stimulation (TENS): This works by numbing the nerve endings in the spinal cord that control pain. The TENS machine sends small to electrodes, or small electric pads, that are applied to the skin on the affected shoulder. Various TENS machines from different brands are available to purchase online.

Physical therapy: This can provide training in exercises to maintain as much mobility and flexibility as possible without straining the shoulder or causing too much pain.

Shoulder manipulation: The shoulder joint is gently moved while the patient is under a general anesthetic.

Shoulder arthroscopy: A minimally invasive type of surgery used in a small percentage of cases. A small endoscope, or tube, is inserted through a small incision into the shoulder joint to remove any scar tissue or adhesions. The doctor will suggest a suitable option depending on the severity of signs and symptoms.

Prevention

Frozen shoulder can only be prevented if it is caused by an injury that makes shoulder movement difficult. Anyone who experiences such an injury should talk to a doctor about exercises for maintaining mobility and flexibility of the shoulder joint.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Shoulder Replacement Surgery: What to Know

Medically Reviewed by Tyler Wheeler, MD on December 08, 2019 from WebMD

If your shoulder joint gets seriously damaged, you might need surgery to replace it. Before you have your procedure, you should know some things.

About Your Shoulder

The joint where your upper arm connects to your body is a ball-and-socket joint. The bone in your upper arm, called the humerus, has a round end that fits into the curved structure on the outside of your shoulder blade.

Ligaments and tendons hold it together. Ligaments connect the bones, while tendons connect muscles to the bone. A layer of tissue called cartilage keeps the bones apart, so they don’t rub against each other.

The ball and socket lets you move your arm up and down, back and forward, or in a circle.

Why You’d Need It Replaced

You may have to have it done if you have a condition that makes it painful and hard to use your arm, such as:

  • A serious shoulder injury like a broken bone
  • Severe arthritis
  • A torn rotator cuff

Your doctor will probably try to treat you with drugs or physical therapy first. If those don’t work, they may recommend surgery.

Shoulder replacement surgery is less common than hip or knee replacements. But more than 50,000 shoulder replacements are done in the U.S. each year.

What to Expect

An orthopedic surgeon will replace the natural bone in the ball and socket of your shoulder joint with a material that could be metal or plastic. It’s a major surgery that’ll keep you in the hospital for several days. You’ll also need several weeks of physical therapy afterward.

There are three types of shoulder replacement surgeries:

Total shoulder replacement: This is the most common type. It replaces the ball at the top of your humerus with a metal ball, which gets attached to the remaining bone. The socket gets covered with a new plastic surface.

Partial shoulder replacement: Only the ball gets replaced.

Reverse shoulder replacement: Usually, you’d get this if you have a torn rotator cuff. It’s also done when another shoulder replacement surgery didn’t work. The metal ball gets attached to your shoulder bones, and a socket is implanted at the top of your arm.


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

What to Know About Front Shoulder Pain

From Medical News Today; Medically reviewed by William Morrison, M.D. — Written by Sunali Wadehraon January 22, 2019

Damage to the shoulder may result from repetitive movements, manual labor, sports, or aging. A person may also injure this part of the body due to a bad fall or accident. Many people visit the doctor with front, or anterior, shoulder pain.


The shoulder is a mobile structure that allows the arm to move freely in all directions. Shoulder problems may limit arm movement, causing pain or discomfort.

The shoulder has three major bones:

  • the humerus, which is the long arm bone
  • the scapula, or shoulder blade
  • the clavicle, or collarbone

These bones interact at four joints. A joint called the glenohumeral or shoulder joint connects the upper arm bone and shoulder blade. Although surrounding structures provide support, this joint is susceptible to injury.

In this article, we discuss some common causes of front shoulder pain and explain how doctors diagnose and treat them.

What are the causes?

Shoulder pain can develop from problems in any part of the shoulder.

Damage to the joint may result from repetitive movements, manual labor, sports, or aging.

It may also occur when a person has a bad fall or accident.

Some injuries may cause a sudden onset of shoulder pain. Examples include dislocations, separations, and fractures.

Common causes of chronic front shoulder pain include the following:

Rotator cuff injury

The rotator cuff comprises muscles and tendons that act to stabilize the shoulder.

Bursae, which are fluid-filled sacs, reduce friction between the shoulder structures. The rotator cuff tendons, which connect the muscles to the bone, are vulnerable to compression from surrounding bony structures.

Rotator cuff tendinopathy, or injury to the rotator cuff tendons, may develop from repetitive activity, generally at or above shoulder height. People with rotator cuff tendinopathy may have pain around their shoulder, particularly when reaching overhead.

Impingement occurs when the acromion, a part of the shoulder blade, puts pressure on the rotator cuff tendons and bursae. It presents in an almost identical way to rotator cuff tendinopathy.

Rotator cuff tendon tears may result from sudden injury or slow, degenerative change. Symptoms include shoulder weakness and pain, as well as popping sensations during arm movement. Severe tears may impair the use of the shoulder, limiting day-to-day activities.

Biceps tendinopathy

Biceps tendinopathy is an injury to the tendon of the biceps muscle, which may result from repetitive lifting and reaching overhead. Symptoms include pain in the front of the shoulder that becomes worse when lifting, reaching overhead, and carrying objects. Continued performance of these activities may result in the sudden rupture of the tendon.

Adhesive capsulitis

Adhesive capsulitis, which people sometimes refer to as frozen shoulder, may develop from not using the shoulder. People with this condition may experience pain, a decrease in their range of motion, and stiff joints. Common causes of shoulder disuse include rotator cuff tendinopathy, diabetes mellitus, biceps tendinopathy, and trauma to the shoulder.

Osteoarthritis

Osteoarthritis, also known as “wear and tear” arthritis, commonly occurs in either the glenohumeral joint or the acromioclavicular joint. In this form of arthritis, the bones rub together as the cartilage between them wears away. Symptoms include pain, swelling, and stiffness in the shoulder joint.

Osteoarthritis generally worsens over time.

Fracture

Fractures, or breaks, occur most often in the collarbone or upper arm bone. Both types of fracture may result from a fall onto an outstretched hand or a blow to the shoulder. In most cases, they will cause severe pain, swelling, and bruising. The shoulder will be tender to touch around the injury, and the bones may appear out of position.

Dislocation

Shoulder dislocations occur when the ball of the upper arm bone pops out of its socket. The arm bone may dislocate forward, backward, or downward, either partially or completely.

Dislocations may recur if the surrounding structures of the shoulder become worn down. Symptoms include pain, swelling, numbness, and weakness. The arm may look out of place.

Separation

A shoulder separation occurs when the ligaments tear. The ligaments are tissues connecting the bones and cartilage. Separations in the acromioclavicular region between the collarbone and shoulder blade may occur from falls or direct blows. Symptoms include pain, swelling, and tenderness in the front shoulder, as well as a bump at the point of separation.

Treatment

People can manage many types of shoulder problem at home.

Treatment typically involves a period of rest and avoidance of activities that aggravate the pain.

A doctor may also recommend applying heat or ice to the injury for pain relief, as well as placing pressure on the area to reduce swelling. Physical therapy improves shoulder strength and flexibility.

Slings can be helpful in managing shoulder dislocations, separations, and fractures, as they keep the structures of the joint in position. Before applying a sling, a doctor will put the bones back into place.

Sometimes, doctors recommend medication to reduce pain and inflammation. Over-the-counter drugs, such as ibuprofen and aspirin, are available. Doctors can also prescribe medications and inject steroids or numbing medicine directly into the shoulder to relieve pain.

Some injuries require surgery for treatment. For example, rotator cuff tears and adhesive capsulitis do not always improve with rest and medicine. Severe rotator cuff tears or recurrent dislocations may warrant early surgical consultation rather than a trial of at-home management.

Diagnosis

Several conditions lead to shoulder pain.

A thorough clinical evaluation helps pinpoint the cause. A doctor will take a medical history and carry out a physical examination, during which they may ask the individual to perform several specific movements to assess the injury. They may also order lab and imaging tests if they need additional information.

If the pain is mild, it may not be necessary to visit a doctor right away. Some people prefer to rest and see if the pain will go away. If the pain does not improve, it is best to go to the doctor for further evaluation.

People should see a doctor right away if they experience any of the following signs or symptoms:

  • intense pain
  • sudden swelling
  • weakness or numbness in the arm or hand
  • inability to use the shoulder
  • deformity

Takeaway

Shoulder pain is a common complaint. The unique anatomy and range of motion of this joint make it susceptible to injury. Common triggers for injury include accidents, repetitive movements, manual labor, sports, and aging.

An injury that causes severe pain requires immediate care. A person should also see a doctor right away if they have any joint deformity, sudden swelling, an inability to use the joint, weakness or numbness in the arm or hands, or intolerable pain.

 


The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Common Causes of Shoulder Pain and How to Treat it

Article Featured on Harvard Health

You probably don’t think about your shoulders much, until you suddenly experience pain in one of them. Shoulder pain can make a simple act — brushing and drying your hair, reaching behind your back to fasten a bra, or grabbing something overhead — seem like a monumental task.

As you age, you’re more likely to experience shoulder pain from a variety of common conditions. “Shoulder problems are very common,” says Dr. Arun Ramappa, associate professor of orthopedic surgery at Harvard Medical School. The pain can come on gradually or abruptly, and it may range from mild to excruciating.

Shoulder pain can vary between severity and frequency. Below are some of the most common conditions causing shoulder pain, and some tips for how to address them.

Read more

Two Injury-Prone Areas Bow Hunters Should Scout For

Article Featured on OSMSGB

If you think about the basic actions of shooting a bow – pull back with the fingers and arm, rotate through the shoulder, hold, and release – it probably becomes clear why upper extremity conditions are some of the most commonly diagnosed injuries among bow hunters. The drawing back of the strings demands a lot from the smaller muscles of the rotator cuff, forearm, wrist, and fingers. Plus, repetitive target practice to improve aim, timing, and other hunting skills can easily result in chronic pain or injury from overuse.

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What To Do About Shoulder Pain?

Description

The shoulder (Figure 1) is a ball and socket joint that allows a wide range of movement. Because it is composed of several key structures such as tendons, cartilage and bone, the shoulder can be affected by a variety of conditions.

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