Shoulder
Shoulder Arthritis
What is shoulder arthritis?
Shoulder arthritis is a common condition that affects the shoulder joint. In a healthy shoulder, a firm, rubbery material, known as cartilage, covers the bones and allows them to slide smoothly within the joint. When a shoulder is affected by arthritis, this layer of cartilage breaks down and causes pain, swelling and reduced motion.
What Causes Shoulder Arthritis?
There are two joints in the shoulder which may be affected by arthritis. One joint is positioned where the clavicle meets the tip of the shoulder blade. This is called the acromioclavicular (AC) joint. The second joint is where the head of the humerus (upper arm bone) fits into the scapula. This is called the glenohumeral joint. Typically, shoulder arthritis is caused by a disintegration of cartilage in one or both of these joints.
The exact cause of arthritis is unknown; however, a number of factors are known to contribute to the condition. These include:
- Being overweight
- Getting older
- Having a joint injury
- Undertaking activities which place extra stress on the shoulder
Shoulder arthritis often develops slowly over several years, however, occasionally, it may also be the result of a joint that has not formed properly.
Shoulder Arthritis Symptoms
Shoulder arthritis symptoms include stiffness in the shoulder and either a sharp, stabbing pain, or a dull ache. Other symptoms include:
- Swelling
- A limited range of motion
- A sensation of grinding within the joint.
A sensation of grinding within the joint.
In the early stages, shoulder arthritis may be treated with a range of non-surgical options. These include; activity modification, physiotherapy, anti-inflammatory medication, cortisone injections as joint supplements such as glucosamine.
Surgery for Shoulder Arthritis
If your shoulder pain is severely affecting your quality of life, your doctor may refer you a specialist about shoulder surgery. Most surgeries for shoulder arthritis aim to:
- Relieve strong pain
- Improve shoulder joint movement and flexibility
- Help you move your shoulder more comfortably
The most common types of surgery for shoulder arthritis include:
- Shoulder Arthroscopy: which involves keyhole surgery to remove damaged cartilage and repair tendons
- Shoulder Replacement Surgery: in which the damaged part of the shoulder is removed and replaced with artificial components.
Rotator Cuff Tear
What is a Rotator Cuff Tear?
Rotator Cuff Tears are a common cause of shoulder pain. The rotator cuff is a group of muscles and tendons in the shoulder joint that help the shoulder to move. A Rotator Cuff Tear is a tear or strain in these muscles or tendons. Rotator Cuff Tears can happen quickly, or develop gradually over time.
What causes Rotator Cuff Tears?
Rotator cuff tears can be caused by a sudden injury to the shoulder or a gradual deterioration of the tendon tissue. Repetitive overhead movements and heavy lifting may irritate or damage the tendon.
The following things are known to increase your risk of having a rotator cuff injury:
- Age Rotator cuff tears are most common in people over 40.
- Sports. Sports which involve repetitive arm motions, such as tennis, cricket and archery.
- Physical labour. Jobs such as carpentry or house painting which involve repetitive overhead arm motions can damage the rotator cuff.
Rotator Cuff Tear Treatment
Physical therapy and medication are used to treat Rotator Cuff Tears in the first instance. Up to 80% of people who experience rotator cuff tears find that these non-surgical treatments are able to relieve pain and improve movement and function in the shoulder. If physical therapy and medication does not work, your doctor may suggest a cortisone injection.
Surgery for Rotator Cuff Tears
If non-surgical methods do not work, your doctor may recommend surgery. Depending on your individual situation, surgery may be a good option for you if:
- Your symptoms have lasted longer than 6 months
- You have a large tear (more than 3 cm)
- You have lost strength and functionality in your shoulder
- Your tear was caused by a recent, acute injury
What happens in surgery?
- Shoulder Arthroscopy: which involves keyhole surgery to remove damaged cartilage and repair tendons
- Shoulder Replacement Surgery: in which the damaged part of the shoulder is removed and replaced with artificial components.
Shoulder Dislocation
What is a Shoulder Dislocation?
Shoulder dislocation happens when the head of the upper arm bone (humerus) moves out of the shoulder socket. This can happen as a result of a sudden impact injury or from overuse. After a shoulder has dislocated, it can happen again, especially if the muscles, tendons and ligaments which keep it in place are torn or become loose. When a shoulder slips out of place repeatedly, it is called chronic shoulder instability.
Shoulder dislocations can be partial or complete. Partial dislocation (subluxation) involves the ball of the upper arm coming partially out of the socket. In a complete dislocation, the ball comes all the way out of the socket.
What causes Shoulder Dislocation?
Injury from a sudden impact is the most common cause of shoulder dislocation. When the head of the humerus dislocates, the ligaments in the front of the shoulder are often injured and the cartilage around the edge of the bone may also tear. A severe first dislocation can lead to continued dislocations or a feeling of instability.
Repetitive movement can also cause shoulder instability and dislocation. Repeated actions such as those experienced in swimming, volleyball and tennis can cause shoulder instability. Jobs that require regular overhead work such as carpentry or house painting can also stretch out the shoulder ligaments and make them loose.
Shoulder Dislocation Symptoms
Most people who experience a shoulder dislocation report feeling the ball of the shoulder come out of the socket. This is usually painful and connected to a sensation of the shoulder ‘giving way’. Other symptoms include a decreased range of movement in the arm and shoulder, as well as swelling and bruising. Usually, a shoulder dislocation happens during an activity such as throwing a ball or reaching backwards.
Treatment for Shoulder Dislocation
Initial treatment for shoulder dislocation involves a medical professional putting the ball of your upper arm back into the socket. This is often done with pain relief medication. As soon as the ball is back in the socket, the intense pain should end. A sling is often used for a few days to temporarily immobilize the joint. After any pain and swelling has been addressed, physical therapy exercises are introduced.
Surgery for Shoulder Dislocation
If you are experiencing repeat dislocations, surgery may be necessary. The aim of surgery will be to repair torn or stretched ligaments so that they can keep the shoulder joint in place. In some instances, this surgery can be performed via arthroscopy, which is minimally invasive, key-hole surgery. In other instances, traditional, open surgery is required. Dr de Villiers will talk to you about which one is right for you when you attend for your consultation.
After surgery, your shoulder will be immobilized with a sling. You will also be given a range of exercises to strengthen your shoulder as part of your rehabilitation plan.
Common Shoulder Conditions
Your shoulder is an amazing joint that can move forwards, backwards upwards and around in a circle. You rely on your shoulder ever day to do basic things such as pushing, pulling, lifting and throwing. Unfortunately, due to its wide range of movement, the shoulder is also prone to injury and arthritis.
Painful shoulder conditions can limit your movement and impact on your quality of life. Many shoulder conditions can be treated without surgery. Techniques such as movement modification, Non-Steroidal Anti-inflammatory Drugs (NSAIDs) and physiotherapy are typically recommended in the first instance.
If conservative treatments do not relieve your shoulder pain, surgery may be an option. Dr de Villiers specialises in treating a range of shoulder dysfunctions, including:
- Rotator cuff disorders
- Frozen shoulder (adhesive capsulitis)
- Dislocated shoulder
- Shoulder instability
- Ligament tears
- Osteoarthritis
What causes shoulder pain?
There are a number of things that cause shoulder pain. Most commonly, shoulder pain is a result of an injury or a medical condition such as rheumatoid arthritis or osteoarthritis. Be sure to talk to your doctor if you are experiencing ongoing shoulder pain, a reduced range of motion, fever and redness and swelling around the joint.
Do you need to see a shoulder surgeon?
If you are experiencing shoulder pain, consult your GP. In the first instance, non-surgical treatments will be explored.
If your shoulder pain has not responded to non-surgical treatments you may need to see a specialist. Most shoulder surgery involves the repair of muscles, tissues, and connective joints. Many shoulder surgeries are now able to be performed via arthroscopy, which is a minimally invasive medical procedure, usually conducted as day surgery. Other procedures might require you to stay for a few nights in hospital. Surgery for most shoulder conditions also requires a period of shoulder rehabilitation. This is usually done with a physiotherapist, under recommendation from your surgeon.
If your shoulder condition is causing you pain, and non-surgical treatments aren’t working, talk to your doctor about whether a referral to Dr de Villiers is right for you.