Your shoulder is the most flexible joint in your body. It allows you to place and rotate your arm in many positions in front, above, to the side, and behind your body. This flexibility also makes your shoulder susceptible to instability and injury.
Depending on the nature of the problem, non surgical methods of treatment often are recommended before surgery. However, in some instances, delaying the surgical repair of a shoulder can increase the likelihood that the problem will be more difficult to treat later. Early, correct diagnosis and treatment of shoulder problems can make a significant difference in the long run. Other much less common causes of shoulder pain are tumors, infection, and nerve-related problems.
Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues, and help reduce friction between the gliding muscles and the bone.
Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis. Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult.
A tendon is a cord that connects muscle to bone. Most tendinitis is a result of a wearing down of the tendon that occurs slowly over time, much like the wearing process on the sole of a shoe that eventually splits from overuse.
Generally, tendinitis is one of two types:
• Acute. Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis.
• Chronic. Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis.
The most commonly affected tendons in the shoulder are the four rotator cuff tendons and one of the biceps tendons. The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability.
Splitting and tearing of tendons may result from acute injury or degenerative changes in the tendons due to advancing age, long-term overuse and wear and tear, or a sudden injury. These tears may be partial or may completely split the tendon into two pieces. In most cases of complete tears, the tendon is pulled away from its attachment to the bone. Rotator cuff and biceps tendon injuries are among the most common of these injuries.
Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted away from the body. As the arm is lifted, the acromion rubs, or "impinges" on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limiting movement. Over time, severe impingement can even lead to a rotator cuff tear.
Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse.
Shoulder dislocations can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket.
Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body. Repeated episodes of subluxations or dislocations lead to an increased risk of developing arthritis in the joint.
Shoulder pain can also result from arthritis. There are many types of arthritis. The most common type of arthritis in the shoulder is osteoarthritis, also known as "wear and tear" arthritis. Symptoms, such as swelling, pain, and stiffness, typically begin during middle age. Osteoarthritis develops slowly and the pain it causes worsens over time.
Osteoarthritis, may be related to sports or work injuries and chronic wear and tear. Other types of arthritis can be related to rotator cuff tears, infection, or an inflammation of the joint lining.Often people will avoid shoulder movements in an attempt to lessen arthritis pain. This sometimes leads to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.
Fractures are broken bones. Shoulder fractures commonly involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade).Shoulder fractures in older patients are often the result of a fall from standing height. In younger patients, shoulder fractures are often caused by a high energy injury, such as a motor vehicle accident or contact sports injury. Fractures often cause severe pain, swelling, and bruising about the shoulder.
Your doctor may order specific tests to help identify the cause of your pain and any other problems.
X-rays. These pictures will show any injuries to the bones that make up your shoulder joint.
Magnetic resonance imaging (MRI) and ultrasound. Thes imaging studies create better pictures of soft tissues. It may help your doctor identify injuries to the ligaments and tendons surrounding your shoulder joint.
Computed tomography (CT) scan. This tool combines x-rays with computer technology to produce a very detailed view of the bones in the shoulder area.
Electrical studies. Your doctor may order a tests, such as the EMG (electromyogram), to evaluate nerve function.
Arthrogram. During this x-ray study, dye is injected into the shoulder to better show the joint and its surrounding muscles and tendons.
Arthroscopy. In this surgical procedure, your doctor looks inside the joint with a fiber-optic camera. Arthroscopy may show soft tissue injuries that are not apparent from the physical examination, x-rays, and other tests. In addition to helping find the cause of pain, arthroscopy may be used to correct the problem.
• Arthroscopic acromioplasty - This is an arthroscopic procedure to widen the space between the upper arm and the shoulder blade so that the rotator cuff tendons do not get stuck between them. Arthroscopy with shoulder instability - In case of dislocation of the shoulder, it is normal to have an arthroscopy. It is often possible to repair damage to the shoulder but sometimes a separate operation is needed.
• Rotator Cuff Repair - Arthroscopic repair of the shoulder tendons. The goal of these procedures is to minimize the pain, restore strength and functionality.
• Total Shoulder Replacement SurgeryAlso known as Total Shoulder Arthroplasty, the Total Shoulder Replacement Surgery is a surgical procedure wherein the intention is to reduce the joint pain and improved the motion function in patients suffering from a variety of arthritic conditions. In this type of surgery, the both sides of the joint are replaced which include humeral head and the glenoid.
From all the surgical shoulder replacement procedures, the one single benefit that you derive is improved mobility, flexibility and elimination of pain in the shoulder joint. However in India, the major benefit is lower cost treatment, advanced infrastructure and state of the art equipments.
• The minimal invasive surgery will allow faster healing when compared to more severe surgeries.
• Arthroscopy allows less scars and scar tissues so that you can have improved movement in your arm and shoulder.
• Patient’s arm and shoulder recuperate faster when compared to living with the damage or inflammation that was hindering it.
• Arthroscopic procedures cause minimal blood loss. This allows for less bruising and pain during recovery.
After Shoulder Replacement Surgery, you are required to wear an arm sling for a few days. The arm movement will depend upon the specific instructions given by the doctors. Following the surgery, most physicians will start some light physiotherapy which includes pain management and rehabilitation. In 2 to 3 months, a patient will get back to the normal routine activities.
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