Bursitis or tendinitis can occur with overuse from repetitive activities, such as swimming, painting, or weight lifting. These activities cause rubbing or squeezing (impingement) of the rotator cuff under the acromion and in the acromioclavicular joint. Initially, these problems are treated by modifying the activity which causes the symptoms of pain and with a rehabilitation program for the shoulder.
IMPINGEMENT AND PARTIAL ROTATOR CUFF TEARS
Partial thickness rotator cuff tears can be associated with chronic inflammation and the development of spurs on the underside of the acromion or the acromioclavicular joint.
The conservative nonsurgical treatment is modification of activity, light exercise, and, occasionally, a cortisone injection. Nonsurgical treatment is successful in a majority of cases. If it is not successful, surgery often is needed to remove the spurs on the underside of the acromion and to repair the rotator cuff.
FULL-THICKNESS ROTATOR CUFF TEARS
Full-thickness rotator cuff tears are most often the result of impingement, partial thickness rotator cuff tears, heavy lifting, or falls. Nonsurgical treatment with modification of activity can be successful in some cases.
If pain continues, surgery may be needed to repair full – thickness rotator cuff tears. Arthroscopic techniques allow shaving of spurs, evaluation of the rotator cuff, and repair of some tears.
Repair of a rotator cuff tear requires extensive rehabilitation to restore the function of the shoulder.
Instability occurs when the head of the upper arm bone (humerous) is forced out fo the shoulder socket. This can happen particularly in Rugby, Football and Gaelic Games. Gradual stretching of the capsular ligaments can occur in people involved in overhead throwing activities.
The two basic forms of shoulder instability are subluxations and dislocations. A subluxation is a partial or incomplete dislocation. If the shoulder is partially out of the shoulder socket, it eventually may dislocate. Even a minor injury may push the arm bone out of its socket. A dislocation is when the head of the arm bone slips out of the shoulder socket. Some patients have chronic instability. Shoulder dislocations may
Repeated dislocation can cause increased wear in the shoulder joint and repair i.e. reconstruction is usually recommended. This can be done openly or arthroscopically (keyhole) and depends on the patients requirements i.e the game they play, the age they are and other considerations.
Usual healing time following surgical reconstruction would be in the order of about four months.
FRACTURED CLAVICLE AND ACROMIOCLAVICULAR JOINT SEPARATION
A fractured clavicle and acromioclavicular separation are common injuries of children and others who fall on the side of their shoulder when playing. Most of these injuries are treated nonsurgically with slings or splints. Severe displaced fractures or acromioclavicular joint separation may require surgical repair.
FRACTURED HEAD OF THE HUMERUS (ARM BONE), OR PROXIMAL HUMERUS FRACTURE
A fractured head of the humerus is a common result of falls on an outstretched arm, particularly by older people with osteoporosis. If fragmented or displaced, it may require open surgical repair and possibly replacement with an artificial joint (prosthesis).
OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS
Osteoarthritis and rheumatoid arthritis can destroy the shoulder joint and surrounding tissue. They can also cause degeneration and tearing of the capsule or the rotator cuff. Osteoarthritis occurs when the articular surface of the joint wears thin.
Rheumatoid arthritis is associated with chronic inflammation of the synovium lining which can produce chemicals that eventually destroy the inner lining of the joint, including the articular surface.
Shoulder replacement is recommended for patients with painfuil shoulders, limited motion and failure to respond to conservative treatment. The treatment options are either replacement of the ball of the joint and/or replacement of both the ball and the socket. This is something that needs discussing and is tailored to each individual patient.