Shoulder pain and discomfort can be very uncomfortable. The team of highly-skilled orthopedic surgeons at Washingtson Sports Medicine Institute Team can diagnose and treat your shoulder condition so you can gain back the use and mobility of your shoulder.
If you have shoulder pain caused by some form of arthritis, you deserve the best treatment possible. The team at Washi9ngton Sports Medicine Institute provides patients in the Tysons, Virginia and Washington, DC area with high-quality orthopedic services to ensure you receive high-quality care. Our compassionate team will take the time to understand your condition fully.
Many patients can be treated non-surgically. The modalities used include gentle physical therapy, use of non-steroidal anti-inflammatory drugs (NSAIDs), topical treatments such as lidocaine patches, and corticosteroid injections. All of these have a role in treatment and have provided varying levels of success albeit in most cases temporarily. Some patients will be able to remain functional with these treatments administered periodically indefinitely. Although there has been a great deal of discussion recently about the use of viscosupplementation (hyaluronic acid), platelet rich plasma and stem cell treatments, there is at this time very little scientific data to support their use.
For patients with unremitting pain not relieved by the above treatments, loss of sleep due to pain, inability to perform activities or increasing bone loss to the point that surgical options would be compromised, there is the option of shoulder replacement surgery. As in other joint replacement surgeries, some bone is removed from the shoulder joint and components made of metal and high-density polyethylene are inserted. The shoulder is unique from other joint replacements because of its much greater range of motion, flat unconstrained glenoid (shoulder socket) and dependence on soft tissues (muscle, tendon and ligaments) for proper functioning and stability. There are some situations when a shoulder replacement is contraindicated and this includes, infection, nerve damage around the shoulder, insufficient bone stock or loss of deltoid muscle function.
The preoperative planning involves appropriate x-rays of the shoulder in at least 2 planes to allow the determination of any loss of bone stock, orientation of the joint and presence of any bone abnormalities. At times, additional studies such as CAT scans and MRI scans are utilized to determine any damage to the rotator cuff tendons or other soft tissues and to further delineate bone damage. Routinely, computer sizing of the appropriate components are determined in advance of all procedures. For patients with significant deformity or bone loss, custom designed devices for determining the proper orientation of the components can be made and at times actual custom cad/cam (computer assisted design/computer assisted manufacturing) components are made specifically for the individual to fit their unique anatomy. All of these high-tech features are available and used when needed but there is no evidence to support their use in routine shoulder replacement cases
The rotator cuff is a group of tendons in the shoulder joint that cover and provide support to the shoulder joint, enabling a wider range of motion. A rotator cuff tear involves one or more of the four muscles that starts on your shoulder blade, the scapula, and inserts on your upper arm, or humerus. These 4 muscles work together to lift and rotate your arm and keep the ball of the shoulder joint (proximal humerus) centered on the socket (glenoid). Although there are 4 separate muscles they share a common tendon – tendons attach muscles to bone. This group of tendons is called the rotator cuff. A tear in the rotator cuff is one of the most common causes of shoulder pain in middle-aged adults and older individuals. It may occur with repetitive movements while working or playing sports, during motor accidents, lifting a heavy object, or a fall on an outstretched arm. As aging occurs, bone spurs may develop and can damage tendon tissue causing tears.
Rotator cuff tears can be diagnosed with a medical review and thorough physical exam and confirmed following X-ray, magnetic resonance imaging (MRI), or ultrasound. Symptomatic relief may be obtained with conservative treatments including rest, shoulder sling, pain medications, NSAIDs, steroidal injections, and shoulder exercises. However, surgery is required when these methods do not help relieve symptoms.
Rotator cuff repair may be performed by traditional open surgery (involving a large incision) or minimally invasive with arthroscopy (a lighted narrow fiber-optic tube with a camera is inserted through tiny incisions). Surgery may involve removal of bone spurs, repairing and re-attaching torn tendons with suture anchors to the shoulder bone, and sometimes transferring a functional tendon (graft) from its original location to restore function. Following the surgery, you may be advised to practice motion and strengthening exercises.