Rotator Cuff (RTC) Injury
Overview: The rotator cuff of the shoulder consists of four muscles and their tendons, which support the shoulder joint. The tendon is typically injured more often, but the muscle can suffer damage as well.
Causes: Overhead motions performed repetitively are a major risk factor for developing injury to the rotator cuff. The prevalence of RTC injury also increases significantly with age.
Symptoms: A dull ache is generally felt over the upper portion and deltoid region of the shoulder. Difficulty sleeping on the shoulder is also common.
Treatment: Anti-inflammatory medications can provide pain relief. Physical therapy can help to strengthen the RTC muscles and improve range of motion. A shoulder joint injection can provide pain relief for up to 6 months on average. Repetitive steroid injections into the joint should be avoided due to increased risk of further tendon damage and inhibition of healing. Regenerative medicine has been very effective in healing damage seen in partial tears of the RTC. Surgical intervention should be reserved for those who fail more conservative measures and have significant pain and functional impairment.
Overview: The shoulder joint is made up of three bones: the humerus (arm bone), the scapula (shoulder blade) and the clavicle (collarbone). Within the shoulder joint is a cartilage lining over the bones called the labrum. The labrum serves to increase the joint socket surface area for improved stability and is the attachment site for several ligaments. Labrum tears can occur, which alters the stability and function of the shoulder joint.
Causes: Trauma is a common cause of labrum damage. Falling on an outstretched hand, a direct blow to the shoulder, and repetitive motions (such as throwing or weightlifting) are all common causes of labrum tears.
Symptoms: A patient with a labrum tear presents with pain in the shoulder with decreased range of motion, and loss of strength may be seen. Sleeping on the affected shoulder at night may also be difficult.
Treatment: Patients that have the clinical signs and symptoms of labrum damage may be further evaluated with advanced imaging, such as MRI or CT scan. When an accurate diagnosis has been made, treatment options depend on the severity of the labrum tear. For those with mild to moderate symptoms, anti-inflammatory medications and physical therapy can be very helpful. Regenerative Medicine can be used to heal the cartilage tear. Surgical intervention is reserved for cases that don’t respond to more conservative measures or those with significant functional impairment.
Overview: The shoulder is a complex joint with a large range of motion. Every part of the shoulder must be working appropriately for the entire shoulder unit to be effective.
Causes: Impingement syndrome is a condition that is secondary to another issue, usually damage to the rotator cuff or bursa or poor posture.
Symptoms: Impingement leads to pain in and around the shoulder, decreased range of motion of the shoulder and functional impairment.
Treatment: First and foremost, the primary diagnosis that is causing secondary impingement must be determined. That primary diagnosis must then be treated in an effort to restore the normal biomechanics of the shoulder. Physical therapy is very helpful in restoring range of motion and strength. Joint injections can help to alleviate acute and sub-acute pain for advancement with rehabilitation efforts.
Overview: Bursa are fluid-filled sacs that are found in several places within the body. They are placed to reduce friction and decrease chance of injury. Bursa may become irritated and inflamed when excessive stress is placed on them or following direct trauma.
Causes: The bursa in the shoulder that lies directly beneath the acromion (subacromial) can be irritated by overuse of the shoulder, or trauma such as a fall on outstretched hand.
Symptoms: Shoulder pain over the outside portion of the shoulder is common. Pain with lying on the affected shoulder or trying to elevate the shoulder between 60 degrees and 90 degrees is often described.
Treatment: Anti-inflammatory medications may be helpful to reduce inflammation and pain. Physical therapy can help to restore the range of motion and strength to the shoulder and decrease the irritation to the bursa. A PRF or steroid injection using ultrasound guidance directly into the bursa can help to decrease inflammation and pain. Surgical removal of the bursa is reserved for severe cases of bursitis that have failed more conservative measures