Shoulder
Clavicle (collarbone) Fracture
Description
The clavicle is the bone situated between the ribcage and the shoulder blade and connects the arm to the body. It is a long bone and generally most breaks occur in the middle of it, usually caused by a direct blow to the shoulder.
Symptoms
Clavicle fractures can be very painful and result in the following symptoms; an inability to lift the arm due to pain, a grinding sensation when trying to raise the arm, a deformity over the break as well as bruising, swelling and tenderness.
Treatment
To determine the severity of the break, an X-ray of the shoulder is done, and in some circumstances a CT scan to see the fracture in better detail if other bones are also broken.
Non-surgical: If the broken ends of the bone have not shifted out of place and line up correctly surgery may not be required. A simple sling for comfort and support may be applied as well as some pain medication. Physiotherapy can assist in limiting any muscle strength loss and is generally commenced as the bone begins to heal to prevent stiffness and weakness and are upgraded as the fracture heals. Regular X-rays to ensure healing and alignment of the fracture are undertaken also.
Surgical: If the bones are out of place surgery may be recommended to align the bones and hold them in a good position until they heal. During this surgery, the bone fragments are realigned into the correct position and then held in place with special screws and/or metal plate. After surgery, as there is not a lot of fat over the clavicle you may be able to feel the plate through the skin. Generally the metal work is not removed, however after the fracture has healed, should the metal/screws become irritating it can be removed. Following surgery physiotherapy is used to help restore movement and strengthen the shoulder.
Recovery
Whether surgical or non-surgical treatment is undertaken, it can take several months for a clavicle fracture to heal. Most people return to regular activities within three months of their injury however this will be determined by your doctor as to when it is safe to do so.
Dislocated Shoulder
Description
The shoulder joint is the most mobile joint of the body, which can also make it easy to dislocate. Subluxation of the shoulder is a partial dislocation where the head of the upper arm bone (humerus) is partially out of the socket. A complete dislocation is when it is all the way out of the socket, however both can cause pain and instability in the shoulder.
Symptoms
Common signs to looks out for include; swelling, numbness, weakness and bruising.
Treatment
A closed reduction, where the doctor places the ball of the upper arm bone back into the socket is performed which almost immediately stops the severe pain.
Recovery
Immobilisation in a sling for several weeks as well as rest and ice are usual protocols for dislocated shoulder. Once the swelling has settled, physiotherapy exercises will be prescribed to help restore range of motion and strength and also to assist in preventing further dislocations.
Shoulder Impingement/Bursitis
Description
The rotator cuff is a common source of shoulder pain and can be the result of:
- Tendinitis which is when the cuff tendons become irritated or damaged
- Bursitis where the bursa becomes inflamed
- Impingement when the space between the acromion and rotator cuff narrows, which can result in acromion impinging (rubbing) on the tendon and bursa
Symptoms
Pain generally is associated with this condition, along with some swelling and tenderness in the front of the shoulder, with associated stiffness when lifting the arm. In the beginning, symptoms may only be mild however as the problem progresses these increase and can cause pain at night; a loss of strength and range of motion as well as difficulties in doing certain activities that place arm behind back.
Treatment
Non-surgical treatment is usually the first line of treatment and can take several weeks to months with gradual improvement and return to full function. Non-surgical modalities include; rest, anti-inflammatory medication, physiotherapy and steroid injections.
If non-surgical measures do not improve function, surgery may be offered, with the aim of surgery being to create more space for the rotator cuff. This surgery can be performed using either an arthroscopic or open technique. Following any surgery, a rehabilitation program will be provided to regain range of motion and strength in the shoulder and arm.
Recovery
It can take typically two to four months for relief of pain post surgery, but may take up to a year for full recovery.
Biceps Tendon Tear at the Shoulder
Description
The biceps muscle is in the front of your arm and assists in bending and rotating the arm as well as stabilising the shoulder. Biceps tendon tears can be partial (tendon is not completely severed) or complete (tendon is split in two).
Symptoms
Common symptoms include; sharp, sudden pain in the upper arm, sometimes an audible pop, bruising of the middle of the upper arm, pain or tenderness at the shoulder and elbow, weakness in both the shoulder and elbow and sometimes a bulge in the upper arm (“Popeye” deformity) may appear.
Treatment
For a lot of patients, pain from a long head of biceps tendon tear can resolve with time and if no other critical structures have been damaged (e.g. rotator cuff) non-surgical treatment is often recommended. These treatment measures include; rest, ice, anti-inflammatory medication, physiotherapy to help strengthen the shoulder.
Surgical treatment in these injuries is not often required, however those who require complete recovery of strength (for example athletes, builders) surgery may be the appropriate treatment option. The goal of this surgery is to re-anchor the torn tendon back to the bone. Following any surgery, a rehabilitation program will be prescribed to assist in a return to full strength and function.
Recovery
It can take typically two to four months for complete relief of pain, but may take up to a year for full strength and function to be restored.
Rotator Cuff Tear
Description
A torn rotator cuff tendon weakens the shoulder and makes many daily activities painful and difficult to do. When one or more of the rotator cuff tendons are torn, the tendon no longer is fully attached to the head of the humerus. There are different types of tears, a partial thickness tear (tear damages the soft tissue but does not completely tear it) or a full thickness tear or complete tear (basically means a hole in the tendon).
Rotator cuff tears can be considered acute (due to an injury/event) or degenerative (wearing down of the tendon slowly over time).
Symptoms
Most common symptoms include; pain at rest and at night, pain when lifting or lowering the arm, weakness and a cracking sensation when moving the shoulder in certain positions.
Treatment
A rotator cuff tear can increase in size over time so early treatment can prevent symptoms from getting worse and assist in getting back to normal activities much quicker.
Non-surgical treatment can relieve pain and improve function in the shoulder, however strength does not usually improve without surgery. This line of treatment can include; rest, activity modification, anti-inflammatory medication, physiotherapy and steroid injections.
Surgical treatment may be recommended if pain does not improve with non-surgical measures, and also in patients who are very active. Surgery may be indicated in the following circumstances; symptoms lasted six to twelve months; significant weakness in the shoulder; tear caused by recent acute injury. The main aim of surgery is to re-attach the tendon to the head of the humerus. A rehabilitation program is essential in regaining shoulder strength and range of motion.
Recovery
A complete recovery from rotator cuff surgery takes several months, with most patients having a functional range of motion and adequate strength by full recovery.
Labral Tear
Description
The shoulder is considered a ball and socket type joint, with the socket of the shoulder surrounded by a ring of soft tissue called the labrum. The labrum serves to deepen the cavity of the socket and helps keep the upper arm bone in place.
The labrum can tear as a result of trauma or with wear and tear.
Symptoms
Similar to other shoulder injuries symptoms of a labral tear can include; pain, catching, locking, occasional night pain, a sense of instability, decreased range of motion and a loss of strength.
Treatment
Non-surgical treatment for this condition generally involves rest and an anti-inflammatory medication along with rehabilitation exercises to assist in strengthening the rotator cuff muscles.
In most cases surgical repair of the torn labrum is required, followed by a rehabilitation program to improve range of motion and strength.
Recovery
Following surgery and physiotherapy it can take three to four months to fully heal, with strength and functional improvements expected up to one year post-operatively.
Arthritis of the Shoulder
Description
Arthritis simply defined refers to inflammation of one or more of your joints. An arthritic shoulder causes the patient pain and stiffness. There are two joints in the shoulder which may be affected by arthritis; one where the clavicle meets the tip of the shoulder blade (the AC joint) the other where the upper arm bone fits into the shoulder blade (known as the glenohumeral joint).
As well as determining which joint is affected, there are also five major types of arthritis that can affect the shoulder. These include;
- Osteoarthritis: Known as ‘wear and tear’ arthritis and protective space between bones decreases
- Rheumatoid arthritis: Chronic disease which affects multiple joints throughout body and is an autoimmune disease
- Post traumatic arthritis: Develops after an injury such as a fracture
- Rotator cuff tear arthropathy: Develops after a large, longstanding rotator cuff tendon tear
- Avascular necrosis: occurs when blood supply to head of the humerus becomes disrupted.
Symptoms
Pain is the most common symptom of arthritis in the shoulder and is generally aggravated by activity and gets progressively worse over time. In addition, a limited range of motion is another common symptom and it can become difficult to lift your arm and may also experience a grinding sound as you move your shoulder.
Treatment
Initial treatment generally begins with non-surgical measures and may include; rest, physiotherapy, anti-inflammatory medication and corticosteroid injections.
Following a course of non-surgical treatment, if pain has not been relieved surgical options may be offered. These options can vary from an arthroscopy which helps clean out the inside of the joint to provide pain relief (however does not eliminate the arthritis from the joint) through to shoulder joint replacement surgery in which the damaged parts of the shoulder are removed and replaced with artificial components.
Recovery
Surgical treatment of arthritis in the shoulder can be very effective in reducing pain and assisting in increasing range of motion, with recovery time and rehabilitation programs dependent upon the type of surgery performed.
Frozen Shoulder
Description
Frozen shoulder (also known as adhesive capsulitis) causes pain and stiffness in the shoulder and over time the shoulder becomes very hard to move. This condition is caused by the shoulder capsule becoming thickened and tight causing adhesions to develop and usually less synovial fluid which helps lubricate the shoulder.
Symptoms
The pain associated with frozen shoulder is usually dull and aching and generally worse early in the course of the disease and when attempting to move the arm.
Treatment
This condition typically gets better over time, although it does take a protracted course and may take 12 to 18 months. The focus of any treatment is to assist with controlling pain and improving range of motion and strength. Treatment measures prescribed include; anti-inflammatory medication, steroid injections and physiotherapy.
In some cases should non-surgical treatment measures fail to improve the condition, surgery may be considered with the goal of trying to stretch and release the stiffened joint capsule.
Recovery
This condition runs a prolonged course and may take up to three years to resolve. Physiotherapy is the most important factor in helping to return to all activities.
Chronic Shoulder Instability
Description
Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket which can result from a sudden injury or overuse. Once a shoulder has dislocated, it can be susceptible to repeat episodes. Once the ligaments, tendons and muscles around the shoulder become loose or torn, dislocations can recur. Chronic instability refers to when the tissues of the shoulder can no longer keep the arm in the shoulder socket.
Symptoms
Common symptoms experienced can include pain, repeated dislocations or the shoulder feeling loose and slipping out of the joint.
Treatment
Treatment again can be either non-surgical or surgical. Non-surgical treatment can include activity modification, anti-inflammatory medication and physiotherapy. Often however it is necessary for surgery to repair the torn or stretched ligaments.
Recovery
Following surgery and physiotherapy it can take three to four months to fully heal, with strength and functional improvements expected up to one year post-operatively.
Biceps Tendinitis (at the Shoulder)
Description
Biceps tendinitis can be described as inflammation or irritation of the biceps tendon at the shoulder. Otherwise known as the long head of the biceps tendon, this structure attached the biceps muscle to the bones in the shoulder. As tendinitis progresses, the covering of the tendon (tendon sheath) can thicken causing further irritation and inflammation. This condition usually occurs in conjunction with other shoulder conditions including; arthritis, tears of the labrum, shoulder impingement and others.
Symptoms
Pain in the front of the shoulder, along with weakness are common symptoms of biceps tendonitis. This discomfort often worsens with overhead activity and lifting.
Treatment
Non-Surgical: Initially treatment usually consists of simple measures including rest, anti-inflammatory medication, steroid injections along with physiotherapy to assist in restoring range of motion and strengthening the shoulder.
Surgical: Should non-surgical treatment not relieve the symptoms, surgery may be considered, especially if other shoulder problems are also present.
Recovery
Following surgery, a rehabilitation plan will be prescribed to restore range of motion and strength in the shoulder. Certain activities may need to be avoided following surgery to allow the repaired tendon to heal, however most patients have very good results and are able to achieve full range of motion and move the arm without pain. Through following an intensive rehabilitation program, improvements can be made out to 9 months following surgery.