By Angus Graham III, MD
The shoulder is one of the most exciting joints in the body and allows us to do much more than we ever thought possible, only to be sorely missed when it’s injured. All these movements are the result of the shoulder’s unique structure — a combination of three bones, at least eight muscles and their attached tendons, and the sinew surrounding the joint called the capsule.
The most common shoulder injuries that an orthopedic surgeon deals with concerning the shoulder are problems with the rotator cuffs and osteoarthritis.
Rotator Cuff Injuries
Rotator cuff injuries can be the most painful and debilitating of the common injuries seen of the shoulder. The rotator cuff is a fascinating group of four muscles with their tendons that allow the complex movements of the shoulder. Rotator cuff tears, for the most part, are not injuries that heal on their own and often need the help of a skilled orthopedic surgeon. Once a painful and open surgery done through a large incision and requiring a night in the hospital, surgery is now frequently performed arthroscopically as an outpatient procedure. Recovery from rotator cuff surgery typically is a test of one’s patience, for the healing time for the newly repaired rotator cuff tendon to become fully functional will take 12-18 months. The recovery usually starts with a four-to-six-week period in a sling with restricted range of motion of the shoulder. At about six weeks, the cuff repair site is strong enough to initiate a six-week program of physical therapy combined with a home exercise routine that will take 20 minutes a day. However, the point when the tendon repair site becomes tough, strong and durable takes much longer as new collagen fibers continue to span the site of the old injury, creating a union that will endure the most strenuous of activities.
Degenerative osteoarthritis of most joints is more often seen in the later decades and rarely seen in persons under age 60. Arthritis is more often due to who you are (hereditary) than what you did (occupation or trauma). Pain and stiffness raise red flags signaling the possibility of arthritis. Arthritis occurs when the soft, durable articular cartilage of the joint, that layer covering the bone, wears away and the underlying rough bone ends up rubbing against the other opposing bone. Fortunately, with arthritis of the shoulder, first-line treatments such as rest, physical therapy and anti-inflammatory over-the-counter medications like ibuprofen, will often work and surgery isn’t required. If the symptoms aren’t alleviated, that’s when surgery enters the discussion. Total shoulder replacement is sometimes the best choice, and if there is also an accompanying rotator cuff tear then reverse shoulder arthroplasty needs to be considered.
Angus Graham III, MD, is an orthopedic surgeon with Brevard Orthopaedics.