Depending on the nature of the problem, non-surgical methods of treatment often are recommended before surgery. However, in some instances, delaying the surgical repair of a shoulder can increase the likelihood that the problem will be more difficult to treat later. Early, correct diagnosis and treatment of shoulder problems can make a significant difference in the long run.
1. The shoulder is a ball-and-socket joint. It is made up of three bones: the upper arm bone (humerus), shoulder blade (scapula) and the collarbone (clavicle).
2. The ball at the top end of the arm bone fits into the small socket (glenoid) of the shoulder blade to form the shoulder joint (glenohumeral joint).
3. The socket of the glenoid is surrounded by a soft-tissue rim (labrum).
4. A smooth, durable surface (articular cartilage) on the head of the arm bone, and a thin inner lining (synovium) of the joint allows the smooth motion of the shoulder joint.
5. The upper part of the shoulder blade (acromion) projects over the shoulder joint. One end of the collarbone is joined with the shoulder blade by the acromioclavicular (AC) joint. The other end of the collarbone is joined with the breastbone (sternum) by the sternoclavicular joint.
6. The joint capsule is a thin sheet of fibers that surrounds the shoulder joint. The capsule allows a wide range of motion, yet provides stability.
7. The rotator cuff is a group of muscles and tendons that attach your upper arm to your shoulder blade. The rotator cuff covers the shoulder joint and joint capsule.
8. The muscles attached to the rotator cuff enable you to lift your arm, reach overhead, and take part in activities such as throwing or swimming.
9. A sac-like membrane (bursa) between the rotator cuff and the shoulder blade cushions and helps lubricate the motion between these two structures.
Treatment should begin with the most basic steps and progress to the more invasive, possibly including surgery. Not all treatments are appropriate for every patient, and you should have a discussion with your doctor to determine which treatments are appropriate for your particular situation. Following are the range of options.
The conservative nonsurgical treatment is a 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.
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.
Both techniques require extensive rehabilitation to restore the function of the shoulder.
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 occur repeatedly.
Patients with repeat dislocation usually require surgery. Open surgical repair may require a short stay in the hospital. Arthroscopic surgical repair is often done on an outpatient basis. Following either procedure, extensive rehabilitation, often including physical therapy, is necessary for healing.
The conservative nonsurgical treatment is a 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.
