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 Inflammation of the rotator cuff muscles. The rotator cuff is 4 muscles on top of the shoulder which serve to rotate the arm in and out, plus pull down on the top of the arm bone (humerus) to stabilize it when lifting overhead. Tendenitis  develops
as a result of overuse of the arm, especially when working overhead, painting
ceilings, washing windows etc. In older people it can result from wear
and tear from rubbing against a bone spur on the bone just above the rotator
cuff, the acromion bone. Pain is the main symptom. Weakness results from
the pain. |
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 Inflammation of the bursa in the shoulder.  The
bursa is a small lubrication sac lying between the rotator cuff and the
acromion bone. It becomes inflamed due to over-use or rubbing against the
acromion. Pain is the main symptom. |
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  Tendenitis and
bursitis result from rubbing the rotator cuff muscles against the acromion.
This is called the impingement syndrome and can be just inflammation in
the early stages or the muscles may begin to breakdown as the problem progresses.
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 Treatment  for rotator
cuff tendenitis, bursitis and impingement syndrome is rest, careful strengthening
exercises with the arm below the shoulder level, anti-inflammatory medications,
cortisone shots or surgery. |
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  The
"cortisone" we use for injections into joints and tendons is
a synthetic anti-inflammatory material which decreases the inflammation,
pain and swelling. By relieving the pain the patient can then better work
on his exercises to strengthen the rotator cuff and often gets complete
relief of his problem. The injected material may affect a patient's blood
sugar if he (she) is a diabetic. We are careful how many shots we give
into a joint because too many may damage the tissues. |
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 When the rotator cuff does not respond to "conservative" treatment, we do shoulder surgery to remove a portion of the acromion bone. There is often a spur pressing downward against  which
the rotator cuff rubs. This can be shaved off and relieve the pain. We
remove the bursa at the same time. Surgery is as an outpatient and recovery
is rapid. Exercises are important and can usually be done by the patient
with help from a Physical Therapist. |
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  The rotator cuff muscles are
usually torn in younger patients due to a single violent episode of applying
too much force to the muscles, such as lifting too heavy an object or falling
on the arm. In older patients a rotator cuff tear may result from too much
heavy lifting or may result from the muscles rubbing against the overlying
acromion. The main symptoms are weakness and pain. Diagnosis may require
a Magnetic Scan (MRI), or an Arthrogram (injecting dye in to the shoulder
before x-rays). |
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 Treatment is surgery to repair the cuff. We usually do this as an outpatient. Some cuff tears are so large or so old that they can not be repaired. Rehabilitation is long and requires a lot of work by the patient. Often one needs to use a Physical Therapist. |
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 (Unstable Shoulder) Shoulders may slip out of place due to trauma  (football,
falls, jerking episodes) or, if one has very loose ligaments, just from
getting the arm into a "wrong" position. Ninety-five percent
of dislocations are anterior (frontward). Sometimes the shoulder will just
come part-way out, called a subluxation. Subluxations will usually slip
back into place by themselves, but true dislocations usually need to be
pulled back into place by someone else, a friend or a trained medical person.
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 When a shoulder joint's surface becomes too badly damaged by arthritis or trauma, we have to replace  the
joint with artificial joint made of metal (stainless steel or a special
chrome/molybdenum alloy) and plastic (ultra-high molecular weight polyethylene).
Prosthetic replacement is occasionally used for fractures also. The results
of shoulder replacement are very good and should last for many years. |
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 After the first 1 or 2 episodes of dislocation, we usually treat the shoulder with rest, a sling and then exercises to strengthen the muscles. However because there are ligaments torn, often the shoulder continues to slip out of place. If this occurs frequently it begins to interfere with the patients life, and may even lead to arthritis if let go too long. We feel that an unstable shoulder needs to be surgically repaired. For more information, please contact:  HAQ ORTHOPAEDIC HOSPITAL 18 Sanda Road, Lahore Pakistan. Phone:92-42-7312860 to 2 Email: info@haq-ortho.com |
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