Common Shoulder & Elbow Injuries and Treatments:
Frozen shoulder (Adhesive capsulitis)
Sometimes the capsule surrounding the shoulder joint can become severely inflamed and stiff, and we call this condition frozen shoulder or adhesive capsulitis. This condition most commonly occurs in individuals with endocrine diseases, such as diabetes and thyroid conditions, but can occur in anyone. Similarly, frozen shoulder may be precipitated by a specific injury, such as a rotator cuff tear, but sometimes it occurs on its own without a preceding injury.
Patients with frozen shoulder may experience severe pain and stiffness in the shoulder that makes simple activities at home and sleeping very difficult. The mainstay of treatment includes rest, therapy and, if needed, an injection.
If you have frozen shoulder and are not improving with these non-operative treatment options, there are arthroscopic surgical procedures that can help you more quickly resolve the pain and regain your function.
Rotator cuff injuries
The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint and provide both stability and strength when moving the shoulder in space. The rotator cuff tendons are frequently injured, either as a consequence of a single traumatic injury or due to wear-and-tear over time.
There is a wide spectrum of rotator cuff injuries, including tendinosis (chronic tendon degeneration), tendonitis (acute inflammation in the tendon), partial thickness tears, and full thickness tears.
Patients with rotator cuff injuries often report pain, stiffness, weakness, and difficulty sleeping.
Some injuries to the rotator cuff can respond well to non-operative measures, whereas others may require surgery to repair or reconstruct the damaged tendons.
Articular cartilage is a special type of tissue in the body that provides a cushion between two bones. In the shoulder, articular cartilage covers the humeral head (the “ball”) and the glenoid (the “socket”) to help your shoulder glide smoothly. When articular cartilage is damaged, one bone rubs directly on the other, and this causes pain, stiffness, and weakness. There are many other adaptions that the body makes in a response to the loss of articular cartilage, such as the growth of bone spurs, which can contribute to your pain.
When articular cartilage is worn throughout a joint, we call this “arthritis”. There are actually many forms of arthritis that can affect joints. The most common type of arthritis that affects the shoulder is called primary osteoarthritis, which is due to wear-and-tear of the articular cartilage over time. Other types of arthritis include rheumatoid arthritis and other inflammatory conditions, trauma, infection, and as a consequence of chronic massive rotator cuff tears.
Regardless of the specific type of arthritis affecting the shoulder, treatment options aim to decrease pain and restore function. There are many treatment options, including non-operative measures like therapy and injections, as well as surgical procedures, such as total shoulder replacement and reverse shoulder replacement.
When a shoulder injury occurs and the humeral head is forced off the glenoid, this is called a shoulder dislocation. It is akin to a golf ball falling off a golf tee. Following the immediate injury, the shoulder must be put back in place (“reduced”), typically in an emergency room or on the sidelines of a game.
For some people, this singular event is the only shoulder dislocation they experience, and they are able to regain complete function in the shoulder with rest and time. For others, however, they may develop recurrent shoulder dislocations that cause pain, damage to the articular cartilage, and and/or limit activities.
Surgery for shoulder instability, when required, addresses the specific injuries that have occurred in the shoulder. Injured tissues can include the labrum (which is a soft “bumper” that encircles the glenoid bone), the capsule and ligaments, the glenoid bone, and the humeral head bone. The nature of your surgery depends on the nature and severity of the injured tissues.
Just like in the shoulder, articular cartilage in the elbow joint can be damaged over time, resulting in the condition known as arthritis. The three most common causes of elbow arthritis are wear-and-tear osteoarthritis, inflammatory conditions such as rheumatoid arthritis, and after bad fractures of the elbow.
Patients with elbow arthritis often report constant, deep elbow pain that is worse with activities like carrying groceries. Elbow arthritis can make sleeping quite difficult. The first line of treatment for elbow arthritis is non-operative options including anti-inflammatories and therapy. Although these non-operative treatments cannot reverse the articular cartilage damage, they may provide sufficient pain relief for some patients to let them return to their desired activities.
The surgical treatment options for elbow arthritis depend entirely on the type of arthritis that is affecting your elbow. For some conditions, arthroscopic procedures provide the best outcomes. For others, an elbow replacement surgery is required. Your surgeon can discuss with you the particular treatment options that are indicated for your specific elbow ailment.
Tennis elbow (Lateral epicondylitis)
With certain repetitive activities, one of the muscles in the forearm can become inflamed and, over time, damaged. This muscle, called ECRB, starts at the outside (“lateral”) elbow and travels into the hand to help extend the wrist. Common activities that injure ECRB and therefore cause tennis elbow include typing, carrying heavy bags, and (yes) playing tennis.
Repetitive damage to the ECRB muscle can eventually cause lateral elbow pain that is called tennis elbow or lateral epicondylitis. This condition is very common and may be associated with other injuries to elbow, such as irritation to nerves and ligaments.
A similar injury may occur on the inside (“medial”) elbow. This is called golfer’s elbow or medial epicondylitis. Golfer’s elbow is much less common than tennis elbow.
There are many treatments available for tennis elbow, including activity modifications, braces, and therapy. For severe cases of tennis elbow that do not improve with these treatments, there are arthroscopic and open surgery options available. Your surgeon can discuss your specific condition with you and what treatment plan is best for your elbow.
Revisions of prior shoulder and elbow surgeries, including prior joint replacement
Despite surgeons’ and patients’ best efforts, sometimes surgeries are unsuccessful or are initially successful but then fail over time. These failures may be due to the nature of the condition and/or due to a specific complication.
When evaluating and treating patients with failed previous surgeries, it is critical to determine the specific cause of failure prior to proceeding with revision surgery. Some causes of failure include infection, implant loosening, fracture, and tissues stretching out over time.
In these complex cases, your surgeon will perform a number of tests to accurately diagnose the cause of the previous surgery’s failure. Once known, this information will guide future treatments and revision surgery, if required. In these situations, your surgeon will discuss with you the multiple treatment options available for your particular ailment.
Other Shoulder and Elbow Injuries:
Acromioclavicular (AC) joint separations and arthritis
Avascular necrosis (AVN) of the shoulder and elbow
Calcific rotator cuff tendonitis
Distal biceps tendon tears
Distal clavicle osteolysis
Elbow contractures and stiffness
Elbow instability and dislocations
Fractures of the shoulder and elbow, including the scapula (including the acromion and glenoid), clavicle, humerus, ulna, and radius bones
Glenohumeral internal rotation deficit (GIRD)
Internal impingement of the shoulder
Medial ulnar collateral ligament tears (Tommy John procedure)
Nerve compression syndromes (ulnar nerve, radial tunnel, PIN, LABCN, median)
Osteochondritis dissecans (OCD) of the elbow
Pectoralis major ruptures
Pectoralis minor tightness
Quadrilateral space syndrome
Rhomboid muscle tears
Scapular winging and dyskinesis
Shoulder labral (“SLAP”) tears
Snapping scapula syndrome
Snapping triceps syndrome
Sternoclavicular (SC) joint dislocations and arthritis
Subacromial bursitis and shoulder impingement
Triceps tendon ruptures, tendonitis, and olecranon bone spurs
Valgus extension overload of the elbow
There are several non-operative treatment options that can decrease pain and limitations due to shoulder and elbow ailments. These therapies include activity modifications, icing and heat, oral and topical medications, stretching, specific therapy regimens, injections, ultrasound treatments, and many more.
Arthroscopic surgery is minimally-invasive surgery in which small cameras and instruments are inserted into joints (“arthro-“) to view, manipulate, and treat pathologic tissues.
Some pathologies, such as fractures, diseases of the scapula, and instability of the elbow, are best treated via open surgical procedures to correct the injury. Each of these surgeries is unique, and your surgeon will discuss with you the details of both the surgery and the recovery process for your specific ailment.
Joint replacement surgery (Arthroplasty)
When the articular cartilage of a joint is severely damaged, either due to wear and tear osteoarthritis, an autoimmune disease, or another cause, often the best surgical treatment option is a joint replacement. In this procedure, the diseased bone and remaining cartilage are removed and replaced with arthroplasty implants, thereby decreasing your pain and restoring function in your injured joint.
For the shoulder, there are two common types of shoulder replacements – total shoulder arthroplasty (sometimes called “anatomic”) and reverse shoulder arthroplasty; the names refer to the geometry of the implants. Both procedures reliably decrease pain and restore function for patients with shoulder arthritis. Your surgeon will discuss with you when one form or the other is indicated for your particular shoulder ailment.