The top of the shoulder (acromion) meets the collarbone (clavicle) at the acromioclavicular (AC) joint. Three ligaments hold the joint steady. An injury may stretch or tear these ligaments, resulting in an AC joint sprain, also called a separated shoulder. Most often, this occurs when a person tries to break a fall by holding his/her arm out, "jamming" the joint on impact. A severe sprain may cause the clavicle to dislocate (separate from the shoulder) when the torn ligaments can no longer hold the bones together. Depending on the extent of the injury, an AC joint sprain may cause mild to severe pain, tenderness, swelling, limited arm motion and visible deformity at the front of the shoulder. Many of these injuries are treated with rest and immobilization. More severe forms of this injury are treated with surgery.
Adhesive capsulitis, also known as frozen shoulder, is a chronic inflammation of the shoulder capsule that causes abnormal tissue growth around the area, significantly restricting movement. Other symptoms associated with this condition include pain and overall stiffness. The cause of the condition is unknown. Patients with a history of diabetes, history of injury to the shoulder, or connective tissue disorders are at a higher risk for having this problem.
Treatment for this condition usually begins with physical therapy and corticosteroid injections. If these treatments fail to be effective, a manipulation under anesthesia (MUA) of the shoulder may be performed. In addition, sometimes an arthroscopic surgery of the shoulder is performed to release the tight tissue from around the shoulder.
Impingement is a common shoulder condition that causes pain as a result of pressure on the rotator cuff from the undersurface of the shoulder bone, the acromion. When the arm is lifted, the acromion and its associated ligament can rub or "impinge" on the rotator cuff, causing pain and limiting movement. This condition is common in young athletes and older adults, as it is often caused by overuse and a repetitive wide range of motion. Symptoms of impingement can range from mild to severe and can include pain during activity and rest, and pain that radiates down the arm.
Shoulder impingement can be treated with oral anti-inflammatory medications, physical therapy, and corticosteroid injections. Occasionally, cases of impingement may require surgery to remove the pressure and create more space for the rotator cuff. This is done with an arthroscopic procedure where the bursa around the rotator cuff is removed, as well as a portion of the undersurface of the anterior acromion bone.
The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement of the upper arm while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury, overuse, and aging, and can lead to pain, weakness, and inflammation. Surgery may be used to treat this often serious condition. Rotator cuff surgery may be performed arthroscopically or through an open procedure, depending on the type and severity of the condition. Both procedures are performed under general anesthesia and aim to reattach the tendon back to the arm.
Rotator cuff repair surgery is usually successful in relieving shoulder pain, although full strength cannot always be restored. Recovery time depends on the type of surgery, but can take several months or longer.
Severe shoulder conditions with persistent symptoms that have not responded to conservative treatments may benefit from shoulder replacement surgery. Shoulder replacement surgery replaces the damaged joint with an artificial one that allows patients to decrease their shoulder pain symptoms and increase the amount of activities they can do with their shoulder.
Shoulder replacement surgery is often performed to treat conditions such as:
Patients with these conditions often experience pain, limited range of motion, stiffness, swelling, and more. These symptoms can be effectively relieved by replacing the damaged bone and cartilage with a metal and plastic implant.
Shoulder replacement surgery takes about two to three hours and is usually done under general anesthesia. Patients will be required to stay in the hospital for one to two days and will need physical therapy in order to restore function to the joint after surgery. Most patients are able to return to all of their regular activities after three to four months.