Definition

The rotator cuff is a group of tendons and related muscles that stabilize the shoulder joint. The shoulder is a ball-and-socket joint consisting of three main bones: the humerus (upper arm bone), the clavicle (the collarbone), and the scapula (the shoulder blade). Muscles, tendons, ligaments and the joint capsule hold the bones together. The rotator cuff helps keep the arm bone in the socket of the shoulder blade, and allows you to raise and rotate your arm.

 

Symptoms and Causes of a Rotator Cuff Disorder

You may experience pain, weakness or stiffness in your shoulder, most often on the front and side of the shoulder and upper arm. You may have increased pain during the night and have trouble sleeping on the affected side.

Rotator cuff disorders can be caused by:

• normal wear and tear
• natural aging and degeneration of the tendon
• overuse from repetitive activities using overhead motions
  such as tennis or swimming
• irregularly shaped shoulder bones
• calcium buildup in the tendons (calcific tendonitis)
• extreme forceful injury or a nearly broken bone

A rotator cuff disorder may begin with abrasion, bleeding and swelling and lead to inflammation and damage. Over time, the healthy tendon tissue is replaced by scar tissue and the tendons become stiff, stringy and more fragile.

 

Treatment

An evaluation by your primary care physician or orthopedic surgeon is necessary to discuss your pain and observe your joint motion. If needed, an X-ray, ultrasound or MRI may be performed to determine the size of the tear and amount of tendon damage.

Most rotator cuff injuries can be treated without surgery. Rest, ice or heat, NSAIDs (non-steroidal anti-inflammatories such as Advil or Motrin) and/or physical therapy often relieve or remedy the injury. In some cases, a physician may give cortisone injections to alleviate pain.

If surgery is recommended, partial tears can usually be repaired using minimally invasive techniques such as arthroscopy (procedure allowing the doctor to view and repair an injury through a thin viewing instrument called an arthroscope).

 

Definition

A shoulder separation is the partial or complete separation of two parts of the shoulder: the collarbone (clavicle) and the shoulder blade (acromion). The collarbone and shoulder blade are connected by a joint (the acromioclavicular joint), which is held together by ligaments (the acromioclavicular, or AC, and the coracoclavicular, or CC). In a shoulder separation, one or both of these ligaments is partially or completely torn.

 

Symptoms and Causes of a Shoulder Separation

This injury is most often caused from a blow to a shoulder or a fall onto the shoulder or outstretched hand or arm.

Symptoms may include:

• pain at the moment of injury
• limited movement in the shoulder
• swelling and bruising
• tenderness over the AC joint
• possible deformity (bump on top of the shoulder, or collarbone looking out of place)

 

Treatment

A physical examination and an X-ray will indicate if you have a shoulder separation. The physician will look for a deformity or bump, damage to nerves or blood vessels, and will assess your range of motion, muscle strength, and blood flow.

Treatment of a shoulder separation depends on its severity. Minor injuries may only require you to support your shoulder with a sling until the discomfort subsides (usually a few days to a week). Physical therapy is important to regain strength and range of motion, and to prevent frozen shoulder (adhesive capsulitis), a condition that limits shoulder motion. More severe injuries may require surgery.

 

Definition

Shoulder replacement is a surgical procedure in which the ends of the damaged upper arm bone (humerus) and usually the shoulder bone (scapula) are replaced or capped with artificial surfaces lined with plastic, metal or a combination of both. Shoulder replacement may be partial or total.

 

Why It’s Done

When shoulder pain becomes severe enough that there is a loss of shoulder function, and medications and other treatments no longer alleviate pain, your physician may recommend shoulder replacement surgery. This surgery is intended to allow a person to do ordinary daily activities with less pain, and is not intended to restore the same level of function that person had before the surgery. Therefore, it is not recommended for people who do activities such as competitive tennis, painting ceilings, etc. that would continually stress the shoulder joint.

 

Treatment and Rehabilitation

The top end of your upper arm bone is shaped like a ball, with muscles and ligaments holding this ball against a cup-shaped part of your shoulder bone. Your physician will replace the top of the upper arm bone with a long metal piece with a rounded head. If the cup-shaped part of your shoulder bone is also damaged, the doctor will smooth it, then cap it with a plastic or combination plastic/metal piece.

A new procedure for patients with painful arthritis in their shoulder as well as damage to shoulder muscles is called a reverse total shoulder replacement. In this procedure, the doctor removes the damaged bone, smoothes the ends, and attaches a rounded joint piece to the shoulder bone while using the cup-shaped piece to replace the top of the upper arm bone.

Most joint replacement surgeries are done using regional anesthesia, meaning the area of the surgery is numb and you are in a drowsy, relaxed state. You may be required to take antibiotics before and after surgery to reduce the risk of infection.

Though you are not allowed to use the shoulder muscles for several weeks after surgery, gentle rehabilitation begins immediately. Most people eventually regain about two-thirds of normal shoulder motion after surgery, but that is dependent on the damage. A typical rehabilitation schedule consists of 6 weeks of very limited activity, followed by exercises and stretching starting 6 weeks after surgery and lasting until about three months after surgery. More intensive strength training begins three months after surgery.

 

Definition

Radial tunnel syndrome, also called posterior interosseous nerve syndrome, is a condition that affects the elbow, wrist and hand. The radial nerve starts at the side of the neck, where the individual nerve roots leave the spine. The nerve roots join to form three main nerves that travel down the arm to the hand. One of these is the radial nerve, which crosses the outside of the elbow and winds down the forearm and hand. In radial tunnel syndrome, the radial nerve is squeezed, narrowed or flattened, causing pain.

 

Causes and Symptoms

Symptoms are similar to tennis elbow. You may feel pain or tenderness on the outside of the elbow. The pain may worsen when you bend your wrist backwards or turn your palm upwards. Repetitive or forceful pushing or pulling motions, bending of the wrist, gripping or pinching can stretch and irritate the radial nerve. Constant twisting movements, common in assembly work, can also be a cause. In some cases, a direct blow to the outside of the elbow can injure the radial nerve.

 

Diagnosis

Diagnosis of radial tunnel syndrome can be difficult, since symptoms are so similar to tennis elbow. Your physician will take a detailed medical history and perform a physical exam to find the exact location of the pain. Pinpointing these factors is key in differentiating between tennis elbow and radial tunnel syndrome.

 

Treatment

Treatment includes resting the affected limb and avoiding activity that involves repetitive activities or that require your wrist to bend backwards or twist. You may wear a splint at night to restrict movement and ease pain. Your physician may recommend working with a physical therapist who will show you how to perform activities without putting extra strain on your elbow. You may also be given stretching exercises, and anti-inflammatory medications may be prescribed. If symptoms persist, surgery may be necessary, but it can usually be performed on an outpatient basis.

 

Definition

Tennis elbow (lateral epicondylitis) is a form of tendonitis caused by overuse of the arm and forearm muscles, resulting in soreness or pain on the outer (lateral) part of the elbow. Contrary to its name, you do not have to be a tennis player to suffer from this problem. Tennis elbow occurs when the tendons at the elbow where some of the forearm and hand muscles connect to the outside bony area (epicondyle) are torn or damaged. Tennis elbow usually occurs in the dominant arm (i.e. your right arm, if you are right-handed).

Golfer’s elbow (medial epicondylitis) is also caused by overuse of the forearm muscles, but the pain and tenderness is felt on the inside (medial) of the elbow, around the joint’s bony prominence.

 

Symptoms

Both tennis elbow and golfer’s elbow may begin as a dull aching or soreness; in tennis elbow it will be felt on the outer part of the elbow, in golfer’s elbow it will be felt on the inside part of the elbow. This discomfort may initially go away within 24 hours of activity. As the condition progresses, the pain may take longer to go away and may hamper everyday movements such as lifting a coffee cup, twisting a jar lid or shaking hands. The pain may spread to your hand, arm, shoulder or neck.

 

Diagnosis

Through a physical exam, your physician will evaluate the history of your elbow problems, your daily activities and past injuries. An X-ray, MRI or bone scan may be necessary if the condition persists to check for any bone problems or tissue damage.

 

Treatment

Resting of the arm is usually the best treatment for tennis elbow. In some cases, you may apply ice to the affected area. You may take pain relief medications as directed by your physician, or he may prescribe a cortisone injection. You may wear a forearm brace or a sling for a few days. Once the pain has subsided, rehabilitative exercises can strengthen your arm and improve your flexibility. In the future, you should perform warm up exercises with the arm before starting any activity, and massage it to relieve stress and tension.

 

Definition

Trigger finger is a painful condition that causes the fingers or thumb to catch or lock in a bent position. Often trigger finger is caused by inflammation of tendons located within a protective covering called the tendon sheath.

 

Causes and Symptoms

A tendon usually glides through the tissue that covers it, called the tendon sheath. When a tendon becomes inflamed or swollen, the action of bending the finger or thumb may pull the inflamed tendon through the sheath, making it snap or pop. Repetitive or forceful use of the finger and thumb can cause trigger finger. Medical conditions such as rheumatoid arthritis, gout or diabetes may also contribute to the condition’s onset. Prolonged grasping may aggravate symptoms.

Soreness at the base of the finger or thumb is an initial symptom of trigger finger. A painful clicking or snapping sound is common when attempting to flex or extend the affected finger. In some cases, the finger or thumb may lock in a flexed or extended position, and joint contraction or stiffening may occur.

 

Diagnosis

Trigger finger is usually diagnosed through a physical examination of the hand and fingers. No X-rays or lab tests are usually performed.

 

Treatment

Limiting the activity that aggravated the condition is usually the best recourse. Sometimes your physician may splint the hand to restrict movement. If the symptoms persist, anti-inflammatory medications may be prescribed, or steroid injections into the tendon sheath may be recommended. If these treatments are unsuccessful, surgery may be performed to release the tendon sheath and restore movement.

 

Definition

Three nerves in the arm control the sensation and motor function to the upper extremity: the median, the radial and the ulnar nerves. Carpal tunnel involves the median nerve that controls sensation to the thumb, index, long fingers and half of the ring finger. The carpal tunnel is a small space or “tunnel” in the wrist formed by the wrist bones (carpal bones) and a ligament (transverse carpal ligament). Carpal tunnel syndrome is caused by activities that put pressure on the median nerve and decrease blood supply. People most affected by carpal tunnel syndrome are those whose jobs require repetitive hand movements (such as data processors, computer programmers and assembly-line workers) and pregnant women, due to the swelling and fluid retention common during pregnancy.

 

Symptoms

Tingling, numbness, weakness or pain in the fingers are all common symptoms of carpal tunnel syndrome. They most often occur in the parts of the hand supplied by the median nerve: the thumb, index finger, middle finger and half of the ring finger. One notable sign of carpal tunnel syndrome is that the little finger usually is not affected because it is controlled by a different nerve than the thumb and other fingers.

 

Diagnosis

A physician will evaluate your medical history and perform a physical exam. He or she may ask about any health conditions you have, recent accidents or injuries, and daily activities. Tests may be recommended, including blood tests (to see if any other health conditions could be contributing to your symptoms), nerve testing and X-rays to evaluate the size and shape of the carpal tunnel.

 

Treatment

Mild carpal tunnel syndrome is often treated simply by changing the way you do things, including doing the activity less often, taking a rest between repetitions, or changing the position in which you do the activity. Stretching and strengthening your hand and arm will help, and you may want to wear a wrist brace to wear at night. Surgery is an option, but is usually reserved for cases that are not alleviated by the above treatments. Surgery involves cutting the ligament that forms the roof of the carpal tunnel, making more room in the tunnel and relieving the pressure on the median nerves.