Shoulder Pain and Instability

The shoulder is the most moveable joint in the body. It is able to turn in many directions allowing us to lift our arm, rotate it and reach over our head.

However, this greater range of motion also makes the shoulder susceptible to injury. The shoulder is a complex joint which relies on the surrounding soft tissue structures for stability and strength. These structures include the four muscles of the rotator cuff, as well as the biceps tendon ligaments, and scapular muscles.

Diagnosis

Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder pain (with rest or movement) or general shoulder instability are common symptoms of strains or tears of any of these soft tissue structures. In most cases, your history of symptoms along with a thorough physical examination by an experienced sports medicine orthopedist can substantiate a diagnosis. Due to the complexity of the shoulder joint, special tests have been designed to isolate different shoulder problems. These tests which can be performed during an examination, along with an MRI and/or MRI arthrogram can confirm the diagnosis of a shoulder injury.

Treatments

Most orthopedists will recommend a conservative nonsurgical approach as the first option for shoulder pain and instability. This may include activity modification which may require making some lifestyle changes and avoiding some activities; non-steroidal anti-inflammatory medication to reduce pain and inflammation; and physical therapy to strengthen the shoulder muscles and improve shoulder control. However, nonsurgical treatment plans may often take several months before you can tell if they are working.

When Shoulder Arthroscopy Is Recommended

Your doctor may recommend shoulder arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Arthroscopy is a minimally invasive procedure that orthopedic surgeons use to inspect, diagnose and repair problems inside a joint by utilizing a thin camera and instruments. The camera and instruments are inserted into the shoulder by a series of small cuts and the shoulder anatomy is visualized on a TV monitor.

Minimally invasive procedures such as shoulder arthroscopy make the diagnosis, treatment, and recovery from surgery easier and faster than was once thought possible. Improvements to shoulder arthroscopy occur every year as new instruments and techniques are developed.

Planning for Surgery

If you are generally healthy, your arthroscopy will most likely be performed as an outpatient. This means you will not need to stay overnight at the hospital.

Most arthroscopic procedures take less than an hour. However, the length of your surgery will depend on what your surgeon finds and what repairs are required.

Rehabilitation

Shortly after surgery, the shoulder must be rehabilitated with physical therapy. This will prevent scarring as it heals and will improve the range of motion in your shoulder. Your physician's ability to prescribe the correct rehabilitation program is equally as important as making the correct diagnosis.

The goal of the rehabilitation program–restoration of function–is the same for each diagnosis but the rehabilitation program starting point is widely variable depending on the type of diagnosis (rotator cuff tear, ligament tear), the type of treatment (non-operative vs. surgical post-operative), and other associated problems (inflexibilities, strength deficits). This point reinforces the need for a complete and accurate diagnosis as a starting point for rehabilitation.

Summer 2014

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