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Shoulder & Elbow



Shoulder Replacement

Shoulder replacement is a surgery to resurface the ball and socket bones of the shoulder with artificial joint parts. It is usually done if you have severe pain the shoulder area that limits your ability to move your arm. This procedure can be performed because of osteoarthritis, rheumatoid arthritis, poor results from a previous surgery, badly broken bone in the arm near the shoulder or badly damaged tissue in the shoulder.

For total shoulder replacement, the round end of your arm bone will be replaced with an artificial stem with a round metal head and the socket of your shoulder blade will be replaced with a smooth plastic lining. Sometimes only 1 of these 2 bones needs to be replaced, which is a procedure called a partial shoulder replacement.

After surgery, you may need to stay in the hospital for 1 to 3 days. While there, may need to receive physical therapy to help keep the muscles around you shoulder from becoming stiff. Your physical therapist will teach you how to move your arm around by using your other arm to help. Your arm will need to be in a sling for 2 to 6 weeks with no active movement and 6 weeks before strengthening begins. Total recovery typically takes between 4 to 6 months.

Follow any instructions on how to care for your shoulder at home, which will include activities you should not do. You will be given instructions on shoulder exercises to do at home.

Shoulder replacement surgery relieves pain and stiffness for most people, and allows you to resume your daily activities without a problem. May people are also able to return to sports such as golf, swimming, bowling and others.




Cubital Tunnel Syndrome

Cubital tunnel syndrome is a condition in which the nerve that travels from the shoulder to the hand, called the ulnar nerve, is stretched or compressed. This causes numbness or tingling in the ring and small fingers, pain in the forearm or weakness in the hand.

Causes:

  • Pressure: Direct pressure, such as leaning on the arm or on an arm rest can compress the padding over the nerve, causing the arm to “fall asleep”
  • Stretching: Keeping the elbow bent for a long period of time can stretch the nerve behind the elbow
  • Sometimes, the ulnar nerve does not stay in place, and can snap back and forth over a bony bump as the elbow is moved. Repeated snapping can irritate the nerve, and can cause the tissue over the nerve to thicken.

Symptoms:

Wearing a splint on the wrist, and using hot or cold compresses can help control pain and inflammation. Anti-inflammatory medicine like ibuprofen or naproxen will also help greatly. Changing daily activities or habits that cause the pain is most important in the treatment and management of the pain. Using special devices that assist the arm with typing or writing, as well as altering wrist and arm posture during repetitive activities also will help. Surgery is necessary only in severe and persisting cases of median nerve pinching or pressure.

Treatment:

The goal of treatment is to allow you to use the hand and arm as much as possible. Sometimes, no treatment is needed, and you will get better on your own by avoiding leaning on the nerve. Your provider will likely suggest self-care instructions, which may include wearing a supportive splint, an elbow pad, or physical therapy exercises to help maintain muscle strength in the arm.

Surgery to relieve pressure on the nerve may be necessary if symptoms continue to get worse, or if there is proof that part of the nerve is causing muscle atrophy or wasting.


Rotator Cuff Tendinitis

The tendons of the rotator cuff pass underneath a bony area on their way to attaching the top part of the arm bone. When these tendons become inflamed, they can become frayed over this area during shoulder movements. Sometimes, a bone spur narrows the space even more.

Causes of this condition include:

  • Keeping the arm in the same position for long periods, such as doing computer work or hairstyling
  • Sleeping on the same arm each night
  • Playing sports requiring the arm to be moved overhead repeatedly such as in tennis, baseball (particularly pitching), swimming, and lifting weights overhead
  • Working with the arm overhead for many hours or days, such as in painting and carpentry
  • Poor posture over many years
  • Aging
  • Rotator cuff tears

Early on, pain is mild and occurs with overhead activities and lifting your arm to the side. Pain is more likely in the front of the shoulder and may travel to the side of the arm, always stopping before the elbow. If the pain goes down the arm to the elbow and hand, this may indicate a pinched nerve in the neck. There may also be pain when you lower the shoulder from a raised position.

Over time, there may be pain at rest or at night, such as when lying on the affected shoulder. You may have weakness and loss of motion when raising the arm above your head. Your shoulder can feel stiff with lifting or movement. It may become more difficult to place the arm behind your back.

A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions. Your doctor may evaluate your shoulder using X-ray, ultrasound or an MRI.

Treatments:

Follow your doctor's instructions on how to take care of your rotator cuff problem at home. Doing so can help relieve your symptoms so that you can return to sports or other activities.

Your doctor will likely advise you to rest your shoulder and avoid activities that cause pain. Other measures include:

  • Ice packs applied 20 minutes at a time, 3 to 4 times a day to the shoulder (protect the skin by wrapping the ice pack in a clean towel before applying)
  • Taking medicines, such as ibuprofen and naproxen, to help reduce swelling and pain
  • Avoiding or reducing activities that cause or worsen your symptoms
  • Physical therapy to stretch and strengthen the shoulder muscles
  • Medicine (corticosteroid) injected into the shoulder to reduce pain and swelling
  • In severe cases, surgery (arthroscopy) to remove inflamed tissue and part of the bone that may impinge over the rotator cuff in order to relieve pressure on the tendons

Rotator Cuff Tear

Rotator cuff tears may occur in two ways:

  • A sudden acute tear may happen when you fall on your arm while it is stretched out. Or it can occur after a sudden, jerking motion when you try to lift something heavy.
  • A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely when you have chronic tendinitis or impingement syndrome. At some point, the tendon wears down and tears.

There are two types of rotator cuff tears:

  • A partial tear occurs when a tear does not completely sever the attachments to the bone.
  • A complete, full thickness tear means that the tear goes all the way through the tendon. It may be as small as a pinpoint, or the tear may involve the entire tendon. With complete tears, the tendon has come off (detached) from where it was attached to the bone. This kind of tear does not heal on its own.

Treatment:

Rest and physical therapy may help with a partial tear if you do not normally place a lot of demand on your shoulder.

Surgery to repair the tendon may be needed if the rotator cuff has a complete tear. Surgery may also be needed if the symptoms do not get better with other treatment. Most of the time, arthroscopic surgery (minimally invasive) is sufficient to adequately perform the repair. Large tears may need open surgery (surgery with a larger incision) to repair the torn tendon.


Shoulder Instability

Shoulder instability, in which the shoulder joint is loose and slides around too much or becomes dislocated (slips out of the ball and socket joint). Physical therapy may adequately strengthen and rehab the shoulder in some cases

  • If you have a torn labrum that fails to improve with conservative care, the surgeon will repair it. The labrum is the cartilage that lines the rim of the shoulder joint.
  • The Bankart lesion is a tear on the labrum in the lower and anterior part of the shoulder joint.
  • A SLAP lesion involves the labrum and the ligament on the top part of the shoulder joint.

At the end of the surgery, the incisions will be closed with stitches and covered with a dressing (bandage). Most surgeons take pictures from the video monitor during the procedure to show you what they found and the repairs that were made.

Your surgeon may need to do open surgery if there is a lot of damage. Open surgery means you will have a large incision so that the surgeon can get directly to your bones and tissues.

Follow any discharge and self-care instructions you are given.

Recovery can take 1 to 6 months. You will probably have to wear a sling for the first week. If you had a lot of repair done, you may have to wear the sling longer. When you can return to work or play sports will depend on what your surgery involved. It can range from 1 week to several months. Physical therapy may help you regain motion and strength in your shoulder. The length of therapy will depend on what was done during your surgery.

Tennis Elbow

Lateral Epicondylitis, commonly known as tennis elbow, is pain caused by partial tears in the elbow tendon resulting from repetitive motion. The twisting of the wrist and forearm, a motion common for tennis players, are what causes the tendon damage and resulting pain.

Symptoms:

  • Weakened grip
  • Gradually worsening forearm and elbow pain

Treatments:

In most cases, avoiding activities causing the pain and placing ice on the outside of the elbow regularly will treat tennis elbow. Nonsteroidal anti-inflammatory medications and adjusting techniques or posture causing the injury are also suggested measures for managing and preventing pain. Cortisone, numbing medicine, elbow braces, and therapeutic exercises are also common recommendations for treatment. In severe or persistent cases, surgery may be needed.



Golfer's Elbow

Medial epicondylitis is soreness or pain on the inside of the lower arm near the elbow, and is commonly called golfer’s elbow. The part of the muscle that attaches to a bone is called a tendon, and some of the muscles in your forearm attach to the bone on the inside of your elbow. When you use these muscles over and over again, small tears develop in the tendons, and over time, this leads to irritation and pain where the tendon is attached to the bone. The injury can occur from using poor form or overdoing certain sports, such as golf, throwing sports such as baseball and football, racquet sports and weight training. Repeated twisting of the wrist (such as when using a screwdriver) can also lead to golfer's elbow.

Symptoms of golfer's elbow include:

  • Elbow pain that runs along the inside of your forearm to your wrist, on the same side as your pinky finger
  • Pain when flexing your wrist, palm down
  • Pain when shaking hands
  • Weak grasp
  • Numbness and tingling from your elbow up and into your pinky and ring fingers

Pain may occur gradually or suddenly. It gets worse when you grasp things or flex your wrist.

Treatments:

The first step is to rest your arm and avoid the activity that causes your symptoms for at least 2 to 3 weeks or longer, until the pain goes away. You may also want to ice the affected area, and should ask your doctor for strengthening exercises. Your provider may inject cortisone and a numbing medicine around the area where the tendon attaches to the bone which may help decrease the swelling and pain. In severe or persistent cases, surgery (either minimally invasive or open) may be needed.



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