Shoulder Care

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Think about the range of motion permitted by the shoulder joint. The fact that the shoulder is the most movable and flexible joint in the body also means it is one of the most fragile. Many chronic shoulder problems can be traced to over-use motions – typically repeated overhead movements that are common in certain occupations.

Weekend athletes and do-it-yourself-ers can also be affected by the routine motions required to golf, play tennis, swim, lift weights or work on common construction projects. The most likely causes of shoulder pain include tendonitis, bursitis and an inflamed rotator cuff.

Rotator Cuff
The rotator cuff is a group of flat tendons that together wrap around the front, back and top of the shoulder. These tendons attach muscles that originate on the shoulder blade or scapula, and allow the shoulder its wide range of motions. The passages the tendons travel through can be quite narrow in some people, and repetitive motions can cause the surrounding structures to become irritated and inflamed. An irritated rotator cuff can sometimes cause a feeling of clicking or popping as a ragged piece of the cuff slides under the shoulder bone.

Tendonitis
When a tendon is constantly irritated, by repeated rubbing against the shoulder bone for example, it can become inflamed and swollen, leaving even less space between the tendons and the bone. Picture a rope being repeatedly pulled along a craggy rock. This inflammation of a tendon is called tendonitis.

Bursitis
A bursa is a fluid-filled structure that acts as a shock-absorber or cushion in many of the joints in the body. In the shoulder, they cushion the rotator cuff from the shoulder bone. If the rotator cuff becomes inflamed, it can irritate the bursa, causing the bursa to produce more fluid, pressure, and pain.

Arthritis
Arthritis is less common in the shoulder than in the knee or hip, but it does occur. The cartilage surfaces on the bones can wear away over time, or become damaged from an injury or infection. The arthritis can cause a roughening of the joint surfaces, resulting in pain and stiffness.

Several treatment options that may be effective for shoulder pain include:

• Cold and heat therapy
• Rest
• Anti-inflammatory medications
• Physical therapy
• Shoulder surgery

Shoulder surgery may be recommended for some shoulder problems including arthritis, shoulder instability, or a torn rotator cuff. Thanks to recent advances in techniques and technology, many shoulder surgeries can be done arthroscopically. This allows the surgeon to see and work inside the joint through a few small incisions, and is most often an outpatient procedure.

In some cases, such as with advanced arthritis of the shoulder, a shoulder replacement may be recommended. Shoulder replacement involves resurfacing the areas of the bones that meet in the shoulder joint. The ball-shaped end of the upper arm or humerus is replaced with a metal component, while the socket shaped glenoid cavity of the shoulder blade is relined with special plastic.

Shoulder replacement can often offer improved strength and range of motion, as well as reduced pain. With any surgery there are risks and these need to be fully discussed with your doctor. Shoulder replacement is usually performed at a hospital using general anesthesia, though regional anesthesia may be an option for some patients. Your doctor and anesthesiologist will discuss which option is best for you.