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Shoulder Injuries

The mobility of the shoulder makes it prone to injury. The shoulder joint is used in pushing, pulling, reaching and swinging our arms. Even simple tasks like getting dressed in the morning involves use of the shoulder. Because it is used so much and is so complex, problems with the shoulder can occur over time or due to a sudden injury. Fortunately, your orthopaedic surgeon can provide relief from the symptoms caused by such injuries. When these vulnerable joints are injured, our lifestyle suffers. From the repair of rotator cuff injuries, to total shoulder replacement surgery, to elbow reconstruction, HAQ Orthopaedic offer thorough knowledge and experience to restore your shoulder and elbow function.

Rotator Cuff Tendonitis:

Inflammation of the rotator cuff muscles. The rotator cuff is 4 muscles on top of the shoulder which serve to rotate the arm in and out, plus pull down on the top of the arm bone (humerus) to stabilize it when lifting overhead. Tendonitis develops as a result of overuse of the arm, especially when working overhead, painting ceilings, washing windows etc. In older people it can result from wear and tear from rubbing against a bone spur on the bone just above the rotator cuff, the acromion bone. Pain is the main symptom. Weakness results from the pain.

Shoulder Bursitis:

Inflammation of the bursa in the shoulder. The bursa is a small lubrication sac lying between the rotator cuff and the acromion bone. It becomes inflamed due to over-use or rubbing against the acromion. Pain is the main symptom.

Impingement Syndrome:

Tendenitis and bursitis result from rubbing the rotator cuff muscles against the acromion. This is called the impingement syndrome and can be just inflammation in the early stages or the muscles may begin to breakdown as the problem progresses.

Treatment for rotator cuff tendenitis, bursitis and impingement syndrome is rest, careful strengthening exercises with the arm below the shoulder level, anti-inflammatory medications, cortisone shots or surgery.

Cortisone Shots:

The “cortisone” we use for injections into joints and tendons is a synthetic anti-inflammatory material which decreases the inflammation, pain and swelling. By relieving the pain the patient can then better work on his exercises to strengthen the rotator cuff and often gets complete relief of his problem. The injected material may affect a patient’s blood sugar if he (she) is a diabetic. We are careful how many shots we give into a joint because too many may damage the tissues.


When the rotator cuff does not respond to “conservative” treatment, we do shoulder surgery to remove a portion of the acromion bone. There is often a spur pressing downward against which the rotator cuff rubs. This can be shaved off and relieve the pain. We remove the bursa at the same time. Surgery is as an outpatient and recovery is rapid. Exercises are important and can usually be done by the patient with help from a Physical Therapist.

Torn Rotator Cuff:

The rotator cuff muscles are usually torn in younger patients due to a single violent episode of applying too much force to the muscles, such as lifting too heavy an object or falling on the arm. In older patients a rotator cuff tear may result from too much heavy lifting or may result from the muscles rubbing against the overlying acromion. The main symptoms are weakness and pain. Diagnosis may require a Magnetic Scan (MRI), or an Arthrogram (injecting dye in to the shoulder before x-rays).

Treatment for Rotator Cuff Tears:
Treatment is surgery to repair the cuff. We usually do this as an outpatient. Some cuff tears are so large or so old that they can not be repaired. Rehabilitation is long and requires a lot of work by the patient. Often one needs to use a Physical Therapist. 

Dislocating Shoulder:

(Unstable Shoulder) Shoulders may slip out of place due to trauma (football, falls, jerking episodes) or, if one has very loose ligaments, just from getting the arm into a “wrong” position. Ninety-five percent of dislocations are anterior (frontward). Sometimes the shoulder will just come part-way out, called a subluxation. Subluxations will usually slip back into place by themselves, but true dislocations usually need to be pulled back into place by someone else, a friend or a trained medical person.

Artificial Shoulder Joint:

When a shoulder joint’s surface becomes too badly damaged by arthritis or trauma, we have to replace the joint with artificial joint made of metal (stainless steel or a special chrome/molybdenum alloy) and plastic (ultra-high molecular weight polyethylene). Prosthetic replacement is occasionally used for fractures also. The results of shoulder replacement are very good and should last for many years.

Treatment for Unstable Shoulder:

After the first 1 or 2 episodes of dislocation, we usually treat the shoulder with rest, a sling and then exercises to strengthen the muscles. However because there are ligaments torn, often the shoulder continues to slip out of place. If this occurs frequently it begins to interfere with the patients life, and may even lead to arthritis if let go too long. We feel that an unstable shoulder needs to be surgically repaired.