Shoulder and Elbow Problems
In shoulder subluxation, the bones of the shoulder joint become partly out of joint (misaligned), which in turn can irritate the surrounding nerves and tendons. Subluxation can also produce significant pain and dysfunction without any tearing or rupture of the rotator cuff, or surrounding tissues.
Treatment of a shoulder subluxation almost always begins with physical therapy and rehabilitation. If this therapy fails, there are surgical options that can be considered. If left untreated, shoulder subluxations can lead to a rotator cuff tear.
Generally, shoulder dislocations occur after a traumatic event (e.g. a sports collision, fall, automobile accident). Typically, a shoulder is dislocated when a strong force pulls the shoulder outward (abduction) or an extreme rotation of the joint pops the ball of the arm bone (humeral head) out of the shoulder socket (glenoid).
The shoulder can dislocate either forward, backward, or downward, and is characterised by severe shoulder pain. Depending on their age, patients are also at risk of developing recurrent dislocations.
After a first dislocation, traditional treatment includes brief immobilisation followed by physical therapy. Surgery is normally used to treat recurrent, or repetitive, dislocations. However, scientific evidence now supports early surgery for some shoulder dislocations in young patients, who are at a high risk of recurrent dislocation.
Tennis elbow (lateral epicondylitis) is the most common diagnosis in patients seeking medical attention for elbow pain. In tennis elbow, the outer part of the elbow becomes painful and tender, usually as a result of a specific strain, overuse or a direct injury. This is most commonly seen in manual labourers and sports participants. Golfer’s elbow is similar to tennis elbow, but it affects the inner aspect of the elbow.
Treatment for tennis elbow includes rest, the use of anti-inflammatory medications, an elbow brace and physiotherapy. Various surgical treatments are successful in repairing or releasing the affected tendon, if non-operative methods do not settle the problem.
Golfer’s elbow (medial epicondylitis) is a condition where the inner part of the elbow is painful and tender to touch. Patients may also experience pain when moving the elbow. Movements that involve lifting – with the hand underneath, palm upwards – may also hurt.
This condition usually occurs after a strain, overuse, or a direct injury. Sometimes the muscles in the elbow are actually partially torn. Golfer’s elbow is usually a self-limited problem. Treatment includes rest, anti-inflammatory medications, and physiotherapy.
Frozen shoulder (adhesive capsulitis) is an extremely painful condition in which the shoulder becomes painful and stiff. Frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue. Typically, frozen shoulder occurs with no associated injury or specific cause.
Frozen shoulder can last well over a year. Initial treatment consists of pain relief and physical therapy. However, this treatment can take several months to be effective. Arthroscopic capsular release surgery to free up the shoulder is extremely useful for reducing recovery time or treating cases that do not respond to initial therapy.
Rotator cuff muscles consist of four muscle tendons that stabilise the shoulder joint and allow shoulder motion. Rotator cuff tears occur when these tendons become detached from the bone. Common symptoms include pain outside of the shoulder and the upper arm, weakness when raising the arm above the chest, and limited movement of the shoulder and arm. In some cases, a rotator cuff tear can lead to a shoulder joint misalignment (shoulder subluxation).
Non-surgical treatments, such as anti-inflammatory medications, physical therapy, and a cortisone injection can often provide relief of symptoms due to rotator cuff tears. If this treatment fails, surgery may be considered, depending on various factors.
A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. Bursitis is inflammation of any bursa. When a bursa becomes inflamed, the sac fills with fluid, which can cause pain and swelling around the affected area. X-rays and MRI scanning (magnetic resonance imaging) can be used to identify bursitis.
Bursitis usually results from a repetitive movement or else due to prolonged and excessive pressure. Bursitis may also develop after traumatic injury (a car accident or fall), or a systemic inflammatory condition, such as rheumatoid arthritis.
Shoulder bursitis symptoms include localised pain and swelling, tenderness directly over the shoulder/upper arm, and pain with movement of overlying muscles and tendons (e.g., lifting the arm above head height). A combination of bursitis and tendonitis is often seen in cases of shoulder impingement syndrome. Treatment usually involves rest, anti-inflammatory medication, ice and physiotherapy. Corticosteroid injections may also be used if the symptoms are significant. Surgery is rarely needed for shoulder bursitis.
Elbow bursitis (olecranon bursitis) is a common cause of swelling and inflammation around the elbow joint. Symptoms may include pain around the back of the elbow, noticeable swelling directly over the tip of the elbow, and limited motion of the elbow. This condition often develops in patients who rest on their elbows for long periods or those who bend their elbows frequently and repetitively (e.g. vacuuming for long periods). Occasionally, the swelling and inflammation of elbow bursitis can result from an infection within the bursa.
Typical treatment of elbow bursitis involves draining of the swollen bursa by a medical doctor. After removing the excess fluid, a cortisone injection may be used to suppress the inflammatory response. Anti-inflammatory medications, rest and brief immobilisation may also be prescribed.
Shoulder impingement syndrome
In shoulder impingement syndrome, the rotator cuff tendon becomes ‘pinched’ or impinged between two bones: the acromion bone and the ball-joint of the shoulder (humeral head). The space between the acromion and the rotator cuff tendons is filled by the subacromial bursa, a fluid-filled sac, which allows for smooth gliding of the rotator cuff under the acromion and which enables overhead shoulder movements.
Symptoms of shoulder impingement syndrome include pain when raising the arms above the chest, and reduced range of motion. Conservative treatment involves subacromial steroid injections and physiotherapy. Keyhole surgery may also be used to treat shoulder impingement, in order to remove bone spurs and scar tissue. This surgery can reduce pain and increase movement.
Arthritis of the elbow
Arthritis of the elbow involves a narrowing of the joint space and loss of cartilage (tissue) in the elbow. The most common cause of elbow arthritis is rheumatoid arthritis. Heavy manual work and injuries can also cause arthritis of the elbow. X-rays are often used to diagnose the problem.
Non-surgical treatments include rest, reducing certain activities, medications to reduce pain, cortisone injections and physical therapy. If elbow arthritis does not respond to initial treatments, surgery may be used. The type of surgery will depend on the type of arthritis, the stage of the disease, the patient’s age and their activity needs.
Shoulder and elbow fractures
Various types of fractures occur around the shoulder, arm and elbow, ranging from those in the collarbone down into the forearm. Treatment of these fractures will depend on the amount of displacement of the bones and the function of the affected muscles or tendons.
These fractures include:
- Clavicle fractures (collarbone fracture). This is extremely common, and has been traditionally treated simply with rest and a sling. Recent research demonstrates that surgery can be more effective than traditional treatment to fix clavicle fractures that are displaced or separated.
- Proximal humerus fracture (shoulder fracture or broken shoulder). This is one of the most common fractures in elderly individuals due to osteoporosis. These fractures occur when the ball, of the ball-and-socket shoulder joint, is broken at the top of the arm bone.
- A radial head fracture (elbow fracture) is the most common broken elbow bone seen in adults. This type of injury is typically caused by a fall onto an outstretched hand. Radial head fractures cause pain and swelling around the elbow.
- Olecranon fracture is an injury to the most prominent bone of the elbow. The olecranon is attached to the powerful triceps muscle in the arm. Olecranon fractures can affect this muscle and impair a patient’s ability to straighten the elbow joint, and therefore the arm, in general.