Shoulder and Elbow

Most Common

Shoulder and Elbow

Complaints

Rotator Cuff Tears:

Definition: Shoulder pain is often caused by an impingement of the acromion onto the rotator cuff tendon as a result of motion of the shoulder. Generally, elevating one's arm directly forward as if to reach objects on shelves above shoulder level seems to exacerbate the pain. Often patients describe this pain as a toothache which does seem to travel down to the mid portion of the arm, halfway between the shoulder and elbow. It is often associated with night pain and can be associated with significant weakness. Occasionally, the patient may feel a catch in the shoulder when attempting these maneuvers.

Rotator cuff injuries are generally treated with range of motion exercises through physical therapy in order to not lose any of the shoulder's motion. In addition, strengthening of the rotator cuff musculature is attempted with internal and external rotation exercises of the shoulder. Occasionally, the orthopedic surgeon may prescribe nonsteroidal anti-inflammatory medications or perform an injection of the shoulder, in order to reduce inflammation in that region. The definitive treatment for this condition is either an arthroscopic or open removal of the bone spur causing the impingement and a repair of the rotator cuff, if indeed there is a hole which has been generated.

If you have pain in your shoulder, we would recommend being seen by your family physician with a possible referral to an orthopedic surgeon for appropriate treatment. Nonsteroidal anti-inflammatory medications (NSAIDs) can cause gastric, kidney, or liver problems. They should only be taken at the recommendation of your physician so that they can be properly monitored. Repeated cortical steroid injections also may lead to rupture of tendons or long term complications and should only be done under the supervision of your treating physician.

Shoulder instability:

Definition: The patients with shoulder instability are unable to keep the shoulder reduced or located. There is a tendency of the shoulder to dislocate either forward (anterior) or backward (posteriorly). This occurs because the shoulder has the most mobility of any joint of the body, that is it is the only joint which allows 180 degrees of motion. It is a fine line between this motion and instability.

Symptoms: Persons with shoulder instability, that report the shoulder slipping out of the joint, and often times will relocate on its own prior to seeking medical attention. Occasionally, patients are capable of causing their own dislocation and relocation.

Exam: Typically, the position of greatest discomfort for anterior dislocators is the motion one makes to throw a ball (the wind up). Often times they will demonstrate generalized laxity in there elbows, fingers, and knees (double jointed).

Treatment: Shoulder dislocators are initially treated with physical therapy in the form of strengthening exercises in order to reduce the tendency of dislocation by dynamic or muscular contraction. If after two - three months of strengthening exercises the person demonstrates a continued tendency for dislocation, it is our opinion that they may be a candidate for surgical treatment of this problem.

Persons experiencing complaints of dislocation or other shoulder pain should seek medical attention by their family physician with possible referral to an orthopedic surgeon. Nonsteroidal anti-inflammatory medications (NSAIDs) can cause gastric, kidney, or liver problems. They should only be taken at the recommendation of your physician so that they can be properly monitored. Repeated cortical steroid injections also may lead to rupture of tendons or long term complications and should only be done under the supervision of your treating physician.

Arthritis:

Definition: Arthritis of the shoulder is noted by destruction of the joint cartilage which results in a loss of the joint space of the shoulder. Typically, pain and stiffness results, particularly pain when one first gets up in the morning. This most often occurs in patients greater than fifty years of age.

Symptoms: Night pain is often noted, particularly when the person rolls onto the affected shoulder. There may be a cracking or popping with motion of the shoulder (crepitation). Limitation in range of motion, particularly in the ability to lift one's arm above one's head is common. There is often an associated sense of catching within the shoulder appreciated.

Exam: Patient's with arthritis differ from those with only rotator cuff symptoms by pain and limitation of motion being present both with passive (examiner moving the shoulder) as well as active motion.

Treatment: An orthopedic surgeon may choose to use nonsteroidal anti-inflammatory medications or an injection of cortisone into the joint in order to relieve symptoms. Ultimately, the treating physician may recommend a replacement of the shoulder joint to provide a friction free surface for motion once again.

Persons experiencing complaints of arthritis or other shoulder pain should seek medical attention by their family physician with possible referral to an orthopedic surgeon. Nonsteroidal anti-inflammatory medications (NSAIDs) can cause gastric, kidney, or liver problems. They should only be taken at the recommendation of your physician so that they can be properly monitored. Repeated cortical steroid injections also may lead to rupture of tendons or long term complications and should only be done under the supervision of your treating physician.

Tennis Elbow (Lateral Epicondylitis):

Definition: Tennis Elbow (Lateral Epicondylitis) refers to a condition in which pain develops on the outside aspect of the elbow secondary to wear and tear (inflammation) which develops at the origin of the wrist and hand muscles. This often occurs as an overuse phenomenon, secondary to a back hand in tennis (typist) or other activities that require repetitious extension of the wrist and hand.

Symptoms: Patients often will note pain which is located on the outside (lateral) aspect of the elbow. This may radiate towards the forearm and is always exacerbated by the above mentioned activities.

Exam: A simple test for tennis elbow can be done by lifting a light object (approximately five pounds) with the palm facing upward and with the palm facing downward. If the pain is significantly worse with the palm facing downward, it is considered to be consistent with tennis elbow.

Treatment: The best treatment for tennis elbow is avoidance of the activities which aggravate it. Ice after such activities also will help reduce inflammation in the elbow. Nonsteroidal anti-inflammatory medications are sometimes prescribed by physicians. A various array of wrist and elbow splint are also available for treatment of this condition. Occasionally, an injection of this region in order to reduce inflammation is appropriate.

Persons experiencing complaints of tennis elbow or other elbow pain should seek medical attention by their family physician with possible referral to an orthopedic surgeon. Nonsteroidal anti-inflammatory medications (NSAIDs) can cause gastric, kidney, or liver problems. They should only be taken at the recommendation of your physician so that they can be properly monitored. Repeated cortical steroid injections also may lead to rupture of tendons or long term complications and should only be done under the supervision of your treating physician

Olecranon Bursitis:

Definition: Olecranon bursitis is an inflammation of the elbow which causes a fluid filled sac (bursitis) to appear on the point of the elbow. This can grow to the size of a golf ball. It may be red and warm to touch. Due to its location, it is often aggravated by resting one's elbow on a table or chair.

Symptoms: The onset of this swelling may be very rapid if it is an infectious cause. Such infectious causes are often very red and warm to touch, may be associated with fever, chills, or night sweats, and are often very warm. Immediate medical attention is required.

Treatment: Physicians will often aspirate this cyst in order to either confirm or deny the presence of infection in this bursar. If there is an infection found, it must be drained and the person must be placed on antibiotics immediately.