Shoulder Arthoscopy
What are 3 Common Causes of Shoulder Pain treated with Shoulder Arthroscopy?
Shoulder pain is one of the most common problems Dr. Shin treats as an orthopedic surgeon. There are three common causes of shoulder pain. They are:
- Rotator cuff tear
- Rotator cuff impingement bursitis or tendinitis
- Labral tear/Shoulder Instability
Before any of these can be diagnosed, Dr. Shin has to make sure the problem is not coming from the neck, as many neck problems cause referred pain to the shoulder. This is usually done by examining the patient and by asking if the pain is elicited by moving the shoulder or the neck.
1. Rotator Cuff Tear Causing Shoulder Pain
Tearing of the rotator cuff is a very common cause of shoulder pain. It can be caused by a fall, by picking up something too heavy, or an athletic injury. Often as a result of aging, the rotator cuff tears without any traumatic injury. A rotator cuff tear is diagnosed by physical examination and MRI. Most rotator cuff tears require arthroscopic to repair and heal, as it has been found that the cuff tends to tear further if left untreated, plus in most cases the pain does not go away until the tear is fixed.
Dr. Shin has performed hundreds of rotator cuff surgery, which is done as an outpatient procedure.
Rotator cuff tears can be fixed with an arthroscopic or minimally invasive technique. Results of rotator cuff tear surgery are generally excellent in terms of reducing the pain from the tear.
2. Rotator Cuff Impingement Tendinitis the Most Common Cause of Shoulder Pain
Rotator cuff impingement tendinitis is an even more common problem than rotator cuff tears. For patients who lift weights or perform sports that involve overhead or reaching activities it is easy to overuse the shoulder and cause inflammation of the space between the rotator cuff and acromion (the bone above the rotator cuff).
This inflammation causes a painful swelling of the shoulder bursa. In this case a structural tear or hole in the cuff is not present, but the bursitis develops with internal redness, swelling and fluid collection. The pain from this condition can be treated with anti-inflammatory pills, a cortisone shot into the shoulder bursa, and rest for the arm.
Many cases of impingement go away without surgery. In a few cases the inflammation continues or returns following treatment. This failure of treatment is usually caused by a bone spur on the underside of the bone (acromion) that continues to rub the rotator cuff regardless of treatment and causes continuing pain. The older one gets, the larger the bone spur tends to grow. If pain persists, arthroscopic surgery to remove the bone spur is a very effective treatment for this problem.
3. Labral tear/Shoulder Instability
There are several types of labral tears:
- A SLAP lesion (Superior Labrum, Anterior to Posterior) is a tear of the labrum that usually occurs on the upper part of the socket and may also involve the long head of the biceps tendon, which anchors into the superior labrum normally.
- A tear of the front part of the labrum at the bottom of the socket is called a Bankart lesion. This usually happens from an anterior-inferior shoulder dislocation (a dislocation when the humeral head comes out of the front of the socket).
- A tear of the labrum can also occur in the back part of the socket. This is called a posterior labral tear. It can be a traumatic tear due to injury, or it may be degenerative due to normal wear and tear commonly from weightlifting or repetitive pushing activities.
The symptoms of a tear in the shoulder socket rim are very similar to those of other shoulder injuries. While pain is a common nonspecific symptom, other symptoms include
- A sense of instability in the shoulder
- Recurrent shoulder dislocation or subluxation (excessive movement of the ball and socket creating pain)
- Catching, locking, popping, or grinding
- Loss of strength or “dead arm” feeling for throwing athletes
Nonoperative measures are often the first step in treatment. Rest, anti-inflammatory medications, physical therapy, and injections can be discussed as part of the treatment plan.
Arthroscopic shoulder surgery is utilized when conservative measures are unsuccessful. This is done using small incisions and miniature instruments. During arthroscopic surgery, the doctor will examine the labrum and the biceps tendon. A plan is made before surgery, and a final confirmatory decision is carried out during surgery to repair the labrum and in some cases to reattach the biceps tendon if it is involved in the tear.
