Shoulder and Elbow Conditions

What is the rotator cuff?

The rotator cuff is a group of tendons that surround the shoulder joint. This group of tendons connects individually to muscles that start at the scapula, also called the shoulder blade. When these muscles contract, they pull the rotator cuff tendons and cause the shoulder to either rotate inward or outward and allow the arm to rise. 

What is shoulder impingement syndrome?

In a healthy shoulder, the uppermost tendon of the rotator cuff smoothly glides underneath the bone on the top of the shoulder. Repetitive movement of the arm above shoulder level squeezes the lubricating tissue and tendons. 

Impingement syndrome happens when the tendons and the tissue become inflamed and swollen. The space between the bony prominence at the top of the shoulder and the head of the upper arm bone can also be reduced by a down-growth of bone, which causes irritation. 

What is the initial treatment for rotator cuff impingement?

For minor impingement or rotator cuff tendonitis, you can apply ice to the top and front of the shoulder for 20 minutes three to four times a day for some immediate relief. Oral medications, cortisone injections, physical therapy and rest may also help. We recommend that you refrain from the activities that cause pain until it has improved. 

How successful is rotator cuff surgery?

Although we are experts at rotator cuff surgery, the outcome relies largely on your willingness and participation in rehabilitation, as prescribed by your surgeon and physical therapist. Surgical outcomes are generally very good. Even with severe injuries, our surgical techniques are able to relieve pain and improve strength without decreasing mobility. 

Frozen shoulder (adhesive capsulitis, stiff shoulder)

What is frozen shoulder?

Frozen shoulder is the more commonly used term for adhesive capsulitis or stiff shoulder. The soft-tissue lining of the shoulder ball-and-socket joint becomes inflamed and scarred and causes the shoulder to lose its ability to move freely above the head and to rotate away from the body. The exact cause of frozen shoulder is unknown, but having a shoulder injury, rotator cuff disease, thyroid problem or diabetes seem to be factors in its development.

What is the treatment for frozen shoulder?

With physical rehabilitation, most patients improve their range of motion. This can take as little as one month or as long as two years. However, some patients do not improve with this conservative treatment and may need to have their shoulder either surgically manipulated or have arthroscopic removal of the scarred tissue. The surgery can lead to a significant increase in range of motion.

Tennis elbow and golfer's elbow

What are tennis elbow and golfer's elbow?

Tennis elbow is a pain on the outer part of the elbow at the bony prominence. The muscles and tendons that pull the wrist backward partially start at this point and can become inflamed and cause pain. Golfer’s elbow is similar to tennis elbow, except that pain starts on the bony prominence on the inner part of the elbow.

What are the treatment options for tennis and golfer’s elbow?

Most tennis elbow symptoms can be managed without surgery. Initially, the best way to manage the symptoms is to conduct a home rehabilitation program as prescribed by your physician. This program generally consists of deep tissue massage, tendon stretching and ice therapy two to three times a day. 

If at-home management fails to alleviate your symptoms after two to three months, we may prescribe a steroid injection to improve the results of the continued rehabilitation therapy. However, if this conservative approach fails to resolve the symptoms and the symptoms are still significantly bothersome, then arthroscopic surgery may be helpful.

Elbow arthritis

What are the symptoms of elbow arthritis?

Common symptoms of elbow arthritis include pain, stiffness, swelling, clicking, catching and locking in the elbow joint. You may experience creaking and grinding sensations, which occur because the cartilage of the joint surface is worn and the bones on the two sides of the joint rub together. 

With rheumatoid arthritis, you may experience worse pain in the mornings. With osteoarthritis, you may experience more pain in the evening or when attempting physical activity.

What are the treatment options for elbow arthritis?

When treating elbow arthritis, many factors have to be considered, including age, activity level, expectations and other medical conditions. You and your physician will discuss which treatment will work best for you. Treatment options include: 

• Physical rehabilitation. 
• Oral analgesic and anti-inflammatory medications. 
• Injections of steroids or viscosupplements. 
• Surgical treatment, such as arthroscopic debridement, synovectomy, interposition of a membrane between the bones, partial or total joint replacement, or joint fusion or joint removal.