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| The Clinic's Shoulder Orthopaedic Physicians Services Offered The Clinic offers a wide range of expertise and treatment options. We specialise in both open and arthroscopic surgery. The most common types of surgery performed are rotator cuff repair, stability procedures, fracture care and arthroplasty. Common Diagnoses Rotator Cuff Problems This term means more or less the same thing as bursitis and tendonitis of the shoulder. There are several causes of this problem. In young patients, the most common cause is overuse such as repetitive throwing, weightlifting, overhead racquet sports, swimming and so forth. In some athletes, these activities lead to inflammation or tendonitis. As mentioned above, the rotator cuff is composed of four muscle-tendon units and any or all of these can be involved. The supraspinatus and the biceps are most commonly involved. What overuse does to the tendons in these cases is not known absolutely. It is felt that small, microscopic tearing of the tendon occurs. Because of poor blood supply to the tendon itself, the body's attempt at healing is not totally successful. We think this leads to an irritative process in the tendon which ultimately is called tendonitis.
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| Shoulder Dislocation / Subluxation A shoulder that dislocates comes all the way out of the joint. Significant trauma is usually required to cause a shoulder to dislocate. The usual direction of dislocation is the front or anterior. It can go out at the bottom or inferior, or a combination of anterior and inferior. Very rarely does it go out the back or posterior. Anterior dislocations often occur when the arm is outstretched and is forced backwards, for example, as when arm tackling. It is usually quite painful and there may be partial numbness of the shoulder, arm and hand. Most of the time, a doctor has to put it back in place (reduce the dislocation). A shoulder that subluxes is one that comes part of the way out of the joint, but not all the way and then goes back in, usually on its own or when the patient wiggles their arm or changes the position of the arm. This occurs with less significant trauma than a dislocation. Subluxation, like dislocation, often occurs when the arm is outstretched as in throwing a football or baseball. It is painful and often the arm feels weak, numb or 'not there'. The first time a shoulder subluxes is usually rather painful and the shoulder may be sore for several days.
Total Shoulder Replacement In a total shoulder replacement, a metal ball replaces the humeral head and a polyethylene cup replaces the glenoid socket. The primary indication for a total shoulder replacement is pain which does not respond to conservative treatment. Pain may be due to abnormalities and changes in the joint surfaces as a result of arthritis, avascular necrosis or abnormalities due to trauma or fractures. The primary goal of shoulder replacement surgery is to relieve pain with the secondary goals of improving motion, strength and function.
Acromioclavicular Joint Injuries The most common problems that occur at the AC joint are arthritis, fractures and dislocations. Arthritis is a condition characterised by loss of cartilage in the joint. Like arthritis at other joints in the body, it is characterised by pain and swelling, especially with activity. Over time, the joint can wear out, leading to swelling and formation of spurs around the joint. These spurs are a symptom of the arthritis and not a primary cause of the pain. Motions which aggravate arthritis at the AC joint include reaching across the body toward the other arm. AC joint arthritis is common in weight lifters, especially with the bench press, and to a lesser extent, military press. AC joint arthritis may also be present when there are rotator cuff problems.
Frozen Shoulder Frozen shoulder (adhesive capsulitis) is a disorder characterised by pain and loss of motion or stiffness in the shoulder. It affects about 2% of the general population. It is more common in women between the ages of 40 to 70 years old. The causes of frozen shoulder are not fully understood. The process involves thickening and contracture of the capsule surrounding the shoulder joint. A doctor can diagnose frozen shoulder based on the history of the patient's symptoms and physical examination. X-rays or MRI (magnetic resonance imaging) studies are sometimes used to rule out other causes of shoulder stiffness and pain, such as rotator cuff tear.
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