Wave Your Hands in the Air for Your Shoulders, Part 3
This blog series explores common shoulder ailments, treatment options, recovery and preventive measures with Torrance Memorial orthopedic surgeon Dr. Brian Magovern. Parts 1 and 2 covered three traumatic conditions: rotator cuff tears, dislocations and fractures. Dr. Magovern pointed out that rotator cuff injuries and fractures can happen to younger and more experienced individuals, while shoulder dislocations are usually youthful injuries. In this final installment we turn to two non-traumatic shoulder conditions: frozen shoulder and arthritis.
Frozen shoulder (adhesive capsulitis) may not be as well known as the other ailments we’re discussing, but it is not uncommon, Dr. Magovern says. The shoulder’s ball-and-socket joint is complex, involving three major bones: the humerus or upper arm bone, scapula or shoulder blade and clavicle or collar bone. The ball on the upper end of the humerus fits into the scapula’s socket, but as Dr. Magovern notes, that socket is fairly shallow, and a series of ligaments and tendons (including the rotator cuff’s four tendons), as well as the labrum’s cartilage rim around the socket, help keep the bones in place.
All of this is protected within a flexible capsule of collagen. Frozen shoulder occurs when the body produces collagen that is thick and fibrous, rather than flexible; the result is a painful loss of shoulder motion. The cause hasn’t been identified, although it occurs most often in women between the ages of 40 and 60, and in people with diabetes. Frozen shoulder can be diagnosed with a physical exam and typically fades after about a year. In a small percentage of patients (less than 10%) the condition does not improve, in which case surgery is an option. This involves removing a strip of the collagen capsule; as the body heals the capsule after the surgery, it again produces flexible collagen. Frozen shoulder rarely recurs in the same shoulder, although there is about a 20% chance that it will occur in the other shoulder.
Arthritis is perhaps the most well-known age-related wear-and-tear joint condition. Simply put, “arthritis means that the cartilage surface cushioning the bones in the joint has worn down,” Dr. Magovern explains. Arthritis can affect any joint, including shoulders. “We don’t really know why it occurs, but it can affect people as young as their 50s. It’s probably somewhat hereditary, somewhat due to activities throughout life. Heavy-duty weightlifting is a risk factor for shoulder arthritis, for example. Individuals experience stiffness and pain when they move the joint. It’s a deeper pain than a rotator cuff tear; it feels like it’s inside your shoulder.” The pain tends to get worse throughout the day, he notes, adding that X-rays provide a definitive diagnosis.
As a degenerative, progressive condition, people can experience arthritis as anything from mild discomfort to intense pain and loss of motion, so treatment for shoulder arthritis varies. It can be as simple as stretching the muscles around the stiff joint to relieve pressure, Dr. Magovern says. Additional treatment options include anti-inflammatory drugs, cortisone or lubricating shots, and topical rubs for symptomatic relief.
Dr. Magovern stresses that patients decide how aggressively to treat their arthritis. For many, that includes considering surgical options when pain or limited movement prevents them from accomplishing daily activities. Surgery to alleviate shoulder arthritis replaces part or all of the worn joint; the type of surgery depends on the specifics of each case and individual. A standard partial shoulder replacement provides the patient with a new, artificial ball on the upper humerus. Dr. Magovern says this is often the best option for younger patients who will continue to be active – say, a 48-year-old weightlifter. A complete shoulder replacement, in which both a new ball and socket are implanted, may be the recommended option for older patients who want to remain active. Finally, a reverse replacement implants a socket on the upper humerus and a ball on the shoulder blade. This option, for patients who have both arthritis and rotator cuff conditions, retains the mechanics of the ball-and-socket joint while easing post-surgery recovery, Dr. Magovern explains.
Shoulder replacement surgery usually lasts about 90 minutes; Dr. Magovern says more than half of patients are able to return home the same day – a significant increase over the past 10 years, as pain blocks administered during surgery have come into wide use and reduced the need for post-surgical pain medication. Which isn’t to say recovery is immediate: the shoulder is usually protected in a sling for four weeks, followed by physical therapy to regain motion, and then to rebuild strength. Recovery is complete after four to six months. “Some of that is time needed for the rotator cuff to heal,” Dr. Magovern explains. “One of the four rotator cuff muscles is a ‘front door’ to the joint itself, so to replace the joint we have to cut and then repair that muscle.”
So there you have it: the five most common shoulder troubles and treatment. The takeaway: if you have shoulder pain, you don’t have to live with it. If you have persistent shoulder pain, discuss it with your physician – it may be anything from an easily treatable tight muscle to arthritis. Whatever it may be, you have options, so you can wave your hands in the air again.
To schedule an appointment with a Torrance Memorial orthopedic specialist, call 310-517-4700. To reach Dr. Magovern, call 310-316-6190.