Dr. Shaw Frequently Asked Questions

Shoulder FAQs with Dr. Shaw

Why does my shoulder hurt?

Most adults have shoulder pain at some point in their life.  Usually the pain is related to an overuse or strain injury. These episodes of pain are usually self-limited and can be resolved without medical attention. When shoulder pain persists after resting and using a daily NSAID for 2 weeks, typically this indicates there may be more significant injury that requires an evaluation. Your orthopedic surgeon will take x-rays and evaluate the shoulder with a detailed history and physical examination. The diagnosis can usually be made after this evaluation.

What is shoulder tendonitis or impingement?

Shoulder pain that exists at the front and side of the shoulder for more than a couple weeks is often tendonitis, the structural inflammation of the rotator tendon. Pain can occur when the space above the rotator cuff (the deep muscles and tendons surrounding the shoulder) and under the acromion (the flat bone on top of the shoulder) is tight, and the bone rubs on the bursa and the rotator cuff tendon. If this friction lasts for a significant amount of time, it can cause tendonitis and bursitis, inflammation of the lubrication cushion that is above the tendon. Sleeping and extensive side reaching will aggravate this shoulder pain. Many of my patient’s primary complaints are of shoulder pain at night. The pain will travel down the side of the upper arm and into the deltoid (the large shoulder muscle). Both tendonitis and bursitis are painful, and both are treated in a similar fashion. Orthopedic surgeons call this tendonitis “Shoulder Impingement.” The impingement develops from the dysfunctional shoulder movement during reaching activities which causes the acromion to “pinch” the rotator cuff.

What can be done to treat my shoulder tendonitis?

Shoulder impingement (tendonitis) will be diagnosed by physical examination and x-ray. Sometimes an MRI will be necessary to rule out tears or other problems. Physical therapy is the best way to treat most shoulder impingement. NSAIDs, including ibuprofen, naproxen and other prescription anti-inflammatory medicines, will also be used if the patient has no contraindications. The treatment plan also requires rest from overhead activity, sports, and certain work activities. Sometimes the orthopedic surgeon will offer a steroid injection into the shoulder bursa to help with pain, also known as a “cortisone shot.” While the shot can help tremendously, it is a temporary fix, so physical therapy is crucial to the success of the treatment.

Why does physical therapy work, and can I do it on my own?

Physical therapy is very successful in treating many shoulder problems, especially impingement.  I am often asked if the patient can do therapy at home. Certainly there are many exercises that can be done at home with the help of an instructional sheet. However, having the professional assistance of the physical therapist is important to evaluate the functional deficits so that a personalized program can be given.  Many exercises can be done incorrectly if the patient is not observed by a professional.  This can worsen rather than better the initial problem. Once a patient is in physical therapy, specific home exercises will be given to the patient to be done on the days when they are not at physical therapy.

Physical therapy is highly beneficial because it increases the range of motion and re-trains the shoulder to work in a coordinated fashion. If the shoulder remains stiff and weak, every activity with the shoulder will not work efficiently. The analogy I use often is: when a car needs a tune up, it will still drive, but it doesn’t work super well. When the shoulder is properly “tuned up” it will move and work normally.

How do I know if I have a rotator cuff tear?

The short answer is that sometimes you don’t know. Population studies have shown there are many people who have rotator cuff tears that are asymptomatic. One study found that of all tears in their sample population, 65% were asymptomatic. Obviously if there is no pain in the shoulder, patients will not seek help. Other research has shown that shoulder pain lasting more than 6 months either with or without nonsurgical treatment (physical therapy and rest) is usually because the rotator cuff is torn. There are many variations and sizes of a tear which can dictate the level of pain a patient may experience. Sometimes a trial of therapy and activity modification will allow resolution of pain. The tear will not truly “heal”, but if it is small, the nearby muscles can compensate for the issue. When nonsurgical treatment doesn’t work or the patient’s rotator cuff is weak, an MRI is necessary. This imaging study provides a clear picture of the tendons so that a diagnosis can be made. If the shoulder is painful, weak, and disability persists, a surgical repair is often the only effective treatment no matter the size of the tear.

How is surgery done to fix a rotator cuff tear?

Rotator cuff tears are almost always fixed arthroscopically. This procedure is done using anesthesia and through very small incisions around the back, side and front of the shoulder. During surgery, the entire shoulder is arthroscopically examined to ensure there are no other injuries. The bursa and some of the bone on the acromion are cleared away to provide space for the rotator cuff and prevent further injury. The rotator cuff is then repaired with strong sutures and anchored to the bone. The anchors used are typically bio-absorptive and not seen on an x-ray. The anchor can be thought of as a small screw or tack that goes into the bone. They allow the tendon to be pressed firmly onto the bone and enable healing. Finally, the small incisions are stitched, then dressings and a sling are placed.  Patients leave the surgery center about an hour later.

How long does it take to recover from shoulder rotator cuff surgery?

Most patients will use the sling and have arm-lifting restrictions for 6 weeks.  Physical therapy will usually need to occur for 3 months, but it can depend on the patient and the size of their tear.  Larger tears can take up to 6 months to heal. Normal activity, including independent exercise and some sports, will be allowed about 4-6 months after surgery.  Your surgeon will have an individualized time table based on your circumstance.

How do I know if I have shoulder arthritis?

Typically shoulder arthritis will become symptomatic by age 60 or older. Many patients first notice the problem with simple activities like reaching behind their back or getting dressed.  The throbbing or aching pain in the shoulder and down the upper arm becomes constant when arthritis develops.  Like arthritis in other parts of the body, shoulder arthritis is usually a wear and tear arthritis known as osteoarthritis. Patients will notice stiffness and pain. There can be grinding and clicking in the shoulder as well. These symptoms are similar to many other shoulder problems, so the only way to accurately know if there is arthritis is to have x-rays of the shoulder by your orthopedic surgeon.

How is shoulder arthritis treated?

Initial treatment for shoulder arthritis is management of the pain symptoms with acetaminophen, NSAIDs and activity modifications.  Physical therapy can help maintain and restore motion and strength.  An occasional steroid injection can help alleviate pain for a couple months, but these injections cannot be given too frequently because the rotator cuff can become damaged.

When pain is affecting daily activities and nonsurgical management is ineffective, you and your surgeon should discuss the risks and benefits of total shoulder replacement to decide if this is the right option for you. The total shoulder is very effective at relieving pain and allows the patient to return to many activities.

What is a total shoulder arthroplasty or replacement?

The shoulder joint is known as a ball and socket joint, like the hip. The humerus has a hemispherical shape, and the shoulder blade or scapula includes a part that encapsulates with the humerus — this is known as the glenoid. The glenoid resembles a flat dish and has an edge of cartilage known as the labrum. When arthritis develops in the shoulder, the glenoid and humerus cartilage is worn, and inflammation occurs, causing shoulder pain. In a shoulder replacement, the humeral head is removed and replaced with a metal hemisphere, and the glenoid is reamed flat and covered with a small plastic implant. Afterwards, shoulder movement occurs at the artificial surfaces and is pain free.

What if I have arthritis and a rotator cuff tear?

There is a solution to this combination of problems in a patient older than 60 years.  A reverse shoulder replacement can restore function and remove pain from the arthritis. Some rotator cuff tears that are very large and have been present for more than a year cannot be repaired.  Over time, a shoulder with a chronic tear will develop arthritis — this is known as “cuff tear arthropathy”.

Why is the reverse total shoulder replacement called “reverse”?

When a shoulder has arthritis and there is no functioning rotator cuff tear a reverse total shoulder is the best way to address the problem surgically.  The “reverse” part of the total shoulder means that the hemispherical part of the implant is fixed to the glenoid, the shoulder blade side of the joint.  In a normal shoulder, the hemispherical part of the shoulder is the top of the humerus bone. So when a reverse total shoulder is performed, the metallic hemisphere is put on the glenoid, and the plastic socket is put on the top of the humerus, creating a reversed orientation. This reverse is important because the mechanical pull of the deltoid can effectively work to lift the arm.