SHOULDER PAIN LIFE OR SPORTS, WE GET YOU BACK IN THE GAME.SM.

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1 LIFE OR SPORTS, WE GET YOU BACK IN THE GAME.SM SHOULDER PAIN Fort Sanders Regional The Trustees Tower th Street, Suite 600 Knoxville, TN Tel Fax The Tower at Parkwest 9430 Park West Boulevard, Suite 130 Knoxville, TN Tel Fax Seymour Chapman Highway Seymour, TN Tel Fax Oak Ridge Physicians Plaza 988 Oak Ridge Turnpike, Suite 100 Oak Ridge, TN Tel Fax Randall R. Robbins, MD 961 Oak Ridge Turnpike Oak Ridge, TN (865) Fax (865) Lenoir City 576 Fort Loudoun Medical Center Drive, Suite 100 Lenoir City, TN Tel Fax SPINEKnoxville Kingston Pike Knoxville, TN Tel Fax Shoulder Brochure.indd 1-2 9/6/07 11:51:06 AM

2 We know that getting back to normal is important to you. That s why patients at TOC are always seen quickly. For urgent needs you can receive same-day treatment at one of our Quick Care clinics. For orthopaedic problems relating to the shoulder, see our shoulder specialists at TOC. When should you see a shoulder specialist? If your pain: is increasing is continuous or prolonged prevents you from enjoying and performing daily activities occurs at night and interferes with sleep is non-specific and has failed to be diagnosed by previous exams What can a shoulder specialist do for you? TOC s shoulder specialists provide comprehensive therapy catered to the specific symptoms and needs of the patient. By following steps of treatment starting from the simplest to the most complex, TOC will give you a correct, accurate diagnosis appropriate for your specific orthopaedic condition. TOC Shoulder Specialists: Paul C. Brady, MD Michael T. Casey, Jr., MD Richard B. Cunningham, MD Sean P. Grace, MD Robert C. Jackson, MD Paul T. Naylor, MD Rick E. Parsons, MD Jean-François P. Reat, MD John M. Reynolds, MD Randall R. Robbins, MD Shoulder Brochure.indd 3-4 9/6/07 11:51:09 AM

3 Your Shoulder The shoulder is the most mobile joint in the human body. In fact, a normal shoulder can rotate 360 degrees, whether it s to reach for a basketball goal, reach for a friend or reach for a just-out-of-reach itch in the middle of your back. That flexibility, however, comes at a price. Age, strenuous exercise, repetitive work and disease can contribute to injury or the deterioration of your shoulder. The most common shoulder problems include: Bursitis / Tendonitis Rotator Cuff Tears Frozen Shoulder Labral Tears Shoulder Brochure.indd 5-6 9/6/07 11:51:13 AM

4 Bursitis & Tendonitis What are bursitis and tendonitis? Between two of the bones in your shoulder lives a fluid-filled sack called the bursae. This sack acts like a cushion between the bones. The rotator cuff tendons also live in this area. With age some people can develop a bone spur on one of these bones, which will cause irritation of the bursae. If left unchecked this bursitis can irritate the underlying rotator cuff tendons and becomes tendonitis. What are the symptoms? The hallmark of bursitis and tendonitis is pain. The pain can occur in the shoulder but often occurs down in the arm region. Probably the most aggravating aspect of this pain is night pain, which interferes with your sleep. Few things can be as frustrating as losing sleep as a result of pain. Often simple bursitis responds very well to conservative treatments such as cortisone injections, medications and physical therapy. Occasionally if someone is unresponsive to these measures, surgery is required to remove the bone spur and the inflamed bursae. If this is all a patient needs surgically then recovery can be quite quick and surgery is about 95% successful at providing long-term pain relief. If bursitis and tendonitis are left unchecked they (along with the bone spur) can eventually lead to a rotator cuff tear. Labral Tears What is a labral tear? The labral is a soft fibrous tissue rim that surrounds the shoulder socket for the upper arm bone (the humerus). It helps stabilize the joint and also serves as an attachment site for several ligaments. A labral tear occurs when this tissue is torn. What causes it? Injuries to the labral can occur from acute trauma or repetitive shoulder motion. Examples of traumatic injury include: A direct blow to the shoulder A sudden pull, such as when trying to lift a heavy object A violent overhead reach, such as when trying to stop a fall or slide Throwing athletes or weightlifters can experience tears due to repetitive shoulder motion. Tears can also occur with other shoulder injuries, such as a dislocated shoulder. What are its symptoms? Symptoms for a labral tear are very similar to other shoulder injuries. They include: Pain, often associated with overhead activities Catching, locking, popping or grinding Occasional night pain or pain with daily activities A sense of instability in the shoulder Decreased range of motion Loss of strength Your doctor s first line of treatment will consist of anti-inflammatory medication, rest and rehabilitation exercises. Arthroscopic surgery will be considered only after these conservative measures fail to help. During surgery, your doctor will place absorbable anchors in the bone and tie sutures (attached to the anchors) around the torn tissue to facilitate healing. After surgery, you will need to keep your shoulder in a sling for three to four weeks. When the sling is removed, you will need to do motion and flexibility exercises and gradually start to strengthen your biceps. Athletes can usually begin doing sports-specific exercises after six weeks, although it will be three to four months before the shoulder is fully healed. Shoulder Brochure.indd 7-8 9/6/07 11:51:14 AM

5 Frozen Shoulder What is frozen shoulder? Frozen shoulder is a disorder characterized by pain and loss of motion or stiffness in the shoulder. It affects about two percent of the general population and is found mostly in women between the ages of 40 and 70, though it does occur in men as well. Medical problems associated with an increased risk of frozen shoulder include diabetes, hypothyroidism, hyperthyroidism, Parkinson s disease, and cardiac disease or surgery. Frozen shoulder can also develop after a shoulder is injured or immobilized for a period of time. What are its symptoms? Pain caused by frozen shoulder is usually dull or aching but can be quite severe or worsen with attempted motion. It is usually located over the outer shoulder area and in the upper arm. The most obvious sign is restricted motion or stiffness in the shoulder. Motion is also limited when someone else attempts to move the shoulder. What causes it? The causes of frozen shoulder are not fully understood. The process involves the thickening and contracting of the capsule surrounding the shoulder joint. Frozen shoulder can be diagnosed based on your symptoms and a 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 a rotator cuff tear. Frozen shoulder will generally improve with time, but it may take as long as two to three years. Seeing a doctor will ensure no other injuries are present. Your doctor can prescribe monthly cortisone injections followed by aggressive physical therapy to regain motion and temper your pain. This treatment plan has proven to be effective for more than 90% of patients; however, a small percentage of people require surgery. Surgery for frozen shoulder will allow your doctor to remove scar tissue and manipulate your arm to restore full motion. After surgery, corticosteroid injections and a numbing medicine will help you start aggressive physical therapy, which will begin the next day and continue for several weeks. This technique is successful in the majority of surgery patients. Shoulder Brochure.indd /6/07 11:51:17 AM

6 Rotator Cuff Tears What is a rotator cuff tear? The rotator cuff is made up of four muscles and their tendons. These combine to form a cuff around the head of the upper arm bone (the humerus). The rotator cuff helps lift and rotate the arm. It also stabilizes the ball of the shoulder within the joint. Rotator cuff tears occur most often in people who are over the age of 40 but may occur in younger patients following acute trauma or repetitive overhead work or sports activity. A cuff tear may also happen with another injury to the shoulder, such as a fracture or dislocation. What are its symptoms? Usually the onset of a rotator cuff tear is gradual and may be caused by repetitive overhead activity or by wear and degeneration of the tendon. You may feel pain in your shoulder that radiates down the side of your arm, which may be mild and only present with overhead activities. Eventually the pain may become noticeable at rest or with no activity at all. The most common symptom of rotator cuff problems is night pain. Other symptoms may include stiffness and loss of motion. When the tear occurs with an injury, you are likely to experience a sudden sharp pain, a snapping sensation and an immediate weakness of the arm. A torn rotator cuff is not lethal. If willing, you can try to adjust your activities and live with the discomfort and weakness in your arm. If the pain is too intense, anti-inflammatory medication and steroid injections can help. Physical therapy may be recommended to strengthen the muscles around the torn rotator cuff or in the case of a chronic rotator cuff tear. Your orthopaedic surgeon may recommend surgery: if non-operative treatment does not relieve your symptoms, if the tear is acute and painful, if the tear is located in the dominant arm of an active individual or if you need maximum strength in your arm for overhead work or sports. Over 90% of surgical patients experience substantial or total relief. Restoration of strength depends mostly on the patient. A strong commitment to rehabilitation is important to achieve a good surgical outcome. Shoulder Brochure.indd /6/07 11:51:20 AM

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