Shoulder Care and Treatment
Dr. Barry Waldman M.D., FAAOS Johns Hopkins Medical School Sinai Hospital 410.377.8900
More About Joint Replacement
Thank you for restoring my "quality of life." My hip feels as good as the other one, I was born with and that's because I had a good surgeon.
Dr. Waldman has been caring for shoulder issues for over fourteen years. He he has worked with thousands of shoulder patients. If you're looking for one of the leading shoulder care experts in Maryland, and in the United States, contact Dr. Waldman.
Shoulder CareWhile shoulders wear out much less commonly than hips or knees, shoulder arthritis and other joint problems can prove to be severely limiting conditions. Patients often have pronounced pain and difficulty with daily activities such as putting on clothes, using utensils and combing their hair. Shoulder replacement can be very effective in eliminating pain and restoring function. Like the hip and knee, the shoulder joint may become arthritic and painful as people age. Associated conditions such as rheumatoid arthritis or rotator cuff tears, may speed the process of joint problems.
Shoulder joint replacement surgery, is also known as shoulder arthroplasty. During the procedure, the ball and socket are replaced with metal and plastic components to alleviate pain and improve function. Shoulder surgeries are normally done only as a last resort after other kinds of treatments have failed to work. In some cases, arthroplasty is the only option that will reduce the pain and improve the mobility of the joint.
If surgery is needed, Dr. Waldman is an expert at both total shoulder replacements and shoulder resurfacings. Some of the types of shoulder surgeries Dr. Waldman performs are:
- Total Shoulder Joint Replacement
- Shoulder Resurfacing
- Rotator Cuff Repair
Introduction to the Shoulder
The shoulder is a ball and socket joint similar to the hip. However, instead of two bones, as in the hip, the shoulder joint is made up of three bones: humerus (upper arm bone), scapula (shoulder blade), and the clavicle (collarbone). The ball that is located at the top end of the humerus fits in the socket of the scapula and forms the basis of the joint. The socket portion of the joint has a soft-tissue rim between it and the humerus. Where the bones of the joint (scapula and humerus) meet the articular cartilage, which is smooth and durable and allows the smooth movement of the joint. The shoulder joint also contains a joint capsule (a thin sheet of fibers surrounding the joint), which allows a wide range of motion and provides stability. The rotator cuff covers the joint capsule and the shoulder joint and includes the group of muscles and tendons that attach the upper arm to the shoulder blade. The rotator cuff muscles enable you to reach overhead, lift your arm up, and perform other motions. Between the rotator cuff and the shoulder blade is a sac-like membrane, called a bursa, which cushions and helps lubricate the movement between them.
The shoulder’s unique structure makes it the most flexible joint in the human body. You are able to rotate your arm in front, above, behind and to the side of your body. However, this flexibility makes the shoulder susceptible to injury and instability. Some common shoulder problems include Bursitis (tendinitis), tear (partial or full) of the rotator cuff, instability (subluxation and dislocation), bone fractures, and arthritis (rheumatoid and osteoarthritis).
Shoulder Conditions, Injuries, and TreatmentBursitis can occur from overuse during repetitive activities, including swimming, painting, and weight lifting. The activities cause an impingement (squeeze) or rubbing of the rotator cuff. Modifying the activity that caused the symptoms of pain and starting a rehabilitation program initially treat bursitis and Tendinitis.
Rotator cuff tears can be either partial or full. If the tear is partial the treatment usually consists of modification of activity, adding light exercise, and on occasion an injection of cortisone. A full tear of the rotator cuff is often the result of an impingement, heavy lifting or falls. Treatment of a full tear of the rotator cuff is often successful without resorting to surgery, through the same steps taken as treatment for partial tears. However, if pain is ongoing after treatment, surgery may be required to repair the shoulder joint. Both techniques will require extensive physical rehabilitation to restore function to the shoulder.
Instability in the shoulder joint occurs when the ball portion of the humerus is forced out of the shoulder socket. This type of injury typically is the result of a sudden injury or overuse to the shoulder ligaments. Instability is a general term while the specific injuries are known as subluxation and dislocation. Subluxation is a partial dislocation or incomplete dislocation. If the shoulder joint is subluxated, it may become fully dislocated with only a minor push or subsequent injury. Some patients have chronic instability and they suffer from repeated dislocations. With chronic instability, surgery may be required to repair the damaged joint. The repair can either be done open or arthroscopically. For both surgical treatment options extensive physical therapy and rehabilitation will be required.
Fractures to the bones of the shoulder joint are commonly the result of falls, whether by the elderly or children. For collarbone fractures, the injury will likely be treated with a splint or a sling. Only severe fractures will require surgery. For fractures of the arm bone, especially of the ball of the joint, surgery may be needed and potentially may require replacement with an artificial joint, if the injured person is elderly.
Arthritis, both osteoarthritis and rheumatoid arthritis, can destroy the shoulder joint and its surrounding tissue. Rheumatoid Arthritis affects the synovium lining through chronic inflammation, which leads to the destruction of the inner lining of the joint and articular surface. Osteoarthritis is diagnosed when the articular surface of the joint wears thin. Usually surgery to replace the shoulder is recommended when the patient suffers from pain in the shoulder joint and a limited range of motion.
Evaluation of the Shoulder
We will perform a thorough evaluation of your shoulder to diagnose your injury and/or condition and to determine what the best course of treatment for you. The evaluation will consist of a medical history, a physical examination, and diagnostic testing. Through the medical history we will gather information about you current injury and symptoms, pain, limitations and past treatments. In the physical examination, we will measure the swelling, tenderness, strength, range of motion, instability and deformity of the shoulder. The diagnostic tests may include X-ray and Magnetic Resonance Imaging (MRI) and will be used to assess the extent of the injuries or damage to the joint internally.