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Shoulder Tendonitis
Tendonitis is an inflammation of the shoulder tendons. The signs of inflammation are pain, warmth, redness, tenderness to touch, and loss of function. Shoulder tendonitis (often called Rotator Cuff Tendonitis) can occur when the rotator cuff is overloaded, fatigued, traumatized, and with age-related degenerative changes. Pinching or impingement of the rotator cuff tendons occurs in a region under a bony structure called the acromion (the projection of the shoulder blade that forms the tip of the shoulder). Impingement happens when the arm is raised overhead repeatedly, or raised overhead with a heavy load in your hand, or may occur when you sleep on your shoulder. X-rays may show a hook or spur that increases the odds that you will pinch the rotator cuff tendons.

Treatment for impingement or rotator cuff tendonitis usually involves rest, anti-inflammatory medications like ibuprofen, physical therapy to restore proper strength and movement, and less often, a cortisone injection.

SHOULDER INSTABILITY
Shoulder instability occurs when the shoulder moves completely out of its socket (dislocation) and requires a medical professional to "relocate it", or to a lesser degree, when it slips out of joint but spontaneously move back in place (subluxation). Usually, the shoulder dislocates or subluxes forward (this is called an anterior dislocation). Much less often, it dislocates backward (posterior dislocation), and sometimes, it can slip out forward, backward, or downward (this is called multidirectional instability). Remember, you may have an "unstable" shoulder that has not completely dislocated.

The shoulder is most at risk for anterior dislocation when the arm is placed in an abducted and external rotated position (such as a fall on the outstretched hand or tackling a player).

An anterior dislocation is obvious because it is immediately noticed by the person right after the trauma. However, minor instability may result in a sensation that the shoulder is slipping out of place with or without pain. One might also experience pain or a sense of "apprehension" when the arm is abducted and externally rotated (ask your physical therapist about this).

ROTATOR CUFF TEAR
Rotator cuff tears happen in younger people when they experience a trauma such as a fall. In middle-aged people and seniors, rotator cuff tears are usually the result of a gradual wearing out of the rotator cuff tendon(s). The signs and symptoms of rotator cuff tears are pain in the shoulder often radiating down to the middle of the arm especially when the arm is raised overhead, weakness, and in severe cases, a complete loss of the ability to lift the arm. Diagnostic tests sometimes include an arthrogram (a radio-opaque dye is injected into the shoulder, and if it leaks out of the rotator cuff, it can be viewed on x-ray) or an ultrasound, but an M.R.I. of the rotator cuff is the most common test used for diagnosis.

Treatment in young and middle-aged patients is usually arthroscopic or open repair of the torn tendons. In older patients, activity modification, anti-inflammatory medication, physical therapy and cortisone injections are typical.

LABRALTEAR
The labrum is a cartilage ring that surrounds the shoulder socket (called the glenoid) and makes it deeper. In the above picture, it is numbered "5" - the thin blue ring around the glenoid. Since the socket is deepened by the labrum, the ball of the arm bone (called the head of the humerus) has a better fit into it. Labrum or labral tears are usually associated with trauma, instability of the shoulder, or repetitive throwing as with a baseball player.

The signs and symptoms of a labral tear are painful clicking, locking, or popping. Instability may be present because the labrum is not doing its job of holding the ball in the socket. Medical intervention for a labral tear typically involves an MRI for diagnosis and arthroscopic repair but labral tears are often hard to diagnose. A special kind of labral tear, a superior labral anterior to posterior (SLAP) tear, often involves the biceps tendon as well.

ADHESIVE CAPSULITIS
Adhesive Capsulitis, or a frozen shoulder, is condition in which the deepest layers of soft tissue, called the joint capsule, become diseased. Shoulder range of motion becomes very limited and painful. The cause of a frozen shoulder is still not known but minor traumas, hyperthyroidism, diabetes, psychiatric patients, post-surgical patients, and prolonged immobilization of the shoulder may in someway cause this condition. The disease is characterized as having freezing, frozen, and thawing stages.

Physical therapy consisting of patient education, stretching, joint mobilization, and a home exercise program can help speed recovery.

Shoulder & Elbow

TENNIS ELBOW/LATERAL EPICONDYLAGLGIA
Lateral (meaning away from the midline of the body) epicondylalgia (meaning pain of the epicondyle) is a painful condition on the outer aspect of the elbow. The common name for lateral epicondylalgia is tennis elbow but only 5% of the people afflicted with this condition play tennis.

Pain at the elbow may have one or more causes: it could be from the forearm tendons that attach at the outer aspect of the elbow, it could be referred pain from the next, it could be from one or more of the joints at the elbow, or it may originate from the radial nerve that is in close proximity to the elbow joint.

It often occurs with repetitive use of the arm especially with a clenched fist. Most cases are not due to tennis.

Local tenderness and pain with resisted and passive extension of the wrists is common.

Activity modification, anti-inflammatory medications, ice, and progressive stretching and strengthening will relieve most cases. Surgery is only an option in recalcitrant cases.

GOLFER'S ELBOW/MEDIAL EPICONDYLALGIA
People that suffer from golfer's elbow are often involved with racquet sports or golf. As with tennis elbow, they may overuse the forearm, traumatize the elbow by hitting several "fat" golf shots, or have poor swing technique.

Pain at the inner aspect of the elbow and reproduction of symptoms with resisted wrist flexion are common.

Activity modification, anti-inflammatory medications, ice, and progressive stretching and strengthening will relieve most cases. Surgery is only an option in recalcitrant cases.

FRACTURE/DISLOCATION
Elbow fractures usually involve a fall onto the outstretched arm or a direct trauma to the elbow. With elbow dislocations there may be associated nerve and/or blood vessel injuries. X-rays may show the fracture or dislocation but small breaks may be difficult to see.

Fractures are an emergency and immediate reduction (or placing the bones together to allow healing) is necessary. Bone breaks within the joint need special attention to ensure recovery of proper function of the joints.

LOOSE BODIES
Loose bodies are usually the result of old injuries or osteoarthritis of elbow joint. Locking and pain are the predominant signs and symptoms. The condition may be treated by surgical removal of the loose bodies if conservative care fails.

ULNAR NERVE INJURIES
This injury is usually the result of excessive valgus stress on the elbow during repeated throwing (especially during the cocking phase of a throw). Sometimes a direct injury to the nerve within the cubital tunnel ("hitting your funny bone") will result in nerve damage. Symptoms include tingling and numbness in the ring and pinky fingers. This may occur during or after throwing or with prolonged bending of the elbow.

Changing throwing technique, bracing if necessary, and therapeutic exercise may be helpful. If the problem persists, or there is prolonged weakness, then surgery is indicated.

BICEPS RUPTURE AT THE ELBOW
This injury is usually the result of a sudden forceful straightening of the elbow during concurrent contraction of the biceps muscle. Typically, there is sudden forearm pain and weakness. Surgical repair is necessary.

Post-surgical rehabilitation can be helpful with the recovery of range of motion, strength, and function.