The shoulder is a ball and socket joint. The ball portion of the joint consists of the rounded head of the upper arm bone (humerus), and the socket portion is made up of a depression (glenoid) in the shoulder blade. The ball (humeral head) fits into the socket (glenoid). The joint is surrounded and lined by cartilage, muscles, and tendons that provide support and stability. The shoulder’s construction allows for the rotation of the arm in all directions.
Many patients seek medical attention for shoulder pain, and a common diagnosis given is “shoulder bursitis” or “shoulder tendinitis.” Shoulder bursitis and rotator cuff tendinitis are both just a way of saying that there is inflammation of a particular area within the shoulder joint that is causing pain and discomfort. Shoulder bursitis and a rotator cuff tear are different problems, and although related, the treatment is different for each condition.
Shoulder bursitis is inflammation around the rotator cuff tendons. A rotator cuff tear is an actual tear within the tendons. A sign that differentiates these problem areas is the strength of the rotator cuff muscles. Typically, these injuries have been brought about by high impact activities from contact sports like football and rugby, or from heavy use in overhead activities, such as tennis, golf, or baseball. In either case, both types of injuries produce pain and limit range of motion.
Common symptoms include:
- Pain with overhead activities (arm above head height)
- Pain while sleeping at night
- Pain over the outside of the shoulder/upper arm
In shoulder replacement surgery, the damaged shoulder is resurfaced and replaced with a prosthesis. When both sides of the joint are resurfaced, it is a total shoulder replacement. When only the ball is involved, it is a partial shoulder replacement.
Learn more about shoulder replacement surgery.
The type of surgery you have and your doctor’s recommendations will determine how soon you can begin using your shoulder after surgery. If you have arthroscopic surgery, you may go home in a few hours after surgery, but you will need to arrange to have someone drive you home because the pain medications and anesthesia are likely to make you sleepy. If you have a total shoulder replacement, you could remain in the hospital for one to three days.
Physical therapy is an extremely important part of the success of shoulder surgery, and your full participation is necessary for an optimal outcome. Some degree of pain, discomfort, and stiffness can be expected during the early days of physical therapy.
The medical staff and therapist will teach you proper movements and exercises to do so that you can regain your strength and mobility in your shoulder. Continue to move the way you were taught by the physical therapist and return to activity slowly. Don’t be surprised if you feel a little stiff at first; it may take a few months to achieve a complete recovery. And remember, it is very important to keep all your scheduled follow-up visits with your surgeon.
The elbow is subjected to daily use through normal, everyday activities as well as during participation in sports activities. It’s not surprising that problems can develop in the elbow over time. Trauma, overuse, aging, and degenerative disorders, such as arthritis, can affect your elbows.
The elbow is a hinge joint where three long bones meet in the middle portion of the arm. The bone of the upper arm (humerus) meets the inner bone of the forearm (ulna) and the outer bone of the forearm (radius). The bicep muscle is the major muscle that flexes the elbow hinge. The tricep muscle is the major muscle that extends the elbow hinge. A fluid-filled sac (bursa) that serves to reduce friction overlies the tip of the elbow. The elbow can be affected by inflammation of the tendons or the bursa, or conditions that affect the bones and joints, such as fractures, arthritis, or nerve irritation.
Many conditions that cause elbow pain can be managed without surgery through a treatment plan prepared by your orthopaedic doctor. Some of the more common problems are:
- Tendinitis: Sometimes referred to as “tennis elbow,” tendinitis occurs when the tendons attached to the elbow from the muscles of the forearm become injured, resulting in inflammation.
- Injury to the “Funny Bone” (Ulnar Nerve)
- Golfer's Elbow: Inflammation at the point where the tendons of the forearm are attached to the bony prominence of the inner elbow
- Bursitis: Inflammation of the bursa at the tip of the elbow
Most often these problems can be treated non-surgically. However, there are some conditions that may cause you to explore surgical options if you are experiencing elbow pain.
Fractures: The bones of the elbow can break (fracture) into the elbow joint or adjacent to the elbow joint. Fractures generally require immobilization and casts, pinning, or open joint surgery.
Arthritis of the Elbow: Inflammation of the elbow joint (arthritis) can occur as a result of many systemic forms of arthritis, including rheumatoid arthritis, gouty arthritis, psoriatic arthritis, and reactive arthritis. Range of motion is decreased with arthritis of the elbow because the swollen joint impedes the range of motion. Generally, this is associated with signs of inflammation of the elbow joint, including heat, warmth, swelling, pain, tenderness, and decreased range of motion.
Elbow Spurs: Elbow spurs are usually precipitated by years of overhead activities (pitching, tennis, etc.) that produced swollen bone linings that develop spurs.
Bone Fragments: Fragments or loose “bodies” are usually caused by a trauma-related condition that results in decreased blood supply, bone collapse, and cracking. “Bodies” already broken free from a cracked surface can be arthroscopically removed; however, the resulting pre-arthritic condition may leave the elbow unable to tolerate the stress of high-impact activities like gymnastics or baseball.
When possible, arthroscopic surgery is preferred by surgeons for spur removal and removal of bone fragments because traditional inpatient surgical techniques tend to produce significant loss of motion after the recovery period. In contrast, arthroscopic surgery is usually successful in restoring almost all motion and allowing a return to activities after the recovery period.
The type of surgery you have and your doctor’s recommendations will determine how soon you can begin using your arm again after elbow surgery. If you have arthroscopic surgery, you may go home in a few hours after surgery, but you will need to arrange to have someone drive you home because the pain medications and anesthesia are likely to make you sleepy. If you have a total elbow replacement, you could remain in the hospital for one to three days.
Physical therapy is an extremely important part of the success of elbow surgery and your full participation is necessary for an optimal outcome. Some degree of pain, discomfort, and stiffness can be expected during the early days of physical therapy.
The medical staff and therapist will teach you proper movements and exercises to do so that you can regain your strength and mobility in your elbow. Continue to move the way you were taught by the physical therapist and return to activity slowly. Don’t be surprised if you feel a little stiff at first; it may take a few months to achieve a complete recovery. It is very important to keep all your scheduled follow-up visits with your surgeon.
Dramatic advances have been made in recent years in treating patients with hand injuries, degenerative disorders, and birth defects of the hand. Orthopaedic surgeons who specialize in hand surgery undergo additional medical training in hand surgery, and they can treat patients with a wide range of hand problems. After examination and review of the medical history of your hand, the surgeon will discuss possible methods of treatment for your problem and let you know if surgery is necessary.
The most common procedures in hand surgery are those done to repair injured hands, including injuries to the tendons, nerves, blood vessels, and joints; fractured bones; and burns, cuts, and other injuries to the skin. The information below highlights some of the most common procedures hand surgeons perform and is intended for informational purposes only.
Carpal Tunnel Syndrome: The carpal tunnel is a passageway through the wrist, carrying tendons and one of the hand’s major nerves. Carpal tunnel syndrome (CTS) is a problem that affects the wrist and hand when pressure builds up within the tunnel because of disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, overuse, or repetitive motions. The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand, often accompanied by numbness and aching, and can make simple tasks hard to do.
In some cases, non-surgical treatment can relieve the problem. For that reason, it’s a good idea to see a doctor for a complete examination and analysis if you suspect you have carpal tunnel syndrome.
If surgery is required, your results from surgery can vary depending in part on how long the condition has existed and how much damage was done to the nerve.
After surgery you will spend a few hours in recovery and then you will be sent home. While recuperating, you should:
- Keep your hand raised above heart level to reduce swelling
- Limit hand and wrist use
- Take all medication as directed
- Do hand exercises as instructed
Rheumatoid Arthritis: An inflammation of the joints, rheumatoid arthritis is a disabling disease that can affect the appearance and the function of the hands and other parts of the body. It often deforms finger joints and forces the fingers into a bent position that hampers movement.
Disabilities caused by rheumatoid arthritis can often be managed without surgery by wearing special splints or using physical therapy to strengthen weakened areas. For some patients, however, surgery offers the best solution. Whether or not to have surgery is a decision you should make in consultation with your surgeon.
While your hand may not regain its full use, you can generally expect a significant improvement in function. Remember that surgical repair doesn’t eliminate the underlying disease. Based on your situation, your doctor will discuss the best treatment plan for you.
Dupuytren’s Contracture: Dupuytren’s Contracture is a disorder of the skin and underlying tissue on the palm side of the hand. Thick, scar-like tissue forms under the skin of the palm and may extend into the fingers, pulling them toward the palm and restricting motion. The condition usually develops in mid-life and has no known cause, although it appears to be hereditary.
Surgery is the only treatment for Dupuytren’s Contracture. The results of the surgery will depend on the severity of the condition. You can usually expect significant improvement in function, particularly after physical therapy.
Since the hand is a very sensitive part of the body, you may have mild to severe pain following surgery. Your surgeon can prescribe injections or oral medication to make you more comfortable. How long your hand must remain immobilized and how quickly you resume your normal activities depends on the type and extent of surgery and on how fast you heal. To enhance your recovery and give you the fullest possible use of your hand, your surgeon may recommend a course of physical and occupational therapy. Keeping all follow-up appointments and adhering to instructions will maximize the results of your hand surgery.