About half the patients who see an orthopaedic surgeon will do so because of shoulder pain. Younger patients typically have shoulder pain secondary to instability or dislocation. As individuals age, common shoulder disorders pop up, including problems with the rotator cuff, shoulder arthritis and adhesive capsulitis (frozen shoulder). In addition, shoulder pain can emanate from the neck secondary to cervical disc disease. Below, Elliott Leitman, M.D., an orthopedic surgeon with First State Orthopaedics, explains the diagnosis and treatment of some of the more common shoulder complaints.
A thorough history and exam are essential. I like to know the etiology of the pain. In particular, whether there was trauma to the shoulder or if the pain started gradually. In addition, I inquire as to the duration of the symptoms; the exact location; aggravation or relieving factors; occupation; hand dominance and past medical history. As part of the examination, I look at the patients posture and general mobility. It is essential to evaluate the neck as well.
Focusing on the shoulder, one checks for range of motion, strength and stability along with a few other special tests.
Plane X-rays are helpful to assess for arthritis and possible bone spurs. An MRI is helpful to determine the degree of injury to the soft tissues such as the rotator cuff or labrum.
Typically younger individuals often present a history of dislocation. Patients in their 30s with non traumatic pain typically have tendonitis, which typically resolves itself with rest, anti-inflammatories and physiotherapy.
Patients in their 40s and 50s will also have tendonitis but, women in this age group start to see adhesive capsulitis/Frozen Shoulder. This presents itself with pain and loss of motion. Frozen shoulder is painful and can last for seven to nine months.
It’s more common in diabetics. It responds to a regimen that may include steroid injections, physiotherapy to focus on stretching and occasional manipulation of the joint under anesthesia.
Rotator cuff tears become increasingly common in patients over the age of 50. They can be traumatic or atraumatic in etiology. In younger active patients with full thickness tears we are more aggressive with surgical repair.
Many people as they approach 70 and beyond can function quite well with even a full thickness tear. Only if they have limitations in function and/or pain that does not respond to nonoperative treatment do we consider surgical repair.
Rotator cuff tears are typically fixed arthroscopically. The arthroscope is a small camera about the size of a pen. The surgery involves a few small incisions. Through these small incisions we are able to reattach the tendon to the bone. After the surgery, which may last between 45-90 minutes, patients are discharged.
During the first four to six weeks following surgery, patients keep their arm in a sling for most of the day, removing it to do their range of motion exercises. Also, I will often allow them to remove the arm from the sling to use a computer and eat. Following the initial four to six weeks, the sling is removed. Therapy to restore strength and range of motion then follows for the next one to three months.
The best predictor for surgical success is the size of the tear. It is important that full thickness tears be diagnosed and appropriately treated in a timely fashion.
Elliott H. Leitman, M.D. received his medical degree from Boston University School of Medicine. Following his orthopaedic surgery residency at Albert Einstein Medical Center in Philadelphia, he completed a sports medicine fellowship at 3B Orthopaedics, also in Philadelphia. He is board-certified by the ABOS and has an added certification in Orthopaedic Sports Medicine. In addition to being a retired lieutenant colonel from the U.S. Army, Dr. Leitman has served as a team doctor for the Philadelphia Eagles and Philadelphia Flyers, along with several area high schools and colleges. He is a licensed pilot and a triathlete. He specializes in arthroscopic knee and shoulder reconstruction along with joint replacement surgery.
To schedule an appointment with Dr. Leitman, call (302) 731-2888 or visit www.firststateortho.com/contact.php.
First State Orthopaedics
731-2888 • www.firststateortho.com
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Medical Arts Pavilion I
4745 Ogletown-Stanton Road
Suites 225 & 238, Newark