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Proper functioning of the shoulder (parts of the body that are also called the "upper extremities") – is necessary for daily activities. Writing, grabbing, driving, or lifting are severely limited if the muscles, nerves, joints, and bones in these areas are not working properly.

shoulder diagram orthopedic surgery

The design of the shoulders and their daily use put them at risk for injury. In fact, according to the American Academy of Orthopaedic Surgeons, one-third of all acute injuries treated in emergency rooms involve the upper extremities.

Many injuries to these areas can be treated without surgery, and at BMC, physicians explore such options before considering surgery. However, there are times when surgery can be the better option. BMC surgeons are fellowship-trained in shoulder surgery and have extensive expertise in caring for the shoulders.

Conditions of the Shoulder

Osteoarthritis, or "wear and tear" arthritis, is a common degenerative disease that can affect any joint in the body, causing inflammation with pain and stiffness. As the body ages, osteoarthritis is quite common; it usually effects people over age 50. There are two joints in the shoulder that can be affected – one where the upper arm bone (humerus) fits into the rounded socket in the shoulder blade (scapula); the other where the collarbone (clavicle) meets the shoulder blade; both can lose the cartilage that protects the bone, causing the bones to rub together.

Diagnosing Osteoarthritis of the Shoulder

Physical Exam

Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.

X-Rays

A form of electromagnetic radiation with very high frequency and energy. X-rays are used to examine and make images of things such as the bones and organs inside the body.

MRI

This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be injected with a contrast agent for better imaging, and you will most likely lie on a moving table as pictures are taken. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT. MRI may not be recommended if you have a pacemaker or other metal implants.

Blood Tests

A common tool for disease screening, blood tests provide information about many substances in the body, such as blood cells, hormones, minerals, and proteins.

Treatments for Osteoarthritis of the Shoulder

Nonsteroidal anti-inflammatory drugs (NSAIDs)

A class of medications, including but not limited to aspirin, naproxen, and ibuprofen, that are used for reducing pain and redness, swelling, and heat (inflammation) in arthritis and other painful inflammatory disorders.

Physical Therapy

Sometimes referred to simply as "PT," this is a type of rehabilitative treatment that uses specially designed exercises and equipment to help patients preserve, regain, or improve their physical abilities following injury, disability, disease, or surgery. Physical therapy can include therapeutic exercise, massage, assistive devices, and patient education and training.

Activity Modification

Physicians may prescribe general lifestyle changes to a patient, in order to help relieve the symptoms of their condition and improve their overall physical function and well-being. Depending on the medical condition being treated, activity modification may include: decreasing or increasing one's level of physical activity; added rest; beginning a new activity or exercise program; changing sleep habits; or modifying one's physical environment at home, in their vehicle, or at work.

Corticosteroid injections

Also known as cortisone shots, these are injections that may help relieve pain and inflammation in a specific area of the body. Cortisone shots are most commonly given into joints — such as the ankle, elbow, hip, knee, shoulder, spine, and wrist.

Glucosamine & Chondroitin Sulfate

Glucosamine is found naturally in the body. It stimulates the formation and repair of articular cartilage. Over-the-counter supplements come from animal sources. Chondroitin sulfate is another natural substance found in the body. It prevents other body enzymes from degrading the building blocks of joint cartilage.

Surgery for Osteoarthritis of the Shoulder

For patients whose condition has not responded to nonsurgical treatments, there are several different shoulder surgery options. For milder arthritis cases, arthroscopy may be performed. This involves the surgeon inserting a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments. Arthroscopy allows for only very small incisions (cuts), due to the very thin pieces of equipment that are used. For more advanced cases, shoulder joint replacement (arthroplasty) may be performed. During shoulder joint replacement, the damaged parts of the shoulder are removed and replaced with an artificial component, called a prosthesis. Replacement surgery techniques include hemiarthroplasty, total shoulder arthroplasty, resection arthroplasty, and reverse total shoulder arthroplasty. The patient's surgeon can discuss which option is best for each individual's case.

mary capo reverse shoulder surgery

mary capo xray

BMC offers specialized expertise in reverse shoulder surgery, which can result in less pain and greater range of motion for patients with shoulder arthritis called "cuff tear arthropathy." These photos show pre-op and post-op x-rays and photos of BMC patient Mary Capo, 74, of Saugus, MA. After suffering with pain in her right shoulder for more than four years, Mary underwent reverse shoulder surgery with Xinning "Tiger" Li, MD, at BMC. Shown here at two months post-surgery, Mary is able to once again lift her right shoulder and remarked that she is no longer experiencing any pain or problems sleeping. "I'm very happy with the surgery," Mary said. "I'm glad I had it done, and would do it again if I had to!" Mary also said that she would "absolutely recommend (reverse shoulder surgery) to others" who may be considering the procedure.

The rotator cuff is a group of four muscles that hold the upper arm bone in the shoulder socket and helps to turn and lift the arm. A tear can occur from an injury, or through overuse (from activities such as lifting). A partial tear can occur, as can a full-thickness tear, which is a split in the soft tissue. Symptoms include pain when lifting the arm on the affected side, pain while sleeping, particularly on the affected side, and loss of strength.

Diagnosing Rotator Cuff Tears

Physical Exam

Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.

X-Rays

A form of electromagnetic radiation with very high frequency and energy. X-rays are used to examine and make images of things such as the bones and organs inside the body.

MRI

This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be injected with a contrast agent for better imaging, and you will most likely lie on a moving table as pictures are taken. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT. MRI may not be recommended if you have a pacemaker or other metal implants.

Treatments for Rotator Cuff Tears

Nonsteroidal anti-inflammatory drugs (NSAIDs)

A class of medications, including but not limited to aspirin, naproxen, and ibuprofen, that are used for reducing pain and redness, swelling, and heat (inflammation) in arthritis and other painful inflammatory disorders.

Physical Therapy

Sometimes referred to simply as "PT," this is a type of rehabilitative treatment that uses specially designed exercises and equipment to help patients preserve, regain, or improve their physical abilities following injury, disability, disease, or surgery. Physical therapy can include therapeutic exercise, massage, assistive devices, and patient education and training.

Activity Modification

Physicians may prescribe general lifestyle changes to a patient, in order to help relieve the symptoms of their condition and improve their overall physical function and well-being. Depending on the medical condition being treated, activity modification may include: decreasing or increasing one's level of physical activity; added rest; beginning a new activity or exercise program; changing sleep habits; or modifying one's physical environment at home, in their vehicle, or at work.

Surgery for Rotator Cuff Tears

For patients whose symptoms, particularly their pain levels, do not improve with nonsurgical treatment methods over 6-12 months, their doctor may recommend surgery. Other surgical candidates include: those who need to use their arms to perform overhead work or a sport; those with a large rotator cuff tear (more than 3 cm); those with significant weakness and loss of function; or those with a tear caused by a recent, acute injury. Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone). There are a few options for repairing rotator cuff tears, including open repair, all-arthroscopic repair, and mini-open repair. The patient's orthopedic surgeon will discuss the best procedure to meet each individual's health needs.

When a shoulder dislocates, it means the top of the upper arm bone has either partially or fully slipped out of the joint socket. Because the shoulder joint moves in all directions, it is unstable and prone to dislocation. Injury is usually the cause of dislocation. Swelling, pain, numbness, weakness, bruising, and other symptoms may occur, especially if the dislocation causes a ligament or tendon to tear or damages a nerve. Once a shoulder dislocates, chances are good it will dislocate again.

Diagnosing Shoulder Dislocations

Physical Exam

Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.

X-Rays

A form of electromagnetic radiation with very high frequency and energy. X-rays are used to examine and make images of things such as the bones and organs inside the body.

Treatment for Shoulder Dislocations

Closed Reduction (for Dislocated Shoulders)

Process by which the doctor places the ball of the upper arm bone (humerus) back into the joint socket. Severe pain from a dislocated shoulder stops almost immediately once the shoulder joint is back in place.

Shoulder instability occurs when the top of the upper arm bone has either partially or fully slipped out of the joint socket (dislocated) multiple times. The muscles, ligaments, and tendons that hold the shoulder in place become loose and unstable. Injury and repetitive motion strain (like swimming and volleyball) are often causes.

Diagnosing Shoulder Instability

Physical Exam

Your physician will ask you a series of questions and is likely to do a physical exam. The physical exam will including examining any specific areas of concern, especially as they relate to the reason for your visit to the office.

X-Rays

A form of electromagnetic radiation with very high frequency and energy. X-rays are used to examine and make images of things such as the bones and organs inside the body.

MRI

This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be injected with a contrast agent for better imaging, and you will most likely lie on a moving table as pictures are taken. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT. MRI may not be recommended if you have a pacemaker or other metal implants.

Treatments for Shoulder Instability

Nonsteroidal anti-inflammatory drugs (NSAIDs)

A class of medications, including but not limited to aspirin, naproxen, and ibuprofen, that are used for reducing pain and redness, swelling, and heat (inflammation) in arthritis and other painful inflammatory disorders.

Physical Therapy

Sometimes referred to simply as "PT," this is a type of rehabilitative treatment that uses specially designed exercises and equipment to help patients preserve, regain, or improve their physical abilities following injury, disability, disease, or surgery. Physical therapy can include therapeutic exercise, massage, assistive devices, and patient education and training.

Activity Modification

Physicians may prescribe general lifestyle changes to a patient, in order to help relieve the symptoms of their condition and improve their overall physical function and well-being. Depending on the medical condition being treated, activity modification may include: decreasing or increasing one's level of physical activity; added rest; beginning a new activity or exercise program; changing sleep habits; or modifying one's physical environment at home, in their vehicle, or at work.

Surgery for Shoulder Instability

Surgery is often necessary to repair torn or stretched ligaments so that they are better able to hold the shoulder joint in place. For patients with shoulder instability, surgical options include arthroscopy (a minimally invasive technique involving pencil-thin surgical tools) and traditional open surgery. The patient's doctor will discuss the best option for their individual case.