SHOULDER PAIN – Can Surgery Help?
“My doctor says it is just arthritis and nothing can be done”.
Is your shoulder painful and not settling?
Does it click or grate?
Does it pop out of joint and you’re wondering if this is causing harm?
These are some of the signs that your shoulder may have problems and could progress causing more harm.
Nowadays shoulder pain can easily be treated. Once a more definitive diagnosis is made there are various options for treatment.
Rotator Cuff Injuries
The most common type of shoulder pain is that related to the rotator cuff, and is pain felt in the front of the shoulder at the tip, radiating down the arm which is often worse at night, when reaching or stretching for things or doing overhead work. Rotator cuff problems can start with simple inflammation, also known as bursitis, and lead to tendon tears and if left untreated can develop into arthritis. Whilst your general practitioner is correct that initial treatment involves rest and giving it time, other options include physiotherapy, anti inflammatories, steroid injections and surgery if there is no improvement.
Arthroscopic shoulder surgery has a high success rate, is minimally invasive and only requires one overnight stay in hospital. In many cases a sling isn’t even required and motion is started straight away. Whilst full recovery can take a bit of time, most patients have recovered within a few weeks and at four to six weeks are noticing that they are better than prior to surgery. Many patients are surprised that they put off surgery for so long.
Arthritis can occur:-
- In the acromioclavicular (AC) joint, which is treated the same as a rotator cuff problem with an arthroscopic debridement (clean out), via key hole surgery and can have a very quick recovery.
- In the main shoulder joint itself (Gleno-humeral joint). This is becoming more common with the aging population. Arthritis can develop in shoulders that have undergone regular dislocation episodes and in patients with rotator cuff tears. Repair of these may help reduce the chance of arthritis.
Shoulder arthritis pain is experienced in the front of the shoulder, and may have associated noises in the shoulder with a reduced range of motion (stiffness). In this scenario a simple x-ray will diagnose the problem and whilst there is a tendency for radiologists to comment on the bursa, if there is arthritis in the main shoulder joint (gleno-humeral joint), this explains the symptoms.
In patients who have symptoms that do not respond to simple pain relief and physio, there is a very good option in the form of a shoulder replacement. Shoulder replacements require a two or three day stay in hospital and involve exchanging the surface of the shoulder with an artificial surface. In many ways the operation is easier than a hip or knee replacement in that the patient is discharged with a sling and can commence physiotherapy in a slower process. We find that the majority of patients are very happy with the result. Shoulder replacements are very different to the way they were twenty years ago and the success rate is very high with the requirement for further surgery being less than previously anticipated.
Another cause of shoulder pain is frozen shoulder, which is more common in diabetic patients, and will improve with time. Measures such as steroid injections can speed up the recovery.
The important point with all these is that age is not a barrier to seeking treatment. Whilst it needs to be taken into account the general fitness for intervention, i.e is the patient fit enough for surgery, often the best results are in the older age group, both for rotator cuff problems and for shoulder replacements. Consequently, be reassured that age is no barrier in seeking treatment and there are options for consideration.
Be aware that shoulder pain can be cured or significantly improved in most patients. Rather than accept shoulder pain as a way of life, feel free to contact us for more information.
Glenelg Orthopaedics, providing quality orthopaedic care.