Torn Rotator Cuff

The picture shows how arthroscopic surgical intervention can repair a torn rotator cuff.

Your shoulder is a ball-and-socket joint; the top of the humerus (upper arm bone) forms the ball and the end of the scapula (shoulder blade) called the glenoid creates the socket. The humerus is attached to the scapula by the rotator cuff, the four muscles which allow you to lift and rotate your arm.

When you’ve torn your rotator cuff you’ve either partially or completely separated one or more tendon(s) from the humerus bone. Rotator cuff tears can result from either an acute injury or degeneration. Both types of tears can be associated with overhead motions/lifting. In individuals over 40 symptomatic shoulder pain is generally the result of a torn rotator cuff.

– Acute Injury: Acute tears occur with a significant fall or trying to lift an object that is too heavy. They are often associated with other shoulder injuries like dislocation or a broken collarbone.
– Degeneration: Degeneration is the most common cause rotator cuff tears. They are the result of slight fraying of the tendon, over time, due to repetitive stress, and the risk of tear increases with age.

Rotator Cuff injuries and tears are commonly seen in: baseball players, tennis players, rowers, weightlifters, construction workers, and carpenters.

Symptoms
– Weakness
– Loss of range of motion/limited motion
– Dull achy pain
– Cracking with certain movements
– Swelling
– Pain with:
– Resistance
– Reaching
– Lifting everyday objects like a gallon of milk
– Lifting or lowering your arm
– Sleeping on affected side

If your symptoms last longer than 2 weeks you should consult your primary doctor for a referral.

Your Appointment with Dr. McMillan

During your appointment Dr. McMillan will perform a physical exam to test your shoulder’s range of motion and your arm strength. You may also get X-rays in the office and set up an MRI to diagnose the cause of your pain. Once the results of your MRI come back, Dr. McMillan will map out your treatment options and help you decide of the course of action that is best for you.

Dr. McMillan is examining a patient’s range of motion and arm strength.

Treatment

Non-surgical:
– Rest
– Medication: Non-steroidal anti-inflammatory medications to minimize swelling and pain.
– Physical Therapy: Strengthening your shoulder muscles will help relieve pain and prevent further injury. You will also work on stretches to help regaining mobility.
– Injections: If the other non-surgical treatments fail Dr. McMillan can use injections to help reduce pain.
– Steroid Injection (Cortisone): Has been proven to be very effective at reducing inflammation and pain.
– Platelet Rich Plasma (PRP): Your own blood is used to extract plasma platelets, which are then injected into your shoulder joint. These platelets stimulate the body to repair itself.

Surgical:
If non-surgical methods fail to improve pain Dr. McMillan will discuss surgery as an option. Each patient and tear is different, but most tears can be treated arthroscopically. For more information of Arthroscopic surgery please see ‘What is Arthroscopic surgery?”

Torn Labrum

The picture shows two possible locations labral tears can occur in the shoulder.

Your shoulder is a ball-and-socket joint; the top of the humerus (upper arm bone) forms the ball and the end of the scapula (shoulder blade) called the glenoid creates the socket. The glenoid is extremely shallow and is capped by a soft tissue called the labrum. The labrum molds the glenoid (socket) to the the head of the humerus (ball), to stabilize the joint. The labrum also attaches to several ligaments and tendons, such as the bicep tendon.

A torn labrum, also known as ‘Thrower’s Arm’ in young athletes, occurs when the soft tissue of the labrum gets caught between the the glenoid (socket) and the head of the humerus (ball). Labral tears can result from either an acute injury or degeneration. Both types of tears are associated with overhead motions/lifting and pulling/jerking motions. In individuals under 40 symptomatic shoulder pain is generally the result of a labral tear.

– Acute Injury: Account for the largest percentage of labral tears. Injuries that commonly cause labral tears are falling on an outstretched arm, a blow to the shoulder, or a shoulder dislocation.
– Degeneration: Degenerative tears occur over time when repetitive stress if placed on the labrum, pulling it further in between the glenoid and the humerus.

Labral tears are commonly seen in athletes who play: baseball weight lift, golf, football, and tennis.

Symptoms
– Pop/catching/locking sensation with specific movements
– Loose/unstable feeling in the shoulder
– Deep shoulder pain
– Loss of throwing velocity (in young athletes)
– Loss of range of motion/limited range of motion
– Loss of strength
– Pain with:
– Turning a steering wheel
– Lifting a gallon of milk
– Sleeping on affected side
– Daily activity

If your symptoms last longer than 2 weeks you should consult your primary doctor for a referral.

Your Appointment with Dr. McMillan

During your appointment Dr. McMillan will perform a physical exam to test your shoulder’s range of motion and your arm strength. You may also get X-rays in the office and set up an MRI to diagnose the cause of your pain. Once the results of your MRI come back, Dr. McMillan will map out your treatment options and help you decide of the course of action that is best for you.

Treatment

Dr. McMillan examining a patient for a shoulder labral tear.

Non-surgical:
– Rest
– Medication: Non-steroidal anti-inflammatory medications to minimize swelling and pain.
– Physical Therapy: Strengthening your shoulder muscles will help relieve pain and prevent further injury. You will also work on stretches to help regaining mobility.
– Injections: If the other non-surgical treatments fail Dr. McMillan can use injections to help reduce pain.
– Steroid Injection (Cortisone): Has been proven to be very effective at reducing inflammation and pain.
– Platelet Rich Plasma (PRP): Your own blood is used to extract plasma platelet, which are then injected into your shoulder joint. These platelets stimulate the body to repair itself.

If non-surgical methods fail to improve pain Dr. McMillan will discuss surgery as an option. Each patient and tear is different, but most tears can be treated arthroscopically. For more information of Arthroscopic surgery please see ‘What is Arthroscopic surgery?”

Arthritis

The picture shows an arthritis in the Glenohumeral joint.
Your shoulder contains three bones: the clavicle (collar bone), the scapula (shoulder blade), and the humerus (upper arm bone). These three bones create the two joints of the shoulder;

– Acromioclavicular (AC joint): Where the clavicle and scapula meet.
– Glenohumeral joint: What you commonly think of when you think of your shoulder- where the humerus and scapula join to form the ball-and-socket.

Both of these joints can be affected by arthritis and there are five types of arthritis that can affect the shoulder:
– Osteoarthritis: Osteoarthritis, also known as ‘wear and tear arthritis,’ is a condition that destroys the cartilage covering the bones, which allows the bones rub against each other causing pain. Osteoarthritis usually affects people over the age of 50 and most commonly occurs in the AC joint.
– Rheumatoid Arthritis (RA): RA is an autoimmune disease which, it forces your immune system to attack normal tissues in your joints like synovium (the lining of your joints), cartilage, and bone. It causes inflammation which results in pain and stiffness in the joint.
– Post Traumatic Arthritis: Post traumatic arthritis is a form of osteoarthritis that develops after an injury such as a shoulder dislocation.
– Rotator Cuff Arthropathy: Rotator cuff arthropathy is a type of arthritis that occurs because of a long-term untreated rotator cuff tear. Large untreated tears can allow the head of the humerus to rub against the acromion (tip shoulder blade).
– Avasular Necrosis (AVN): AVN is a condition that occurs when blood supply to the humerus is disrupted. Without adequate blood supply the bone cells that make up the humerus will begin to die. As AVN progresses it can also begin to damage the gleniod socket. There are several causes of AVN including heavy alcohol consumption, sickle cell disease, trauma (such as severe shoulder fractures), and steroid use.

Symptoms
– Limited range of motion
– Grinding, clicking, cracking sensation/sound
– Glenohumeral Arthritis pain is typically described as a deep ache centered in the back of the shoulder.
– Acromioclavicular Arthritis pain is typically on the top of the shoulder and can radiate into the neck.
– Pain with:
– Lifting
– Brushing hair
– Sleeping on affected side

If your symptoms last longer than 2 weeks you should consult your primary doctor for a referral.

Your Appointment with Dr. McMillan

During your appointment Dr. McMillan will perform a physical exam to test your shoulder’s range of motion and your arm strength. He will look for signs of previous injuries, involvement of other joints (a sign of RA), and determine which shoulder structures are affected. You may also get X-rays in the office and set up an MRI to diagnose the cause of your pain. Once the results of your MRI come back, Dr. McMillan will map out your treatment options and help you decide of the course of action that is best for you..

Treatment
Dr. McMillan demonstrating how arthritis can affect a shoulder’s range of motion and which positions can be problematic.

Non-surgical:
– Rest
– Medication: Non-steroidal anti-inflammatories to minimize swelling and pain. There are also specific medications to help reduce the affects of RA.
– Physical Therapy: May help regain range of motion.
– Injections: If the other non-surgical treatments fail Dr. McMillan can use steroid injections (Cortisone) to reduce pain.

Surgical:
If non-surgical methods fail to improve pain Dr. McMillan will discuss surgery as an option. Each patient is different, so surgical plans vary greatly depending on a patient’s stage of arthritis and individual needs. Dr. McMillan is highly experience in surgical treatments for arthritic shoulders, and is one of only a few doctors nationwide to perform reverse total shoulder replacements as well as total shoulder replacements.