We specifically focus on the following problems:
- Shoulder pain with no diagnosis
- Rotator cuff tears
- Acute long head of biceps tendon tears
- Shoulder Impingement, calcific tendonitis and tendonitis
- Shoulder dislocations, labral tears, and recurrent shoulder instability
- Glenohumeral joint arthritis
- Acromioclavicular joint arthritis
- Clavicle, Scapula and Proximal Humerus fractures
- Pectoralis major tear
Shoulder pain with no diagnosis
For many patients with shoulder problems it can be challenging just to receive a final diagnosis and treatment plan. There are many pain generators in the shoulder. There is often an overlap in the symptoms between several structures including the rotator cuff, biceps tendon, acromioclavicular joint (AC joint) and glenohumeral joint/labrum. One of our major goals at The Shoulder Centre is to shorten the time to diagnosis and to provide a treatment plan that will see you through to better shoulder function.
Rotator cuff tears
The rotator cuff is made up of four muscles and their tendons which allow you to move your arm away from your body. Rotator cuff tears are common affecting 60% of 60 year olds. Only a small proportion of these tears cause symptoms such as pain and weakness. Many patients with painful rotator cuff tears also experience sleep disturbances, waking up due to pain in their shoulder.
Arthroscopic rotator cuff repair has the potential to decrease the pain associated with rotator cuff tears and works to restore function to the arm. Many patients find that sleep is also improved after they recover from surgery.
Acute long head of biceps tendon tears
Two of the biceps muscle’s tendons attach it to the bones of the shoulder while a third tendon attaches to the radius bone at the elbow. The “long head” tendon attaches the muscle to the top of the shoulder’s socket and the “short head” attaches it to the shoulder blade. A tear is when a tendon partially or fully comes away from the bone.
Possible Symptoms: Pain in the front of the arm, cramping in the bicep muscle, arm fatigue, anterior shoulder pain
Possible Causes: Serious or constant overuse; as a result of injury (i.e. such as moving or twisting your elbow or shoulder in an awkward way, falling down with your arm outstretched, lifting a heavy object). Biceps problems are also often found with subscapularis tears. The subscapularis is a rotator cuff muscle at the front of the shoulder. It supports the biceps tendon near the shoulder and tears in the subscapularis can lead to biceps instability.
Shoulder Impingement, calcific tendonitis and tendonitis
The shoulder is a very mobile joint even though it has many bones surrounding it. For various reasons there can be changes in the biomechanics (movement) of the shoulder resulting in pinching (impingement) of the structures of the shoulder. In addition, chronic pinching of the structures in the shoulder results in painful inflammation in the tendons of the shoulder and in the fluid that surrounds the shoulder structures. At times there is even a calcium deposit in the rotator cuff tendons.
Possible Symptoms: pain with overhead activity, or a “painful arc” of motion, pain at night causing poor sleep, difficulty lifting, pushing and pulling.
Shoulder Separations (Acromioclavicular Instability)
Shoulder separations are common, often happening in hockey, falls from bikes and in car accidents. Pain and swelling in the front of the shoulder and eventually bruising on the chest are often seen immediately. If the separation is severe early surgery may be necessary to treat the instability. Many separations can be treated without an operation. If the AC joint becomes unstable after treatment in a sling followed by return to activities then a ligament reconstruction may be necessary.
Shoulder dislocations, labral tears, and recurrent shoulder instability
The shoulder becomes unstable when the ligaments, muscles and bones that hold together the shoulder’s ball and socket are over stretched or injured.
Possible Symptoms: It can feel like the shoulder is about to come out of place or that it has jumped back into its socket; sometimes you may experience clicking, catching or looseness of the shoulder
Possible Causes: trauma (such as falling), sports injury (eg football, hockey), as well as repetitive activities such as throwing sports and swimming.
Glenohumeral joint arthritis
The shoulder joint can wear out. Wear-and-tear arthritis (osteoarthritis) of the shoulder joint is relatively uncommon, but it can be a very disabling disease. Arthritis can also be caused by inflammatory arthritis, previous trauma, avascular necrosis or large, chronic rotator cuff tears. Patients with arthritis of the shoulder joint typically have gradually decreasing range of motion with increasing pain. Often locking and clicking with motion are also bothersome to patients.
Frozen shoulder (Adhesive capsulitis)
Every year a large number of people have a sudden decrease in shoulder range of motion without a clear cause. Painful decreases in shoulder motion without associated arthritis are grouped under the diagnosis of adhesive capsulitis. There is still a poor understanding of the reasons behind frozen shoulder, but it has been associated with diabetes and hypothyroidism. The largest problems with adhesive capsulitis is the delay to diagnosis, often putting off treatment of the shoulder through exercises and steroid injections, and potentially surgical capsular release.
Acromioclavicular (AC) joint arthritis
The AC joint joins the clavicle and the scapula at the front of the shoulder. With age the joint often shows signs of arthritis, and in some people it can be a source of pain, particularly when reaching across the body or when lifting heavy objects. When diagnosed as a part of shoulder pain surgical resection of the AC joint can improve shoulder function.
Clavicle, Scapula and Proximal Humerus fractures
The shoulder joint’s ball (humeral head and upper humerus) or socket (glenoid) can be fractured due to trauma. The clavicle, or collarbone can also be fractured, or broken. There is a lot of debate on the right treatment for these fractures, and an individualized approach to each patient should be taken. Specifically, we spend a significant amount of time discussing options with patients to guide them to make the right choice between allowing these fractures to heal or having surgery.
Pectoralis major tears
Pec. Major tears typically happen during bench press exercises. There is usually a pop in the upper arm with bruising in the chest and arm. Some people notice that their chest is asymmetric as well. The pain of injury settles quickly, but bodybuilders will notice that their strength does not come back to normal. Pectorals Major tears are best treated by surgical repair. Results are better with early repair, however, even chronic tears often improve with surgery.