• Who gets shoulder problems? • What is bursitis? • What is tendonitis? • What is an irritated rotator cuff? • What are the symptoms? • What is the treatment for shoulder impingement? • How can physical therapy help? • When is surgery helpful? • What kind of anesthesia is used? • How long does it take?

Who gets shoulder problems?
 
After age 25, most problems are caused by the effect of repeated overhead motions for a long period of time. Weekend athletes and do-it-yourselfers are especially vulnerable to overuse problems in the shoulder. The leading causes of shoulder pain are bursitis, tendonitis, and irritated rotator cuff. This group of conditions is called shoulder impingement syndrome.

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What is bursitis?
 
The bursa is a fluid-filled sac that cushions the rotator cuff tendons from the shoulder bone. An irritated bursa is caused by an inflamed rotator cuff. When irritated, the bursa produces extra fluid, the sac expands, and the pressure creates pain.

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What is tendonitis?
 
Deep in the shoulder are a group of tendons and muscles called a rotator cuff. They help stabilize the upper arm bone in the shoulder joint and rotate the arm. The biceps tendon is also present in front of the shoulder. When the arm is raised repeatedly over the head, the tendons rub against the underside of the shoulder bone and become irritated. The tendons swell, leaving even less space between tendons and bone. The irritation creates more irritation. It is much like a rope being drawn again and again across a craggy rock.

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What is an irritated rotator cuff?
 
Excessive wear on the rotator cuff can lead to severe irritation, roughening, and eventually ulceration and tearing of the cuff. An irritated rotator cuff is felt as a clicking or popping in the shoulder from a ragged piece of the cuff sliding under the shoulder bone, and arm weakness. Occasionally, injuries or infections can all lead to arthritis, although arthritis of the shoulder is less common than in the knee or hip. Arthritis in the shoulder causes a roughening of the joint from worn cartilage and loose fragments of bone.

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What are the symptoms?
 
Bursitis, tendonitis, irritated rotator cuff and arthritis are all inflammatory reactions to overuse. With any of these problems, a continuous dull ache in the shoulder can become a sharp pain when you try to move your arm, especially over your head. The pain may be worse at night after a heavy day of activities using your shoulder.

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What is the treatment for shoulder impingement?
 

•	Rest - Avoid strenuous activity and any motion that causes pain. In some cases a shoulder sling is helpful to rest fatigued muscles and inflamed tendons.
•	Ice - An ice pack on the affected shoulder can help ease inflammation when combined with gentle motion.
•	Oral Medicines - Anti-inflammatory medicines such as Motrin, Feldene, Voltaren, Naprosyn or aspirin will help reduce inflammation.
•	Cortisone Injections - Cortisone is a natural hormone and a very powerful medicine for inflammation. When injected directly into the inflamed area, it can be effective in decreasing swelling and inflammation that cause pain.

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How can physical therapy help?
 
Once the pain and inflammation are under control, a program of exercise, ice, heat, electrical stimulation, ultrasound and massage is used to help you regain motion.

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When is surgery helpful?
 
Thanks to recent advances in arthroscopy, many shoulder problems can be corrected using the same techniques that revolutionized the treatment of knee problems. Arthroscopy is an outpatient procedure requiring three tiny incisions closed with one stitch each. This procedure allows the surgeon to see and work inside the shoulder joint.
 
Problems that can be treated through arthroscopy include:
 

•	impingement syndrome
•	irritated rotator
•	torn cartilage
•	unstable joint

In some cases, however, if the rotator cuff is severely damaged and leads to arthritis, the only option for pain-free motion is a shoulder replacement. Shoulder replacement requires a 1-2 day hospital stay.

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What kind of anesthesia is used?
 
For maximum comfort, general anesthesia is preferred. Regional anesthesia is an option for some patients. Your surgeon will discuss which type is best for you.

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How long does it take?
 
Shoulder arthroscopies are performed as an outpatient procedure. The time from check-in to discharge usually is as little as two hours. Many people return to their normal activities within four to five days. People with physically demanding jobs can usually return to work in two to three weeks.

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