What is the rotator cuff and how does it function. How does impingement syndrome develop and affect shoulder health. What are the symptoms of rotator cuff injury and available treatment options. How is rotator cuff disease diagnosed and managed effectively. What are the surgical procedures for repairing damaged rotator cuff tendons.

Understanding the Rotator Cuff: Anatomy and Function

The rotator cuff is a crucial component of shoulder anatomy, playing a vital role in arm movement and stability. But what exactly is the rotator cuff?

The rotator cuff consists of a group of flat tendons that fuse together, encircling the front, back, and top of the shoulder joint. These tendons are connected to short but powerful muscles originating from the scapula. When these muscles contract, they pull on the rotator cuff tendon, enabling the shoulder to rotate upward, inward, or outward – hence the name “rotator cuff.”

Understanding the anatomy of the rotator cuff is essential for recognizing potential issues and seeking appropriate treatment. Let’s delve deeper into the specific components and their functions:

• Supraspinatus: This muscle helps lift the arm away from the body
• Infraspinatus: Responsible for external rotation of the shoulder
• Teres minor: Assists in external rotation and arm adduction
• Subscapularis: Enables internal rotation of the shoulder

Each of these muscles works in tandem to provide stability and facilitate a wide range of shoulder movements. However, this complex system is also susceptible to various injuries and conditions, one of which is impingement syndrome.

Impingement Syndrome: Causes and Mechanisms

Impingement syndrome is a common shoulder condition that can lead to significant discomfort and reduced mobility. But what exactly causes this syndrome?

The uppermost tendon of the rotator cuff, known as the supraspinatus tendon, passes beneath the acromion – the bone on top of the shoulder. In some individuals, the space between the undersurface of the acromion and the top of the humeral head is quite narrow. This anatomical configuration can lead to the pinching of the rotator cuff tendon and the adherent bursa (lubricating tissue) when the arm is raised forward.

Over time, repetitive impingement can cause inflammation and swelling of the tendons and bursa, resulting in the painful condition known as “chronic impingement syndrome.” This syndrome can have far-reaching consequences for shoulder health and function.

Factors Contributing to Impingement Syndrome

Several factors can predispose an individual to impingement syndrome:

1. Acromion shape and thickness: A bone spur on the front edge of the acromion increases the likelihood of impingement
2. Activities involving forward arm elevation: Certain occupations or sports may put individuals at higher risk
3. Muscle imbalance: Injury or atrophy can cause the shoulder to move forward during specific activities, leading to impingement
4. Age-related changes: Natural wear and tear can contribute to the development of impingement syndrome

The Connection Between Impingement Syndrome and Rotator Cuff Disease

How does impingement syndrome relate to rotator cuff disease? The connection between these two conditions is significant and often progressive.

When the rotator cuff tendon and its overlying bursa become inflamed and swollen due to impingement syndrome, the tendon may begin to deteriorate near its attachment to the humerus bone. As impingement continues, the tendon sustains progressive damage and may eventually tear completely away from the bone.

This progression from impingement to rotator cuff disease highlights the importance of early intervention and proper management of shoulder conditions. Understanding this relationship can help patients and healthcare providers make informed decisions about treatment and prevention strategies.

Stages of Rotator Cuff Disease

Rotator cuff disease often progresses through several stages:

1. Inflammation: Initial swelling and irritation of the tendon and bursa
2. Fibrosis: Thickening and scarring of the bursa and tendon
3. Partial tear: Small tears develop in the tendon
4. Complete tear: The tendon separates entirely from the bone

Recognizing these stages can help in determining the most appropriate treatment approach and predicting outcomes.

Rotator Cuff Injuries: Beyond Impingement

While impingement syndrome is a common cause of rotator cuff damage, it’s not the only factor that can lead to injury. What other mechanisms can result in rotator cuff problems?

In young, athletic individuals, rotator cuff injuries can occur due to repetitive motions involved in activities such as throwing, overhead racquet sports, or swimming. These injuries result from repetitive stretching of the rotator cuff during the follow-through phase of the activity, rather than from impingement.

This type of injury is often associated with a joint imbalance, potentially linked to looseness in the front of the shoulder caused by weakness in the supporting ligaments. Understanding these alternative mechanisms of injury is crucial for proper diagnosis and treatment, especially in active individuals.

Common Causes of Non-Impingement Rotator Cuff Injuries

• Traumatic injuries: Sudden, forceful movements or falls
• Repetitive stress: Overuse in sports or occupational activities
• Degenerative changes: Age-related wear and tear
• Muscle imbalances: Weakness in supporting muscle groups

Recognizing Rotator Cuff Injury Symptoms

Identifying the symptoms of a rotator cuff injury is crucial for seeking timely medical attention. What kind of symptoms does a patient typically experience when the rotator cuff is injured?

The most common complaint is an aching pain located in the top and front of the shoulder, or on the outer side of the upper arm (deltoid area). This pain usually intensifies when the arm is lifted to an overhead position. Many patients report that the pain seems to worsen at night, often disrupting sleep.

Depending on the severity of the injury, there may also be weakness in the arm. In cases of complete rotator cuff tears, patients may be unable to lift their arm in the forward or outward direction at all.

Key Symptoms to Watch For

• Persistent shoulder pain, especially during overhead activities
• Weakness in the affected arm
• Limited range of motion
• Clicking or popping sensations during shoulder movement
• Pain that worsens at night or interferes with sleep

If you experience these symptoms, it’s important to consult a healthcare professional for a proper evaluation and diagnosis.

Diagnosing Rotator Cuff Disease: A Comprehensive Approach

Accurate diagnosis of rotator cuff disease is essential for developing an effective treatment plan. How is the diagnosis of rotator cuff disease proven?

The diagnostic process typically involves several steps:

1. Medical history: The physician carefully reviews the patient’s symptoms and medical background
2. Physical examination: This includes assessing range of motion, strength, and performing specific tests for impingement
3. Imaging studies: X-rays are used to visualize the bone anatomy, particularly looking for acromial spurs
4. Advanced imaging: MRI (magnetic resonance imaging) scans often provide definitive proof of rotator cuff injury

During the physical examination, the healthcare provider may observe signs of muscle atrophy or weakness if the rotator cuff tendons are injured. Special impingement tests can suggest the involvement of impingement syndrome.

The Role of Imaging in Diagnosis

While a thorough physical examination is crucial, imaging studies play a vital role in confirming the diagnosis and determining the extent of the injury. X-rays can reveal bone spurs or other structural abnormalities, while MRI scans provide detailed images of the soft tissues, including the rotator cuff tendons.

In some cases, ultrasound may also be used as a dynamic imaging tool to assess the rotator cuff during movement. This can be particularly helpful in identifying partial tears or tendon instability.

Treatment Options for Rotator Cuff Disease and Impingement

Once a diagnosis is established, what are the treatment options for rotator cuff disease and impingement syndrome? The approach to treatment typically follows a stepwise progression, starting with conservative measures and advancing to more invasive options if necessary.

Initial Treatment Approaches

The first line of treatment for rotator cuff disease and impingement typically includes:

• Rest and activity modification
• Ice or heat therapy
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Physical therapy to improve strength and flexibility
• Corticosteroid injections for pain relief

These conservative measures aim to reduce inflammation, alleviate pain, and improve shoulder function. Many patients experience significant improvement with these initial treatments.

Advanced Treatment Options

If pain and weakness persist despite conservative treatment, what are the next steps? The second line of treatment may include:

1. More intensive physical therapy
2. Evaluation for possible surgical intervention
3. Advanced imaging to assess the extent of tendon damage

In cases where the rotator cuff is already torn, the treatment options may include:

• Arthroscopic repair for partial tears
• Open surgery for large or complex tears
• Tendon transfer procedures in cases of irreparable tears

The choice of treatment depends on factors such as the size and location of the tear, the patient’s age and activity level, and overall health status.

Surgical Intervention for Rotator Cuff Repair

When conservative treatments fail to provide relief, surgical intervention may be necessary. How is a major injury to the rotator cuff tendon repaired surgically?

Rotator cuff repair surgery typically involves reattaching the torn tendon to the humeral head. This can be accomplished through various techniques:

1. Arthroscopic repair: Minimally invasive procedure using small incisions and a camera
2. Mini-open repair: Combines arthroscopy with a small incision for direct tendon repair
3. Open repair: Traditional surgery with a larger incision, typically used for complex tears

The specific surgical approach depends on the size and location of the tear, as well as the surgeon’s preference and expertise.

Post-Surgical Care and Rehabilitation

Following rotator cuff surgery, proper post-operative care and rehabilitation are crucial for optimal recovery. The rehabilitation program typically progresses through several phases:

1. Immobilization: Protecting the repair site immediately after surgery
2. Passive range of motion exercises: Gentle movements to prevent stiffness
3. Active assisted range of motion: Gradually increasing shoulder mobility
4. Strengthening exercises: Building muscle strength and endurance
5. Functional training: Preparing for return to normal activities

The duration and intensity of each phase vary depending on the extent of the repair and individual patient factors. Close collaboration between the surgeon, physical therapist, and patient is essential for successful rehabilitation.

Long-Term Outlook and Success Rates of Rotator Cuff Treatment

Patients undergoing rotator cuff treatment often wonder about the long-term outlook and success rates. How successful is rotator cuff surgery, and what can patients expect in terms of recovery?

The success rates of rotator cuff surgery are generally high, with many patients experiencing significant pain relief and improved function. However, outcomes can vary depending on several factors:

• Size and chronicity of the tear
• Patient age and overall health
• Compliance with post-operative rehabilitation
• Presence of other shoulder conditions

Studies have shown that approximately 80-95% of patients report satisfactory outcomes following rotator cuff repair surgery. However, it’s important to note that full recovery can take several months, and some patients may experience residual weakness or limited range of motion.

Potential Complications and Considerations

While rotator cuff surgery is generally safe and effective, patients should be aware of potential complications:

• Re-tear of the repaired tendon
• Stiffness or frozen shoulder
• Infection
• Nerve injury
• Deltoid detachment (in open surgery)

Regular follow-up with the healthcare team and adherence to post-operative instructions can help minimize these risks and optimize outcomes.

Preventive Measures and Lifestyle Modifications

While not all rotator cuff injuries can be prevented, there are steps individuals can take to reduce their risk and maintain shoulder health. What preventive measures and lifestyle modifications can help protect the rotator cuff?

1. Proper warm-up before physical activities
2. Maintaining good posture and ergonomics
3. Regular shoulder strengthening exercises
4. Avoiding repetitive overhead activities when possible
5. Using proper technique in sports and work-related tasks

For individuals engaged in occupations or sports that put them at higher risk for rotator cuff injuries, working with a physical therapist or athletic trainer to develop a preventive exercise program can be beneficial.

The Importance of Early Intervention

Recognizing the early signs of rotator cuff problems and seeking timely medical attention can make a significant difference in treatment outcomes. Early intervention may help prevent the progression of minor injuries to more severe tears, potentially avoiding the need for surgical intervention.

Regular check-ups with a healthcare provider, especially for individuals at higher risk, can help identify and address potential shoulder issues before they become more serious problems.

Rotator Cuff Impingement | Southern California Orthopedic Institute

Rotator Cuff Disease / Impingement Syndrome

Frequently Asked Questions

1.     What is the rotator cuff in the shoulder?
2.     What is impingement syndrome?
3.     How does impingement syndrome relate to rotator cuff disease?
4.     Why do some people develop impingement and rotator cuff disease and others do not?
5.     Other than impingement, what else can cause rotator cuff damage?
6.     What symptoms does a patient have when the rotator cuff is injured?
7.     How is the diagnosis of rotator cuff disease proven?
8.     What is the initial treatment for rotator cuff disease and impingement?
9.     What is the second line of treatment if pain and weakness persist?
10.     If the rotator cuff is already torn, what are the options?
11.     What will happen if the rotator cuff is not repaired?
12.     How is a major injury to the rotator cuff tendon repaired surgically?
13.     How is my shoulder treated after surgery?
14.     What is the rehabilitation program after rotator cuff surgery?
15.     How successful is rotator cuff surgery?

1. What is the rotator cuff?
The rotator cuff is a group of flat tendons that fuse together and surround the front, back, and top of the shoulder joint like a cuff on a shirt sleeve. These tendons are connected individually to short, but very important, muscles that originate from the scapula. When the muscles contract, they pull on the rotator cuff tendon, causing the shoulder to rotate upward, inward, or outward, hence the name “rotator cuff.”

2. What is impingement syndrome?
The uppermost tendon of the rotator cuff, the supraspinatus tendon, passes beneath the bone on the top of the shoulder, called the acromion. In some people, the space between the undersurface of the acromion and the top of the humeral head is quite narrow. The rotator cuff tendon and the adherent bursa, or lubricating tissue, can therefore be pinched when the arm is raised into a forward position. With repetitive impingement, the tendons and bursa can become inflamed and swollen and cause the painful situation known as “chronic impingement syndrome.”

3. How does impingement syndrome relate to rotator cuff disease?
When the rotator cuff tendon and its overlying bursa become inflamed and swollen with impingement syndrome, the tendon may begin to break down near its attachment on the humerus bone. With continued impingement, the tendon is progressively damaged, and finally, may tear completely away from the bone.

4. Why do some people develop impingement and rotator cuff disease when others do not?
There are many factors that may predispose one person to impingement and rotator cuff problems. The most common is the shape and thickness of the acromion (the bone forming the roof of the shoulder). If the acromion has a bone spur on the front edge, it is more likely to impinge on the rotator cuff when the arm is elevated forward. Activities which involve forward elevation of the arm may put an individual at higher risk for rotator cuff injury. Sometimes the muscles of the shoulder may become imbalanced by injury or atrophy, and imbalance can cause the shoulder to move forward with certain activities which again may cause impingement.

5. Other than impingement, what else can cause rotator cuff damage?
In young, athletic individuals, injury to the rotator cuff can occur with repetitive throwing, overhead racquet sports, or swimming. This type of injury results from repetitive stretching of the rotator cuff during the follow-through phase of the activity. The tear that occurs is not caused by impingement, but more by a joint imbalance. This may be associated with looseness in the front of the shoulder caused by a weakness in the supporting ligaments.

6. What kind of symptoms does a patient have when the rotator cuff is injured?
The most common complaint is aching located in the top and front of the shoulder, or on the outer side of the upper arm (deltoid area). The pain is usually increased when the arm is lifted to the overhead position. Frequently, the pain seems to be worse at night, and often interrupts sleep. Depending on the severity of the injury, there may also be weakness in the arm and, with some complete rotator cuff tears, the arm cannot be lifted in the forward or outward direction at all.

7. How is the diagnosis of rotator cuff disease proven?
The diagnosis of rotator cuff tendon disease includes a careful history taken and reviewed by the physician, an x-ray to visualize the anatomy of the bones of the shoulder, specifically looking for acromial spur, and a physical examination. Atrophy may be present, along with weakness, if the rotator cuff tendons are injured, and special impingement tests can suggest that impingement syndrome is involved. An MRI (magnetic resonance imaging) scan frequently gives the final proof of the status of the rotator cuff tendon. Although none of these tests is guaranteed to be 100% accurate, most rotator cuff injuries can be diagnosed using this combination of exams.

8. What is the initial treatment for rotator cuff disease and impingement?
If minor impingement or rotator cuff tendinitis is diagnosed, a period of rest coupled with medicines taken by mouth, and physical therapy will frequently decrease the inflammation and restore the tone to the atrophied muscles. Activities causing the pain should be slowly resumed only when the pain is gone. Sometimes a cortisone injection into the bursal space above the rotator cuff tendon is helpful to relieve swelling and inflammation. Application of ice to the tender area three or four times a day for 15 minutes is also helpful.

9. What is the second line of treatment if the rotator cuff pain and weakness persist?
If there is a thickened acromion or acromial bone spur causing impingement, it can be removed using arthroscopic visualization. This procedure can often be performed on an outpatient basis, and at the same time, any minor damage and fraying to the rotator cuff tendon and scarred bursal tissue can be removed. Often this will completely cure the impingement and prevent progressive rotator cuff injury.

10. If the rotator cuff is already torn, what are the options?
When the tendon of the rotator cuff has a complete tear, the tendon often must be repaired using surgical techniques. The choice of surgery, of course, depends on the severity of the symptoms, the health of the patient, and the functional requirements for that shoulder. In young working individuals, repair of the tendon is most often suggested. In some older individuals who do not require significant overhead lifting ability, surgical repair may not be as important. If chronic pain and disability are present at any age, consideration for repair of the rotator cuff should be given.

11. What will happen if the rotator cuff is not repaired?
In some situations, the bursa overlying the rotator cuff may form a patch to close the defect in the tendon. Although this is not true tendon healing, it may decrease the pain to an acceptable level. If the tendon edges become fragmented and severely worn, and the muscle contracts and atrophies, repair at that point may not be possible. Sometimes in this situation, the only beneficial surgical procedure would be an arthroscopic operation to remove bone spurs and fragments of torn tissue that catch when the arm is rotated. This certainly will not restore normal power or strength to the shoulder, but often will relieve pain.

12. How is a major injury to the rotator cuff tendon repaired surgically?
The arthroscope is extremely helpful when repairing rotator cuff tendons, but sometimes it is necessary to add a “mini-open” procedure if the tendon is completely torn. Using the arthroscope at the beginning of the case allows visualization of the interior of the joint to facilitate trimming and removal of fragments of torn cuff tendon and biceps tendon. The next step utilizes the arthroscope to visualize the spur and thickened ligament beneath the acromial bone, while they are removed with miniature cutting and grinding instruments. If it is necessary to suture a rotator cuff tear which has pulled off the bone, a two-inch incision can be made directly over the tear that has been visualized and localized using the arthroscope. The deltoid muscle fibers can be spread apart so that strong stitches can attach the rotator cuff tendon back to the bone. If the tear is minimally retracted, small suture screw anchors may be used arthroscopically or open.

13. How is my shoulder treated after surgery?
In a minor operation for impingement, the shoulder is placed in a simple sling. If a full thickness tear of the rotator cuff was present and repaired, then the shoulder will be supported by an UltraSling or a SCOI post-operative brace. The brace is very helpful because it will allow exercise of the elbow, wrist, and hand at all times, and places the arm in a position that promotes better blood circulation and relieves stress on the repaired rotator cuff tissues. In addition, the shoulder can be exercised in the brace much easier than when it is at the side in an immobilizer.

14. What is the rehabilitation program after rotator cuff surgery?
Depending on the type of surgery performed, the program will allow a period of time for healing of the soft tissues followed by time to regain range of motion and then strengthen the shoulder muscles, but particularly the rotator cuff. In minor tendinitis and impingement syndrome, the program takes approximately two to three months. If the rotator cuff tendon has been completely torn, it may take six months or more before the atrophied muscles can resume their function and the range of motion of the arm is restored. Frequently, pain relief is much quicker and return to daily activities is often possible by two to three months.

15. How successful is rotator cuff surgery?
Again, every case is unique. In the young, healthy person with a minor rotator cuff impingement, surgery is predictably successful. As the injury becomes more severe, such as with a large bone spur and fragmentation of the tendon, then a perfect result cannot be expected. Since it is necessary to trim back the unhealthy tendon before reattaching it to the bone, a decreased range of motion of the shoulder will often result. Despite this, pain relief and return of strength are usually well worth the minor decreased mobility. The final outcome often depends on the willingness and ability of an individual patient to work on their post-operative physical therapy program.

Shoulder Arthritis: Symptoms & Treatment

Diagnosis

Diagnosis of shoulder arthritis begins with a history and physical exam. During the exam, the physician will be looking for:

• Pain when moving the shoulder or arm
• Grinding of the joint
• Weakness of the shoulder
• Tenderness to touch

If your doctor is suspicious of shoulder arthritis, he or she may order an X-ray. X-rays show the bones of the shoulder and can show:

• Decreased space between the bones
• Bone cysts
• Bone spurs at the edges of the joint (Figure 2)

If X-ray demonstrates arthritis of the A-C joint, you could be at risk for a rotator cuff injury. If your doctor is suspicious of this, an MRI may be needed.

Treatment

Treatment of shoulder arthritis starts with non-surgical treatment, and some of those options may include:

• Rest
• Activity modifications
• Physical therapy
• Non-steroidal anti-inflammatory medications such as ibuprofen
• Cold treatments and/or moist heat
• Cortisone shots (steroid injections)

If these treatments do not work to decrease your symptoms, then surgery may be discussed. For arthritis of the A-C joint, this would usually involve removal of the end of the clavicle. For arthritis of the G-H joint, surgery usually involves a joint replacement operation. During this operation, the damaged surfaces of the ball and socket shoulder joint are replaced with metal and plastic (Figure 3). If there is a large rotator cuff tear that may not be able to be reliably repaired and arthritis at the same time, you may need a “reverse” total shoulder. The reverse shoulder turns the humeral head into the cup side of the joint and the glenoid into the head side which moves the center of rotation away from the body. This helps lift the arm without the rotator cuff.

© 2020 American Society for Surgery of the Hand

This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.

Shoulder Arthritis: Types, Treatments, Surgery

After the hip and knee, the shoulder is the third most common joint affected by arthritis, perhaps because in most people, it is not a weightbearing joint, as are the large joints of the lower limbs. However, as in the hip and knee, the loss of cartilage that characterizes shoulder arthritis is frequently a source of severe pain, limited function, joint stiffness, and significant diminishment of quality of life. While there is no cure for arthritis, there are many treatments, both nonsurgical and surgical, that enable the symptoms to be well treated and for patients to maintain active lifestyles.

Arthritis has its word origin from the Greek word, “arthron”, meaning joint. “Itis” probably of Latin derivation, and refers to inflammation. While literally arthritis therefore means “inflamed joint,” it has come to refer to any condition of the joint in which there is damage to the smooth cartilage covering a moving surface of a joint (called the articular cartilage), eventually leading to cartilage loss, in the end stage resulting in “bone on bone” of the joint surfaces, and pain.

Fig. 1: X-ray showing osteoarthritis of the shoulder joint

The normal, unaffected shoulder

The shoulder is made up of a number or interconnected bones. The upper end of the humerus is a ball, called the humeral head, which “rests against” the socket, a part of the scapula called the glenoid. Unlike the hip, also a ball-socket joint but one with a deep socket made for stability, the shoulder is made not for stability but motion – and has the most motion of any joint in the body. The ball of the shoulder joint moves against the socket, but because it “rests against” the socket, rather than being well contained in it, it is reliant on the soft tissues for both its stability and motion. It is stabilized by both ligaments (cords that attach to both ball and socket) and tendons (soft tissue attachments of muscle to bone). The tendons of the shoulder “rotate” the ball in the socket, and are called the rotator cuff. The four rotator cuff tendons thus supply movement to the shoulder and stability, and can themselves be subject to injury, wear and tear, and degeneration (rotator cuff tear).

Fig. 2: Anatomy of the shoulder, featuring the humerus (upper arm bone), the glenoid (shoulder socket), the ligaments, and tendons. [Illustration by Robert O’Conor]

What kinds of arthritis affect the shoulder?

The most frequently occurring types of arthritis which affects the shoulder are osteoarthritis, inflammatory arthritis, rotator cuff tear arthropathy, osteonecrosis and post-traumatic arthritis.

Osteoarthritis: Similar to the hip and knee, this is also called a “wear and tear” type of arthritis, and probably occurs as some combination of use, genetics, micro trauma, and increased forces across the joint. The cartilage loses its normal chemical makeup, becomes frayed and worn, and eventually disappears; without this protective covering, the underlying bones grind against one another, causing pain.

Inflammatory arthritis: In conditions such as Rheumatoid Arthritis, multiple factors often having to do with the immune system, lead to inflammation of the joint and joint lining, ultimately wearing away the cartilage surfaces. Fortunately, the medical treatment of many types of inflammatory arthritis has made tremendous advances, and the need for surgical treatment has greatly diminished.

Rotator cuff tear arthropathy: This is the end stage of very large tears of the rotator cuff tendon. A confluence of four muscles which stabilize and are the primary movers of the shoulder joint, which have been left untreated. While large tears of the rotator cuff tendon, are uncommon, an estimated 4% of patients with untreated rotator cuff tears develop cuff tear arthropathy. Treatment of shoulder arthritis caused by cuff tear arthropathy can be particularly difficult, since it results from damage to both soft tissue support of the joint as well as the joint surface.

Fig. 3: Xray showing both arthritis and big tear of rotator cuff tendon

Osteonecrosis (Avascular necrosis): An unusual condition in which the blood supply to the bone forming the ball of the shoulder is interrupted, leading to the death and collapse of a segment of the bone. With loss of the bone support, the overlying cartilage is subject to forces which cause the cartilage to become damaged as well.

Post-Traumatic Arthritis: This can result from a fracture of the ball or of the socket, in which the cartilage surface is damaged at the time of the bone fracture. Eventually, this damage can cause the cartilage surface to wear out and disappear.

What are the symptoms of shoulder arthritis?

As with other joints, the most common symptom of shoulder arthritis is pain during activity. In time, pain can occur at rest, and may even interrupt sleep. As the cartilage disappears, the joint becomes stiff, reducing range of motion, and limiting activity, often causing interference with even the most common tasks of everyday life, such as dressing, reaching for objects, and even personal hygiene. As joint motion is lost, tasks such as driving, athletic activity, housework, and even writing and computer work can be affected. The pain is frequently centered on the back of the shoulder, but commonly is felt all the way down the arm to the elbow.

Perhaps the most disabling symptom for most people is the loss of sleep, as it frequently becomes difficult to find a comfortable position either on the affected or unaffected side.

Motion is often severely affected, and may be accompanied by cracking, grinding, or catching (crepitus) as the ball/socket bones rub against one another.

The doctor’s evaluation

With progression of shoulder arthritis symptoms, examination will frequently demonstrate stiffness or loss of motion. Strength may be affected, and crepitus elicited as the arm is moved.

Usually an x-ray will show the degree of articular cartilage loss and the presence of arthritis. Since cartilage does not show on an x-ray, in a normal joint its presence is demonstrated by a “space” between ball and socket. As the cartilage disappears, the space narrows on an x-ray, and in the end stage, the bone of the ball can be seen directly against the bone of the socket. In addition, bone spurs (osteophytes) which develop around the joint margins are frequently seen in some types of arthritis.

A CT scan is a computerized study which may be used to outline the bone of the shoulder joint in more detail, while a MRI scan is a test in which a magnetic coil is put over the area to be studied. This gives information about the bone and cartilage, but has its greatest use in demonstrating the condition of the surrounding soft tissues, particularly the muscles and tendons of the shoulder.

How is shoulder arthritis treated?

As is the case in any other joint, the initial treatment of shoulder arthritis is usually nonsurgical. This may include: activity modification, physical therapy and other measures. If these prove insufficient, arthroscopic surgery or shoulder replacement may be appropriate.

Activity modification: avoiding the activities which put the most stress on the arms, reducing the weight lifted by the involved arm, and attempting to modify athletic activities to those which may put less stress on the involved arm.

Moist heat may make the arm feel more comfortable.

Icing the shoulder three or four times daily may help role reduce inflammation, particularly after sports or stress on the shoulder

Physical therapy: may play a role in maintaining or improving range of motion and strength, but may in some circumstances aggravate the pain from arthritis – so its role should be reevaluated if it is a source of aggravation of pain.

Nonsteroidal ant-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin can be effective over-the-counter medication. These medications can irritate the stomach, and most people should take them with meals. Prescription anti-inflammatory medications are also available, and may be more convenient in dosages require, have fewer side effects, and be better tolerated. In any event, your doctor should be made aware of any medications you may be taking, and the role of potential interactions.

Dietary supplements, such as glucosamine or chondroitin sulfate. While some patients find relief with these, there is little scientific evidence of the role or value of dietary supplements in arthritis treatment. In addition, the FDA does not regulate these supplements, and there may be interactions with other medications you are taking. Consultation with your physician is recommended before taking dietary supplements.

Injection of corticosteroids (cortisone) may help a role to treat the inflammation inside the joint. While there is often little risk associated with a joint injection of cortisone, its effects, if positive, may not be long lasting. In addition, patients who have diabetes may see a rise in blood sugar for a variable period of time after a cortisone injection

Injection of viscosupplementation: These synthetic compounds such as hyaluronic acid and derivatives are similar in structure to normal joint fluid. They are injected into the joint in an effort to increase lubrication of the joint. These compounds are expensive and are approved only for use in the knee, the joint in which the most medical experience has been obtained. There is little information about whether there is any role for these compounds in the treatment of shoulder arthritis.

What is the surgery for shoulder arthritis?

If non-operative treatments are not effective, your doctor may discuss either shoulder arthroscopy or shoulder replacement surgery.

Arthroscopy: this is a minimally invasive operation requiring anesthesia, in which a small camera is placed inside the joint through a small incision. Through another incision, small instruments can be brought inside the joint to manipulate tissue.

Arthroscopy of the shoulder to remove loose fragments of cartilage and bone in the joint (debridement) may play a role in early arthritis when there is little damage to the joint surface. This does not eliminate arthritis, but can be helpful in removing loose pieces of tissue which are irritants. The benefits may be minimal, subjecting the patient to an operation and anesthesia, with essentially no role in effectively treating the symptoms when arthritis is advanced.

Shoulder Replacement – A shoulder replacement is an operation similar in concept to hip replacement or knee replacement, in which implants made of plastic and metal are placed to create new joint surfaces. During this operation, which requires an incision as with all open surgery, the arthritic ball is removed and replaced by a metal ball (prosthesis) that attaches to a metal stem that goes inside the upper humerus bone (similar to the way in which ice cream sits on top of a cone). The arthritic socket is covered by a smooth plastic socket, also called a prosthesis. It is the smooth metal ball moving on the smooth plastic socket that relieves pain.

Rehabilitation after surgery

Because the shoulder has the widest range of motion of any joint in the body, recovery from injury, damage, or surgery is frequently aided by rehabilitation and physical therapy, either to improve or maintain motion, or to foster improvements in strength.

Future developments

As in all areas of orthopedic surgery, the future continues to be bright for treatment options in shoulder arthritis. At HSS, considerable time and effort is dedicated to improving outcomes and treatment methods to offer our patients with arthritis. Areas currently being investigated include:

• attempting to understand why arthritis develops in an effort to apply our knowledge to its prevention
• new medications by mouth – or other means of administration – to treat the varied arthritic conditions
• joint lubricants, similar to those used in the knee, are being studied
• joint replacement surgery, including ongoing investigation of designs and materials, and understanding how these can be improved
• biologic materials to restore articular cartilage surfaces on a joint or to encourage or engineer more normal tissue when the joint is damaged, to foster new growth and promote healing

Summary

While less common than hip or knee arthritis, shoulder joint arthritis can be equally disabling and have a significant impact on quality of life.

Fortunately there are both effective non-operative and operative treatments, depending on the severity and degree of disability, which makes this disease one which is compatible with a productive, healthy, active life.

Back in the Game patient stories

University Orthopedics – Bone Spur

Overview | Causes | Symptoms | Diagnosis | Treatment | FAQ

Overview

A bone spur, or osteophyte, is an excess growth of bone around a vertebral body. Bone spurs are fairly common in people
over the age of 60. It is not the bone spur itself that is the real
problem; pain and inflammation begin to occur when the bone spur
rubs against nerves and bones. If bone spurs grow too much, they can impinge on nerve roots.

Causes

As we age, the discs in our spine naturally degenerate and lose some
of their natural shock-absorbing ability. Factors that contribute
to and accelerate this process include stress, injury, poor posture,
poor nutrition, and family history.

It is not uncommon for people with osteoarthritis to
get bone spurs. Osteoarthritis is a degenerative condition in which
joint cartilage begins to wear down, causing bone to rub against bone.
As a result, the body may begin to produce new bone to protect against
this, which is how a bone spur forms.
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Symptoms

• Back pain and neck pain
• Pain radiating through an arm and/or leg
• Prominent lumps on the hands, feet or spine
• Numbness
• Burning
• Muscle cramps

Diagnosis

Outlined below are some of the diagnostic tools that your physician
may use to gain insight into your condition and determine
the best treatment plan for your condition.

• Medical history: Conducting a detailed medical history
  helps the doctor better understand the possible causes of your back
  and neck pain which can help outline the most appropriate treatment.
• Physical exam: During the physical exam, your physician
  will try to pinpoint the source of pain. Simple tests for flexibility
  and muscle strength may also be conducted.
• X-rays are usually the first step in diagnostic testing
  methods. X-rays show bones and the space between bones. They are
  of limited value, however, since they do not show muscles and ligaments.
• MRI (magnetic resonance imaging) uses a magnetic field
  and radio waves to generate highly detailed pictures of the inside
  of your body. Since X-rays only show bones, MRIs are needed to visualize
  soft tissues like discs in the spine. This type of imaging is very
  safe and usually pain-free.
• CT scan/myelogram: A CT scan is similar to an MRI
  in that it provides diagnostic information about the internal structures
  of the spine. A myelogram is used to diagnose a bulging disc, tumor,
  or changes in the bones surrounding the spinal cord or nerves. A
  local anesthetic is injected into the low back to numb the area.
  A lumbar puncture (spinal tap) is then performed. A dye is injected
  into the spinal canal to reveal where problems lie.
• Electrodiagnostics: Electrical testing of the nerves
  and spinal cord may be performed as part of a diagnostic workup.
  These tests, called electromyography (EMG) or somato sensory evoked
  potentials (SSEP), assist your doctor in understanding how your nerves
  or spinal cord are affected by your condition.
• Bone scan: Bone imaging is used to detect infection,
  malignancy, fractures and arthritis in any part of the skeleton.
  Bone scans are also used for finding lesions for biopsy or excision.
• Discography is used to determine the internal structure
  of a disc. It is performed by using a local anesthetic and injecting
  a dye into the disc under X-ray guidance. An X-ray and CT scan are
  performed to view the disc composition to determine if its structure
  is normal or abnormal. In addition to the disc appearance, your doctor
  will note any pain associated with this injection. The benefit of
  a discogram is that it enables the physician to confirm the disc
  level that is causing your pain. This ensures that surgery will be
  more successful and reduces the risk of operating on the wrong disc.
• Injections: Pain-relieving injections can relieve
  back pain and give the physician important information about your
  problem, as well as provide a bridge therapy.

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Treatment

The goal when treating bone spurs is to minimize pain and prevent any
additional joint damage. Treatment methods may include weight loss,
stretching and physical therapy, rest and ice. Injections can reduce
inflammation long enough to relieve symptoms. Medications such as
ibuprofen or injections may be administered for pain. Bone spurs
can be surgically removed in the case of serious damage and deformity.
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FAQs

How can osteoporosis impact the spine and cause
a bone spur?

Osteoporosis can have extremely serious consequences on the spine.
It is a degenerative condition in which joint cartilage can begin to
wear down, causing bone to rub against bone. As a result, the body
may begin to produce new bone to protect against this, which is how
a bone spur forms.

How can I tell if I have a bone
spur?

Bone spurs can generally be detected through X-ray, which can provide
a visual of any bony deposits.

Do I need surgery to treat a bone
spur?

Because bone spurs are usually evidence of an underlying problem, this
main problem should be addressed first. This can include treatment
methods for degenerative disc disease, arthritis and osteoporosis.
These conditions can often be successfully treated with nonsurgical
methods, such as interventional pain management.
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Impingement Syndrome of the Shoulder

What structures are involved in an Impingement Syndrome?

There are three bones that make up the shoulder complex: the scapula (shoulder blade), the humerus (the upper arm bone) and the clavicle (the collar bone). The rotator cuff attaches the humerus to the scapula. The muscles that make up the rotator cuff are: supraspinatus, infraspinatus, teres minor and subscapularis.

A tendon is the part of the muscle that attaches it to the bone. The purpose of the rotator cuff is to rotate the humerus as well as to pull the head of the humeral down during arm elevation in order to avoid pinching any structures. The rotator cuff is also responsible for holding the humerus tightly into the socket of the scapula (the glenoid fossa).

The upper part of the scapula that makes up the roof of the shoulder is called the acromion. A bursa is located between the acromion and the rotator cuff tendons. A bursa is a lubricated sac of tissue that cuts down on the friction between two moving parts. This bursa (the subacromial bursa) protects the acromion and the rotator cuff from grinding against each other.

What are the causes of shoulder impingement?

• Weakness in the rotator cuff muscles, which increases the frequency and pressure of contact between the rotator cuff, the bursa and the acromion.
• Constant rubbing of these structures with increased friction can cause bone spurs to form on the acromion. This further reduces the space for these structures.
• Oddly sized acromion where the acromion tilts too far down, which reduces the space between it and the rotator cuff.

Symptoms

• Generalized shoulder aches
• Difficulty sleeping because of pain
• Stiffness in the joint
• Catching sensation when raising the arm overhead
• Weakness in the arm with the reduced ability to raise the arm overhead

Treatment Options

Non-Surgical

• Anti-inflammatory medication
• Cortisone injection into the rotator cuff tendon or the bursa
• Physical Therapy consisting of modalities to decrease pain and/or inflammation, stretching exercises, strengthening exercises for the rotator cuff as well as functional retraining to avoid further or repeated injury

Surgical

Decompression The goal of surgery is to increase the space between the acromion and the rotator cuff tendons. The surgery may first remove any bone spurs that may have developed under the acromion that are rubbing on the rotator cuff tendons and the bursa. Usually the surgeon removes a small part of the acromion to give the tendons even more space. In patients with a downward tilt to the acromion, more of the bone may need to be removed.

Rotator Cuff Repair If the rotator cuff is seen to be torn, it may be from constant rubbing on the acromion, or from a traumatic injury such as a fall. Small tears located within the tendon are repaired utilizing sutures. If the tear is complete and is torn away from the bone (humerus), the surgeon creates a raw bony area by removing soft tissue from the bone. Drill holes are made in the humerus for attaching sutures. The tendon is then sewn together and stitched to the humerus by looping the sutures through the drill holes. Fasteners may also be used during this part of the procedure. The tendon then heals to the bone over time, reattaching itself.

During an open decompression and/or rotator cuff repair, the surgeon must first cut through the muscles and tissues on the front of the shoulder in order to view the rotator cuff tendons. After repairing the tendon, the muscle on the front of the shoulder (deltoid) is reattached to the bone.

It is important to note that not all rotator cuff tears can be repaired. In some cases the tear is so old that the tendons and muscles have retracted and cannot be stretched enough to be reattached. In other cases, the tendon tissue has simply worn away, and the remaining tendon is not strong enough to hold the necessary sutures. In these instances, simply removing all the torn tissue and repairing any other problems in the shoulder may reduce pain. This will probably not increase the strength or motion of the shoulder. In some of these cases, the range of motion of the shoulder may be reduced.

In most cases, these surgical procedures are performed on an outpatient basis. Medication may be pumped through a small tube into your shoulder joint for pain control. This is called a pain pump and will be removed by your physical therapist during the initial visit.

Upon discharge the following instructions should be followed:

• Wear a sling as prescribed by your surgeon
• Avoid getting the incision wet
• Ice the shoulder for 15 minutes every two hours that you are awake
• Avoid active movement of the arm away from your body

Sutures will be removed during the first postoperative visit with your surgeon.

Rehabilitation

In most cases, rehabilitation following a decompression and a rotator cuff repair will begin three days postoperatively.

The physical therapy will include:

• Inspection of the incision
• Passive range of motion during the first couple of weeks to maintain movement in the shoulder while protecting the structures that have been sutured
• Strengthening exercises when appropriate
• Home exercises
• In some cases, where the rotator cuff repair is fragile, the surgeon may recommend an abductor pillow, which maintains the shoulder in a position to protect the repair. In these cases, the surgeon may wait a couple of weeks prior to beginning physical therapy.

To consult with one of our doctors at Orthopedic Associates of Port Huron, please call (810) 985-4900 or click on the Appointment Request button.

To learn more about Shoulder Impingement Syndrome, please view this video.

Do You Know What Causes Them to Form?

Despite their painful-sounding name, most bone spurs actually don’t cause any symptoms or pain. In many cases, you might not even know you have any until an x-ray for an unrelated condition reveals them. 

However, when a bone spur does begin to disrupt the surrounding tissue, it can cause significant pain and loss of mobility. If you’ve begun to experience joint stiffness or weakness in your limbs, bone spurs could be to blame. 

Once they are diagnosed, there are a number of treatment options that can be used to alleviate the symptoms and improve your quality of life. 

What are Bone Spurs and What Causes Them?

A bone spur, also known as an osteophyte, is a smooth, hard bump of extra bone that slowly forms on the ends of bones. Their formation is much more common after age 60, but younger adults can also experience them in some cases. 

Bone spurs most commonly occur at joints, where two bones meet. They are most often caused by inflammation to that area. For example, due to osteoarthritis or tendonitis. 

Chronic inflammation at the joint stimulates osteoblasts, the cells that form new bone tissue, to deposit bone tissue in that area, eventually leading to a bony projection, or bone spur. 

In rare cases, they can occur due to congenital conditions that you’re born with. For example, an osteochondroma.

Common Locations for Bone Spurs

Bone spurs most commonly form around the joints, where two bones meet. This can happen anywhere in the body, but they are most common in your: 

• Hands
• Feet
• Shoulders
• Spine
• Neck
• Hips
• Knees

Generally, inflammation in the joint or surrounding connective tissue (tendons and ligaments) in these areas causes bone spurs to pop up. 

Bone Spur Signs and Symptoms

Most bone spurs take many years to form, and — as mentioned above — you might not ever experience symptoms. However, if the spurs begin to rub against your bones or nerves, you could feel pain or stiffness in the area. 

The exact symptoms you’ll experience depend on the location of the bone spur:

Shoulders

Your shoulder joint is able to move in many different directions due to its complex structure. This also invites formation of bone spurs, which could cause pain, stiffness, and weakness in your shoulder. 

Spine

Bone spurs in the spine usually form between the vertebrae. This can cause stiffness and pain in the back. If the nerves encased by the spinal column are affected, spinal spurs can also cause radiating pain, weakness, or tingling into the limbs. 

Neck

Bone spurs in the neck, or cervical spine, commonly form between vertebrae. This can result in aching or dull pain in the neck, which can worsen with activity. You could also experience headaches, reduced mobility, or radiating pain into your arm.

Hands

Spurs that form in the joints of the fingers are easier to see than in many other locations. You might notice that the joints in your fingers are knobby, and begin to experience stiffness, swelling, and pain at the affected joints. 

Feet

Bone spurs in the feet form on the heel, and can cause severe symptoms, such as a sharp pain when you first stand up in the morning, and a dull ache in the heel through the rest of the day. You might also be able to see a small, bony protrusion under the heel. 

Hips

Hip bone spurs can make it painful to move your hip, although you might actually experience the pain in the knee. Depending on their location on the joint, hip spurs can also reduce your hip’s range of motion.

Knees

The most common symptom of bone spurs in the knee is pain when you extend and bend your knee. 

Risk Factors and Underlying Conditions That Cause Bone Spurs

A number of underlying conditions can cause spur formation: 

Osteoarthritis

Osteoarthritis is by far the most common cause of bone spurs in any location in the body. This is arthritis caused by long-term wear and tear on the joints. It’s most common in adults over the age of 60, but can occur earlier if a joint has been damaged by repetitive use.

Autoimmune Disorders

Autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, and lupus can also cause bone spurs. In these conditions, spurs still tend to become more common with age, but can pop up in younger adults. 

Acute Injury

Spurs can also form after a joint or tendon is injured, such as in a sports injury or auto accident. The natural healing process for these injuries can sometimes stimulate excess bone growth as the body attempts to heal.

Other risk factors for bone spurs include: 

• Overuse — for example frequent running, dancing, or horseback riding over a long period of time
• Genetic predisposition 
• Diet, especially if you have certain food allergies and continue to eat these foods
• Obesity
• Narrowing of the spine (spinal stenosis)
• Degenerative disc disease

Bone Spur Treatment Options

The approach to treatment for bone spurs will depend on the severity of the spur, the severity of the symptoms, and the affected joint.

Conservative treatment options such as physical therapy, anti-inflammatory medications, and injections can help alleviate the pain and loss of mobility associated with bone spurs, and also decrease the underlying inflammation.

In severe cases, spurs can be removed through surgical procedures. This treatment option is more invasive, so is most commonly for severe cases where other treatment options haven’t been effective. 

If you are experiencing pain or stiffness that you think could be caused by a bone spur today, contact us to schedule an appointment with Dr. Bhatti at Atlanta Spine. Our team will identify the root cause of your pain and develop a treatment plan to improve your quality of life. 

Guide | Physical Therapy Guide to Osteoarthritis of the Shoulder

Without Surgery

When someone develops shoulder pain, the first recommended treatment is physical therapy. The following treatments can help decrease pain, improve movement, and allow increased use of your shoulder for daily activities. They may prolong the time until surgery is needed, or help you avoid it altogether.

• Improving tolerance of daily activities. Your physical therapist will work with you to help you get back to performing your daily tasks. Just changing your posture can reduce the pressure and forces at the joint and help reduce your pain. He or she may recommend the use of physical therapy “modalities” such as heat and cold, teach you about proper movement, and help you modify your activities to control your pain.
• Improving shoulder mobility. Your physical therapist can recommend ways to restore shoulder movement (range of motion). Stretching can lengthen tight muscles and ligaments, improving your posture and movement. Shoulder-joint mobilization may help improve movement and ease your pain. Your physical therapist may gently move your shoulder (manual therapy), to stretch the ligaments in ways normal stretching or arm motions do not.
• Improving the strength of your muscles. Strengthening the rotator cuff muscles can reduce the friction caused by the rough arthritic surfaces of the shoulder joint rubbing together. Support from the muscles that maintain your posture can help reduce forces on the shoulder joint.

Other options for treatment may include medications such as steroids or nonsteroidal anti-inflammatory drugs (NSAIDs). Injections of steroid or anesthetic medications may also help.

Following Surgery

There are several surgical options for treating shoulder OA, depending on the degree of damage at the joint and its surrounding structures, and your age, activity level, and occupation. 

Palliative Options: The goal of this surgery is to resolve symptoms; it does not restore or reconstruct the arthritic area. This option is best for people under the age of 65 with minimal cartilage problems, or people in their 20s to 40s with many active years ahead.

Reparative, Restorative, and Reconstructive Options: Over the last several years, surgeons have developed new “biologic resurfacing” techniques for younger people who have shoulder OA who are not yet ready for total shoulder replacement. Your doctor and physical therapist can describe them in detail for you. 

Total Shoulder Arthroplasty: Total shoulder arthroplasty is the medical term for a shoulder replacement. This is the best surgical technique for older patients with advanced OA who have good quality of bone at the shoulder joint and intact rotator cuff muscles. This procedure is best for people who do not plan to do high-level activities (overhead work at a job, overhead sports, or significant amounts of heavy lifting).

Shoulder Hemiarthroplasty: Shoulder hemiarthroplasty is a partial replacement of the joint. It is an option if the muscles that make up the rotator cuff of the shoulder are too weak or damaged to properly support and move the joint.

Reverse (Inverse) Total Shoulder Arthroplasty: This surgery is also an option when the muscles that make up the rotator cuff of the shoulder have failed or are irreparable, or a complex fracture is present.

Arthroscopy: Many shoulder surgeries can be done via arthroscopy, a less invasive surgery by which the surgeon makes small incisions in the skin and inserts pencil-sized instruments (with a camera) into the joint to repair damage.

Postsurgical physical therapy varies based on the procedure performed. It may include:

• Ensuring your safety as you heal. Your surgeon and physical therapist work together as a team to return your shoulder to health. After the surgeon completes his or her work, your work begins. You will perform specific activities and exercises at the correct time to allow for optimal healing. All surgical procedures modify your shoulder joint and surrounding tissues. Restorative and reconstructive options may take several months to heal, with longer precautions.
• Aiding motion of the shoulder. After surgery, your shoulder will be sore and swollen, and you may not feel like moving your arm. However, gentle motion is often recommended. Your physical therapist may move your arm or assist you in moving your arm to begin to gently restore movement. After some surgeries, movement is restricted during healing; your physical therapist and surgeon will choose the best options for recovery and guide you through the process.
• Strengthening the shoulder. Due to prior disuse or postoperative pain, your muscles may not be as strong as normal. If the muscle was repaired during surgery, you will have to let it heal for a period of time, and your physical therapist can let you know what activity is safe to help the healing along.
• Relieving your pain. Using manual (hands-on) therapies and other modalities, your physical therapist can help reduce your pain during exercise and daily activities.
• Getting back to work and activities of daily living. Returning to work and daily activities may be slow, and your physical therapist will guide you through the process to achieve the best results.

Heel spur | ortoped-klinik.com

Heel spur © Viewmedica

How to determine if a heel spur is the cause of foot pain?

A heel spur manifests itself in the form of acute throbbing pain in the foot and especially in the heel. Classically, acute pain occurs at night or after prolonged rest. Because of these cutting pains, the patient, when walking, transfers weight to the forefoot and begins to limp. After a load on the foot, after a while, the pain subsides, so that later, after a longer load, it will reappear.Typical for a heel spur is the course of the disease episodically, with more severe, and then with weaker pain.

It is important for the symptoms of the disease to distinguish between the lower and upper heel spurs. The latter is quite rare and is manifested by pain at the base of the Achilles tendon. This disease (Albert’s disease) requires a different approach to treatment than the typical lower heel spur.

Why does a heel spur appear?

An inferior calcaneal spur occurs as a result of repeated minor injuries at the junction of the tendon with the calcaneus.The forces of pressure and traction are responsible for this. The cause of these microdamages can be both prolonged wearing of hard and uncomfortable shoes, and prolonged forced stay in one position, for example, during regular car trips. As a result of these microdamages in the area of ​​the transition from the calcaneus to the plantar fascia (connective tissue formation, passing from the heel bone to the toes) is the deposition and gradual increase in salt deposits.

This reaction of the body, designed mainly for strengthening, unfortunately leads to additional stress on the connective tissues of the foot.As a result of such constant pressure in the area of ​​the heel spur, an inflammatory process begins and, accordingly, pain occurs.

What methods are used to diagnose a heel spur?

Treatment of a heel spur is carried out according to the so-called progressive scheme. This means that conservative treatment methods are applied step by step first. And only after there has been no improvement, surgical methods of treatment are used.

Possible conservative treatments for heel spur

• Arch support to reduce the load on the painful region
• Instep supports for supporting the instep
• Perforated soft insoles
• Softening heels
• Ultrasound
• Phonophoresis
• Iontophoresis
• Local cold therapy
• Stretching of adjacent muscles and ligaments
• Drug treatment
• Local injections with homeopathic substances
• Local injections of cortisone

Operative methods of treatment

• Extrakorporale Stosswellenlithotrypsie (high frequency wave therapy)
• Endoscopic heel spur removal

All of the above treatment methods complement each other or are applied in turn.In many cases, based on our experience, high-frequency wave therapy is the most effective and gentle pain treatment with a long-term effect. Therefore, only in the rarest cases there is a need for surgical intervention for endoscopic removal of the heel spur.

SRI TRAUMATOLOGY AND ORTHOPEDICS

A new minimally invasive method for endoscopic removal of the heel spur. Download

The youngest department of the institute was established in 2005.The department specializes in minimally invasive (arthroscopic) treatment of patients with injuries and diseases of the musculoskeletal system. The department is headed by M.E. Irismetov.

The department uses arthroscopic instruments from Karl-Storz. The arthroscopic method of treatment is used for injuries of the menisci, cruciate and lateral ligaments, for Koenig’s disease, removal of chondromic bodies, treatment of arthrosis. The staff of the department has developed methods for the diagnosis and treatment of meniscus cysts, extensor contracture of the knee joint, injuries of the extensor apparatus of the knee joint, as well as instability of the knee joint in case of improperly fused tibial fractures.An operation method for the pathology of the rotator cuff of the shoulder has been developed.

Implemented diagnostic and treatment methods for 2020
1. Arthroscopic debridement and resection in / 3 of the fibula of the knee joint.
2. Arthroscopic deep subchondral tunnelization of the knee joint.
3. Autoplasty of the internal lateral ligament of the knee joint.
4. One-stage autoplastic reconstruction of the cruciate ligaments.
5. Simultaneous autoplastic reconstruction of the anterior cruciate and internal lateral ligaments.

Introduced and widely used arthroscopic methods of autoplasty of the anterior and posterior cruciate ligaments from the semitendinosus and tender; muscles. Also, a method of two-beam lavsanoplasty has been developed for ruptures of the anterior cruciate ligament. A method has been introduced to stabilize the patella from the tendon of the tender muscle in case of habitual dislocation of the patella. Since the opening of the department, more than 5,000 patients have undergone arthroscopic surgeries. Currently, the Department of Sports Injury is the leader in arthroscopic diagnostics and treatment in our Republic.In 2015, 1,596 operations were performed. Of these, 172 were operations for reconstruction of the cruciate ligament of the sinus joint. The department employees underwent training in foreign countries such as Russia, Austria, Germany, South Korea and others and are actively involved in the speech of athletes’ injuries, in particular, participants in the International Olympiads in rhythmic and artistic gymnastics, springboard and cycling. Research is underway to improve the treatment of injuries that often occur in athletes. Scientists of the department have received more than 20 patents for inventions and utility models, published 150 journal articles, abstracts and Methodological recommendations.

The department deals with the treatment of the following diseases:

1. Injury of the knee joint meniscus
2. Damage to the cruciate and lateral ligaments of the knee joint.
3. Habitual dislocation of the patella.
4. Discoid menisci of the knee joint.
5. Pathological folds of the knee joint.
6. Goff’s disease.
7. Free chondromic bodies of the knee joint.
8. Synovitis.
9. Chondromatous disease.
10. Arthrosis – knee (gonarthrosis), hip-femoral (coxarthrosis), ankle-foot, shoulder, elbow, wrist joints.
11. Arthritis – knee, pelvic-femoral, ankle-foot, shoulder, elbow, wrist-radial joints.
12. Fractures of tubular bones.
13. Shoulder-scapular periarthritis.
14. Hallux valgus or varus deformity of the knee joint.
15. Bursitis.
16. Hallux-valgus.
17. Hammer-like deformity of the foot.
18. Achillodenia, Achilles bursitis.
19. Heel spur.
20. Habitual dislocation of the shoulder.
21. Intra-articular fractures of the knee joint.
22. Koenig’s disease.
23. Levan’s disease.
24. Extension contracture of the knee joint.
25. Flexor-extensor contracture of the elbow joint.
26. Orthopedic and traumatological problems of joints

contact number: +998 (71) 233-27-13

90,000 Treatment without drugs.- SAMSON Medical Center Severodvinsk

Treatment without drugs.

If you have a shoulder pain, epicondylitis and a heel spur?

We are pleased to offer you a method of Radial Shock Wave Therapy using the latest German equipment.

Radial shock wave therapy (RSWT) has a wide range of applications in Orthopedics, Rheumatology, sports rehabilitation.

Radial shock wave therapy

– affordable and non-invasive outpatient treatment.

– good portability!.

What is this new trend? – you ask.

Shock wave treatment is a medical method that has been successfully applied. An important component of the success of the method is its use as indicated.

Indications for shock wave therapy :

all types of insercytes (chronic pain at the site of attachment of the tendon to the bone), chronic radial and ulnar epicondylitis of the humerus, “tennis elbow”, patellar ligament syndrome, syndrome of the greater trochanter of the femur, achillitis, calcaneal spurs, humeral-scapular periarthropathy, tendinopathies and liopathies (diseases of tendons and ligaments), including those with calcareous deposits, trigger pains, muscle-tonic syndrome.

Contraindications for shock wave therapy are :

– pregnancy, oncological diseases, acute infectious diseases, the presence of a “pacemaker” (pacemaker) in the patient, conditions associated with a violation of the blood coagulation system and increased fragility of the vascular wall, growth zone, bone metaphysis; shock waves can cause irreversible damage to the growth zone and affect the further development of the skeleton, therefore, it is undesirable to prescribe RSWT to patients under 18 years of age, the areas closely adjacent to the ribs, intestines, great vessels.

The presence of metal structures in the affected area is a relative contraindication.

Get rid of pain – make an appointment now.

Shockwave therapy is a method of treatment using acoustic (shock) waves.

Early effects of RSWT

Improvement of microcirculation in tissues during and after the procedure, acceleration of metabolism, local anesthesia during the procedure.

Long-term effects of exposure to RSWT

Loosening of microcrystals of calcium salts and areas of fibrosis, increasing blood flow in damaged tissues and stimulating their regeneration.

Restoration of the structure and elasticity of ligaments, elimination of pain syndrome, improvement of microcapillary growth, restoration of blood supply in tissues!

Shockwave therapy for heel spurs

Heel spur (plantar fasciitis) is a chronic microtrauma of the plantar aponeurosis.

“Calcaneal spur” is a scar in the initial fragment of the plantar ligament at the place of its attachment to the calcaneus. The appearance of a heel spur is characterized by the appearance of sharp pain when resting on the heel. In the fibrous tissue, which forms over time at the site of injury, insoluble calcium compounds are gradually deposited. These deposits irritate the surrounding tissues and cause reactive inflammation, which is accompanied by pain.

On an X-ray image, the heel spur is similar in shadow density to bone tissue, and looks like a thorn.At the initial stage of the disease, when there are tears and inflammation, but there is still no calcium deposits, X-ray diagnostics are not conclusive.

The positive effect is achieved by reducing pain, destroying microcrystals of salts and loosening fibrous areas, improving blood flow and metabolic processes in tissues, Stimulating regeneration.

The device for the treatment of heel spurs creates a shock wave with special properties. The effect of anesthesia is manifested directly during the very first procedure for treating the spur with shock wave therapy.Usually the whole process takes 5-7 procedures, each 15-20 minutes long. and at intervals of 3 – 4 days.

Important! As a result of the treatment of heel spurs, shoulder pain, epicondylitis with RSWT, most patients develop a stable positive effect with weakening and complete relief of pain.

Compared to many other methods, including the use of traditional medicine recipes, shock wave therapy shows a significant result with almost complete absence of complications and side effects.

You have the opportunity to be treated on an outpatient basis without changing the rhythm of life !.

Stop enduring pain and discomfort, sign up to us!

Take Shockwave Therapy course .

Samson Medical Center

On Komsomolskaya!

House 20/38. Tel: 8-952-25-75-111, 8-902-28-58-111, 8 (8184) 566-286

www. samson29.rf

90,000 Impingement syndrome

Impingement syndrome is a condition in which, during movement in the shoulder joint, the tendons of the rotator cuff and biceps are pinched between the head of the shoulder and the acromion.The head of the humerus, with each raising of the hand, hits the acromion, while clamping the tendons between them. The impingement syndrome is characterized by significant pain and leads to a gradual limitation of movement in the shoulder joint.

Causes
Impulsion most often occurs in men after 40-45 years. The widespread prevalence of impingement syndrome among men is probably due to the fact that males are more engaged in physical labor.Shoulder impingement occurs among painters, construction workers, tennis players, gymnasts, and other professions and sports that involve raising the arm and performing above the head. In impingement syndrome, the head of the humerus collides with the acromion during arm movements.

At the moment the head of the shoulder collides with the acromion, the tendons of the rotator cuff are compressed between them. Constant collision in the shoulder joint over many years leads to trauma, degeneration of the cuff tendons and, as a result, to their rupture.

The inflammatory process in the subacromial space stimulates the growth of bones (osteophytes) on the surface of the
Acromion, which further reduces the space in which the rotator cuff moves. Acute osteophytes mechanically damage the rotator cuff, causing it to rupture.

It is the reduction and narrowing of the space between the acromion and the head of the shoulder that scientists associate with the development of impingement syndrome and damage to the rotator cuff.

Symptoms
Shoulder impingement syndrome is mainly manifested by pain. In the initial stages of the disease, pain is not expressed, only short-term discomfort is noted. As the disease progresses, pain appears first when raising the arm above the head, and later with all movements in the shoulder joint. The bursa in the subacromial space also becomes inflamed during impidgemetry.

Inflammation of the bursa is called bursitis in medicine. Pain with bursitis accompanies all types of movements in the shoulder, it can be combined with crunching and clicks in the joint.Sometimes the pain syndrome with bursitis manifests itself at night. In addition to pain, patients note a limitation of joint mobility, as well as a decrease in muscle strength in the shoulder area.

Diagnostics
Diagnosis and treatment of shoulder joint impingement syndrome is carried out by a traumatologist-orthopedist. At the beginning of the consultation, the doctor assesses the medical history. Usually, the doctor asks the patient about the time of the onset of pain in the joint, their intensity, the presence of previous shoulder injuries and chronic diseases.Next, the specialist proceeds to a clinical examination. During the examination, the doctor uses special stress tests to diagnose impingement.

X-ray examination for impingement syndrome is not very informative. However, radiographs can assess the degree of narrowing of the subacromial space, see calcifications in the cuff, and bone growths (osteophytes) in the scapula and clavicle.

This information leads the physician to suspect that a collision of the head of the shoulder and the acromion may occur in the joint, and that compression and damage to the rotator cuff occurs.Computed tomography (CT) allows you to more accurately assess the condition of the bones in the joint. With a CT scan, you can model the shoulder joint in three-dimensional space and examine it from all angles. Tomography allows you to identify the deformation of the acromion and measure the width of the subacromial space with an accuracy of 0.5 mm.

Magnetic resonance imaging allows you to visualize soft tissue formations in the shoulder area, such as the rotator cuff, articular lip, biceps tendons and others.On MRI it is possible to detect even small defects in the cuff, partial tears of the biceps, muscle degeneration, as well as signs of inflammation in the joint. The accuracy of MRI in assessing shoulder injuries is up to 86 percent.

Treatment
The initial manifestations of impingement syndrome can and should be treated conservatively. The main thing is to avoid loads that cause pain, and it is also necessary to avoid such hand movements in which the rotator cuff is squeezed. Physiotherapy is helpful in treating the initial stages of shoulder impingement.

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If all the measures described are ineffective, the patient remains in pain, movement in the joint is limited, there are signs of damage to the rotator cuff, then surgery is required.
Arthroscopic surgeries are currently performed for shoulder impingement syndrome, that is, without incisions through skin punctures.

The advantages of arthroscopy are minor surgical trauma to soft tissues, quick rehabilitation of patients after surgery and excellent cosmetic results.
For impingement syndrome, acromyoplasty and subacromial decompression are performed. During the operation, the resection of bone growths in the area of ​​the lower surface of the acromion is performed and its shape is corrected.

After the operation, the distance between the head of the shoulder and the edge of the acromion increases, and therefore, the rotator cuff is not impaired during movement. During the operation, you can also examine the rotator cuff from all sides and diagnose both full-layer and partial ruptures. If tears and injuries are detected, it is also possible arthroscopically to restore the integrity of the rotator cuff. An inflamed bursa or mucous bag in the subacromial space is also a source of pain, therefore it is also removed during arthroscopy.

The results of arotroscopic interventions with shoulder impingement are generally good and excellent. Relief of joint pain and increased mobility in the shoulder can be achieved in 85 percent of patients.
Duration of rehabilitation after impingement operations is on average about 3 weeks. In the first week, the patient wears a kerchief orthosis, which will be removed during exercise therapy. After surgery, the restoration of the rotator cuff is somewhat longer. The stitches are removed 12-14 days after the operation.

Department of Traumatology and Orthopedics – MEDSI

The Department of Traumatology and Orthopedics is a structural subdivision of the International Center of Oncology on the basis of MEDSI in Botkin Proezd.

The department employs a team of highly qualified doctors under the guidance of using exclusive progressive techniques. The department is specialized in minimally invasive interventions. There is a possibility of treatment under compulsory medical insurance.

Unique techniques:

• Minimally invasive methods of osteosynthesis, restoration of the ligamentous apparatus
• Radical removal of the intervertebral disc with anterior approach with fusion
• Use of cement and cementless endoprosthetics techniques
• All types of orthoscopic interventions on large and small joints

Up to 120 operations per month.

The department provides a comprehensive service (no caring relatives are needed).

Up to 30% of cured patients were refused in other hospitals or were queuing up for a quota for the VMP.

Branch structure:

• 17 double rooms
• 2 single rooms

Branch services:

• Planned surgical treatment
• Emergency medical service

Only large state centers have such functionality and equipment as the International Oncology Center based on MEDSI in Botkin Proezd, but they are limited by quotas.Because of this, there are huge queues (from 6 months to a year).

When working for cash, the price is 25-30% lower than the market price (due to the best prices for prostheses).

The whole range of services is provided in one hospital, Fast Track surgery, own rehabilitation. Compulsory medical insurance services using imported prostheses, when applying for compulsory medical insurance – a simplified document management system.

Services:

• Operations on the upper limb:
  • Replacement of the shoulder joint in case of complex fractures, destruction of the articular surface and other diseases (arthroplasty of the shoulder joint)
  • Minimally invasive (practically do not leave marks on the skin), high-tech surgeries on the shoulder, elbow, wrist joints using arthroscopic equipment.Recovery of muscles, tendons and ligaments in case of their injuries and chronic diseases. Operations for joint stiffness, for persistent pain that cannot be relieved by painkillers. Treatment of recurrent dislocations (restoration of the rotator cuff, restoration of the capsular-ligamentous apparatus of the shoulder joint, decompression of the shoulder and elbow joints, release of the elbow and shoulder joints, stabilization of the shoulder and joints in case of habitual dislocation)
  • Surgical treatment of the consequences of injuries, congenital and acquired deformities of the upper limb (non-union and improperly fused fractures, correction of curvature)
  • Hand surgery (restoration and treatment of tendons, ligaments and muscles of the hand, Dupuytren’s contracture, acquired bone diseases and the consequences of injuries and fractures, snapping finger, inflammation of the tendons and ligaments, restoration of the capsular-ligamentous apparatus of the finger joints, arthrodesis of the joints of the fingers, hand and wrist joint , arthroplasty of finger and hand joints, replacement of finger and hand joints in case of their destruction)
  • Operations for neoplasms of bones, muscles and connective tissue
• Operations on the lower limb:
  • Replacement of the hip joint (in case of destruction of the joint, violation of the shape of the joint, non-union of bone fractures)
  • Replacement of the knee joint (in case of destruction of the joint, violation of the shape of the joint, nonunion fractures of the bones)
  • Minimally invasive (practically do not leave marks on the skin), high-tech operations on the knee joint (cruciate ligament plastic surgery, patellar surgery (patella) for repeated dislocations, lateral ligament plastic surgery, surgical treatment of diseases and cartilage injuries, therapeutic and diagnostic arthroscopy, meniscus injury , stitching menisci)
  • Arthroscopic ankle surgery (treatment of plantar fasciitis (heel spur), Haglund-Schinz disease (bone growth on the heel), Achilles bursitis, tenosynovitis, ankle ligament plasty, ankle decompression)
  • Surgical treatment of deformities and consequences of injuries of the lower extremity (non-fused fractures of the femur and lower leg bones, improperly fused fractures, elimination of limb shortening, restoration of the axis of the lower extremities in acquired and post-traumatic deformities)
  • Foot surgery (surgical treatment of flat feet, straightening of toes, removal of bones and calluses).Treating persistent foot pain for which orthopedic shoes and pain medications do not help. Elimination of planovalgus deformity of the foot, arthrodesis of the joints of the foot and ankle joint, arthroplasty of the joints of the foot, correction of acquired and post-traumatic deformity of the foot and ankle joint
  • Operations for neoplasms of bones, muscles and connective tissue
• Spine surgery:
  • Minimally invasive interventions for chronic pain syndrome – osteochondrosis, dorsopathy (nucleoplasty, radiofrequency destruction)
  • Reconstructive, corrective and decompression operations for injuries, deformities and diseases of the spine
  • Surgical treatment of intervertebral hernias

Equipment

• MRT
• CT
• Arthroscopic equipment
• IOP-X-ray
• Digital radiography with full-length imaging

Directions of work

• Arthroscopic Surgery
• Endoprosthetics of joints
• Hand surgery and plastic reconstructive microsurgery
• Foot surgery
• Rehabilitation and restorative medicine
• Manufacturing of individual insoles and instep supports
• Rehabilitation and restorative medicine

What we treat

• Open and closed fractures (including the neck of the thigh, ankle, lower leg, fingers)
• Sprains and ruptures of ligaments (including ligaments of the knee joint, cruciate ligament, ankle)
• Dislocations (including shoulder, hip, ankle)
• Blunt injuries, bruises (including legs, arms, fingers, knee, coccyx, soft tissues)
• Injury of muscles and tendons
• Concurrent injuries
• Spine
• Shoulder joint
• Humerus
• Elbow joint
• Forearm bones
• Brush
• Pelvic bones
• Hip joint
• Femur
• Knee
• Shin bones
• Ankle
• Stop
• Toes
• Fingers
• Dupuytren’s Contract
• Acquired bone diseases and consequences of injuries and fractures
• We perform operations for neoplasms of bones, muscles and connective tissue
• Joint destruction
• Disorder of the shape of the joint
• Non-union fractures of bones
• Damage to menisci
• Plantar fasciitis (heel spur)
• Haglund-Schinz disease (bony growth on the heel)
• Achilles bursitis
• Tenosynovites
• We perform ankle ligament plasty, ankle decompression

Top-10 diagnoses

• Coxarthrosis
• Gonarthrosis
• Knee instability
• Shoulder instability
• Damage to the meniscus
• Subacromial impingement syndrome
• Fractures of long bones, foot and hand
• Deformation of feet
• Bone soft tissue neoplasms

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