SHOULDER PROBLEMS IN THE AGING PATIENT
Dr. Kendall Black
One of the givens in the adult patient population is that we will begin to experience the effects of the accumulation of those years on our “parts”. In the shoulder this can be the result of previous injury, over-use, under-use, disorders of joints, muscles, ligaments, tendons, or any combination of these factors.
Changes in circulation, metabolism, nutrition, physical fitness, and many other illnesses can also contribute to the development of dysfunction of the shoulder joint. Not infrequently, the failure to recognize the need for a slower pace of activity, serves as the final straw in the precipitation of symptoms.
Most shoulder problems involve muscles, tendons, ligaments, joints, and soft tissues rather than bones. The three major categories of problems are:
Tendinitis is an inflammation of the tissue which connects muscle to bone. It may be Acute such as is seen in sudden overuse activities occurring in yard work, housework, or sporting activities. It may also be Chronic resulting from degenerative wear and tear due to age. Rotator Cuff disorders are the most common of these kinds of problems. Sometimes, excessive use or Rotator Cuff disorders can lead to bursitis which is swelling and inflammation of the fluid filled sacs located around the shoulder joint. One result of these conditions can be the development of adhesions which limit motion and can lead to a “frozen shoulder:
If the bones of the shoulder are forced out of their normal position, this can result in instability of the shoulder. This instability, in turn, aggravates any underlying soft tissue conditions resulting even more pain, weakness and loss of motion.
While the shoulder joint itself is not a weight-bearing joint and, therefore, not as subject to arthritis, the acromio-clavicular joint is more often involved with resulting spurring leading to impingement or pinching of the soft tissues. This also aggravates other conditions about the shoulder producing more symptoms.
Pain is the most common symptom of patients with shoulder problems. The pain is often dull aching pain worsened by position changes such as lifting the arm overhead. It can also be worsened by lifting objects, repetitive use and sleeping on the shoulder. With the onset of arthritis, impingement or bursitis, acute episodes of sharp, severe pain can occur in the sequence of events.
Weakness is another common symptom; especially in patients with rotator cuff involvement. It may be only secondary to the pain but it often result from weakening and tearing of the cuff. The weakness is usually worse with abduction or lifting the arm overhead.
Crepitus, popping or clicking can be caused by tearing of cartilage or the rotator cuff with scarring. It may be the result of instability of shoulder.
Stiffness can be associated with many problems in the shoulder. A build up of scar tissue or arthritis can lead to this loss of motion. In diabetics this loss of motion (0r adhesive capsulitis) can occur for no apparent reason.
Determining the source of the problem is essential to developing the right method of treatment. This requires a thorough history followed by a physical exam. X-rays may be obtained to evaluate the bones and joints. In today’s orthopedic practice, an MRI is often obtained because of its sensitivity for soft tissues and more subtle bone changes.
Treatment generally is conservative. Alterations of activities, rest, physical therapy, and non-steroidal anti-inflammatories will usually resolve the problem. Pain medication may be required in more severe flare-ups. Injections can be used for more direct placement of medication and local anesthetic agents.
Arthroscopy (band-aid incision surgery) is sometimes necessary for diagnosis of the cause of the problem. At that same time, corrective procedures can be carried out. Removal of spurs (called decompression); repair of instability, even repair of the rotator cuff can be done at this time.
The Orthopaedic Surgeons of The SportsMed Orthopaedic Surgery and Spine Center, while dedicated getting you back to your normal active lifestyle, are also dedicated to accomplishing this in the most conservative efficient manner. We have the diagnostic tools available to us at our office as well as the training to perform the necessary surgery when indicated. We stand ready to serve patients with shoulder problems such as yours.