Shoulder Pain? What to Know About Rotator Cuff Tears,Instability, and Replacements

We use our shoulders for nearly everything, so when pain strikes, even everyday tasks get hard. In a recent New Day Northwest segment, Dr. Matthew Lyons, an orthopedic surgeon with Proliance Orthopedic Associates, explained the most common shoulder problems and how they're treated.

Why the shoulder is so injury-prone

The shoulder is a complex ball-and-socket joint, and no other joint in the body offers the same range of motion or function. Over time, wear and tear can take a toll. Dr. Lyons sees everyone from young overhead athletes to older patients with arthritis.

Rotator cuff tears

Rotator cuff problems are the most common reason people seek evaluation. The rotator cuff is a group of muscles that attach to the top of the arm bone by a tendon, and that tendon naturally wears with age. By age 50, more than half of people have some tearing.

Treatment starts conservatively, with gentle exercise, therapy, and injections. If symptoms persist, the cuff can be repaired arthroscopically: small incisions, a camera, and anchors that secure the tendon back to the bone. Thin tendons can be reinforced with a collagen graft. In rare cases where the tendon can't be repaired, a less critical tendon can be transferred to restore function.

Shoulder instability and dislocation

Dislocations tend to affect younger patients, especially those in contact sports. A dislocation can tear the labrum, the ring of tissue around the socket that anchors the ligaments holding the joint in place, and patients who return to sports are prone to dislocating again. The labrum can be repaired arthroscopically. If a piece of bone was knocked off the socket, it can be repaired too, and when the bone loss is significant, a bone graft from the patient or a donor can fill the gap.

Shoulder replacement

Shoulder replacement is growing faster than any other joint replacement. As with the knee or hip, it's an option when the cartilage lining the joint wears down. There are two types:

• Anatomic replacement: A metal stem and ball replace the top of the arm bone, with a plastic insert on the socket side.
• Reverse replacement: For patients who have also torn their rotator cuff, the implants are flipped so the large deltoid muscle can compensate for the missing cuff.

The choice depends on the patient's condition and goals. Both restore function well, with up to about 95% pain relief.

In anatomic shoulder replacement, Dr. Lyons utilizes the Shoulder Innovations Inset glenoid component on the socket side to help minimize the risk of the implant loosening. A shallow, circular pocket is drilled in the socket and the implant is placed within it, with a rim of strong, native bone around it.

CT scan preoperative planning is performed for each case in order to help correct any bone loss or deformity that has developed due to the arthritis. In rare cases with substantial bone loss, a custom 3D implant can be created. All of this is done with the goal of maximizing the function and longevity of the replacement.

Recovery

After a shoulder replacement, patients are typically in a sling for about six weeks. Initial surgical pain steadily fades over that time. By about three months, most people are back to their usual activities, and full recovery takes around six months. In some patients, tendon sparing surgeon can be performed, which has the ability to minimize the needed time in the sling.

Watch the full segment above to hear more from Dr. Lyons.