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

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

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

What is an irritated rotator cuff?
Deep in the shoulder are a group of tendons and muscles called the rotator cuff. They help stabilize the upper arm bone in the shoulder joint and help rotate the arm. Excessive wear on the rotator cuff can lead to severe irritation, roughening, and eventually ulceration and tearing of the cuff.

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

What is the treatment for shoulder impingement?

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

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

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

Problems that can be treated through arthroscopy include:

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

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

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

Where is shoulder arthroscopy performed?
Shoulder arthoscopies are performed at Saint Francis Memorial Hospital in downtown San Francisco. The time from check-in to discharge usually is as little as two hours. Most people return to their normal activities within four to five days. People with physically demanding jobs can usually return to work in two to three weeks.

How can I schedule an evaluation?
To make an appointment with a doctor, please call (415) 353-6380. Joint Center physicians are available on Tuesday and Wednesday mornings from 9 am to 12 noon and alternating Monday afternoons. The Center accepts Medicare assignment and bills Medicare and secondary insurance. The Center also participates in most managed care plans as well as other insurances. Appointments for Workers' Compensation patients are authorized and scheduled through adjusters for the compensation insurance companies

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