Scoping in on Chronic Shoulder Pain
Roger D. Dainer, D.O.

Recent advances in arthroscopic surgery allow the orthopedic surgeon to treat many conditions of the shoulder with minimal injury to surrounding structures of the joint. The patient is able to return more rapidly to work and sports than when extensive "open" surgery is performed.

A tendon is a cord which connects muscle to bone. A group of tendons and muscles in the shoulder make up the rotator cuff. The rotator cuff tendons are used every time you raise your arm forward, outward, or overhead.

Repetitive use of the shoulder may cause gradual wearing process on the tendons that results In tendonitis.

Inflammation of the tendons in the shoulder is one of the most common causes of longstanding shoulder pain.

Tendonitis involving the rotator cuff may be due to sports, work activities, or the degeneration of advancing age. If the tendonitis is allowed to persist without appropriate medical treatment, a rotator cuff tear may result. In addition, excessive use of the shoulder may cause inflammation of the bursa, a condition known as bursitis. The bursa is a fluid filled sac located around the joints of the body. Bursitis is often associated with rotator cuff tendonitis. Persistent tendonitis and bursitis involving the shoulder is orthopedically diagnosed as impingement syndrome.

The symptoms of impingement syndrome include pain with overhead reaching, pushing. pulling, and heavy lifting. Night pain frequently awakens the patient. Initial evaluation by the orthopedic surgeon includes taking a history of the problem, examination, and x-rays. If the symptoms fail to respond to treatment, additional diagnostic studies may be required such as an MRI or arthrogram. Conservative treatment for impingement syndrome includes medication, activity restriction, physical therapy, and sometimes a cortisone injection. Most of the time, this treatment will relieve the pain. However, if conservative care does not help within a reasonable period of time, then arthroscopic surgery would be required.

Arthroscopic surgery is a minimally invasive technique which requires several small incisions about the size of a button hole. The pencil-shaped arthroscope uses a miniature lens and a fiberoptic lighting system to illuminate structures inside the shoulder. Using small surgical instruments, surgery may be completed while the surgeon views the shoulder on a television screen. The procedure is completed in the operating room and the patient is allowed to return home the same day. After surgery, a shoulder sling for comfort is used several days.

Range of motion and strengthening exercises are begun immediately, allowing the patient to return to a full range of activities within several months.