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Fellowship-trained hand and reconstructive surgeon Dr. Christopher Johnson discusses common rotator cuff problems.

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Dr. Johnson: Hi, I'm Dr. Chris Johnson. I'm one of the orthopaedic surgeons with Professional Orthopaedic Associates, and I wanted to talk to you a little bit today about a common shoulder problem involving the rotator cuff, which is one of the most important muscles for shoulder function. I have this nice model here, which I think will help you understand better what I'm talking about. Basically, there are three different groups of patients that I see with rotator cuff problems. The younger patients get that as a result of the fact that their shoulders may not be as stable as say, the most common anatomy in the population. That is a minority group in my practice. The other two groups are patients that have an irritation of the shoulder muscles, which we call impingement syndrome. That's probably more commonly heard as shoulder bursitis. And then there are some patients that don't have treatment for that, they can progress to rotator cuff tears. So let me just briefly review both of those.

The rotator cuff is this actually a series of four muscles; they're involved in moving the shoulder. The anatomy is such that the rotator cuff muscles are located in between a bone above and a bone below and depending on the position of the arm, that can put pressure on the rotator cuff and lead to irritation and thinning. Patients with bursitis, and this blue part of the model represents the bursa above the tendon, can get inflamed as a result of their overhead use of the shoulder. And that can lead characteristically to pain with overhead use. It often can rotate down into the front part of the shoulder. So patients come in and tell me that they have pain in the shoulder that goes down to the front when they use their arm above shoulder level.

Most patients that come in early enough can be treated successfully with conservative care, and that can involve, number one, an education that you have to be careful about overhead use, anti-inflammatory medications, sometimes a cortisone injection, and some therapy. And I would tell you that probably 85% to 90% of people are gonna get better with that. Some patients come in later on where they've maybe not paid as much attention to their shoulders, and they have pain as well as weakness. Those patients may need an earlier evaluation with other types of imaging studies, not just a regular X-ray, like an MRI. If you have a young active person that has a tear involving the rotator cuff that we see on an MRI, then sometimes they need surgical treatment. Nowadays that is an arthroscopic type of treatment, and that involves a same-day surgery, and the recovery period is usually a few months, but we have a 90-plus-percent success rate with that.

So this has been a brief look at a common shoulder problem. Tendonitis of the shoulder, bursitis of the shoulder, and some patients they can have a tear. There are different types of treatment. You know, in general, we try nonoperative care first. And for patients that don't do well as well as they'd like with that, then they sometimes need to have something done surgically. I hope this has been helpful for you and leads to a better understanding of your shoulder problems.

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