"Coping with Shoulder Injuries" FAQs

Public and Patient Education Department Program, May 20, 2004


Edward V. Craig, MD, MPH

Attending Orthopaedic Surgeon, Sports Medicine and Shoulder Service, Hospital for Special Surgery
Professor of Clinical Surgery, Weill Cornell Medical College

What causes bursitis?

Bursa is the thin film of soft tissue covering the rotator cuff tendon. When this gets thicker than normal, or irritated, this condition is commonly known as bursitis. Frequent extension of the arm at high speed under high load (i.e., pitching a baseball) can cause bursitis. Non-sports activities such as painting, hanging wallpaper or drapes, or washing windows also can cause it. Medical research shows that the older you get, the more likely you are to develop bursitis. Bursitis and rotator cuff irritation and pain usually occur together.


If you have a torn tendon, do the other rotator cuff tendons weaken because of it?

If a complete tear develops in one tendon (usually the supraspinatus), the other rotator cuff tendons become more likely to fail as they are subjected to greater tension. The age of the individual can also contribute to the progress of rotator cuff disease, with older tendons not only less able to withstand damaging friction, but also less likely to heal after minor injury. Orthopaedic surgeons also see another kind of rotator cuff injury specific to vigorous shoulder exercise, particularly in throwing athletes such as baseball pitchers. These problems begin with the ligaments in the shoulder becoming stretched and loose from overuse. This in turn allows the shoulder a greater range of translation in the socket, a condition called shoulder instability.


How can you determine if you have a stiff or frozen shoulder? 

If you are having trouble lifting your arm above your head or reaching across your body or behind your back, you may have a problem with the range of motion in your shoulder. Limited motion is an early symptom of a frozen shoulder, which is a general term denoting all causes of motion loss in the shoulder. The cause of frozen shoulder is unknown, but it probably involves an underlying inflammatory process. The capsule surrounding the shoulder joint thickens and contracts. This leaves less space for the upper arm bone (humerus) to move around. Frozen shoulder can also develop after a prolonged immobilization because of trauma or surgery to the joint. Usually only one shoulder is affected, although in about one-third of cases, motion may be limited in both arms.


When a patient has problems with multiple joints, how do you decide which joint to operate on first?

In general, a doctor would operate on the most painful joint first. When there is bilateral disease (when both hips and or both knees have problems), sometimes the surgeon may elect to do both joint replacements at the same time. In the upper extremity, if all joints are involved, the hand and wrist are frequently done first to maximize function. So, reconstruction of the hand and wrist take precedence over reconstruction of the shoulder and elbow. The elbow comes in second to the hand and wrist because of the improved function provided by elbow replacement compared to shoulder replacement.
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