Shoulder

Shoulder complaints separate into a few broad patterns, and identifying the pattern is most of the work. Pain at night and with overhead reach suggests the rotator cuff. A sense that the shoulder shifts, slips or has come out of place points toward instability or labral injury. Stiffness that limits motion even when someone else moves the arm suggests a frozen or arthritic shoulder.

Examination tests strength of each cuff tendon, range of motion in several planes, stability in the positions where the shoulder feels vulnerable, and the contribution of the scapula and neck. Radiographs are standard; MRI or CT is added when it will change what is recommended.

Many rotator cuff problems, most cases of adhesive capsulitis and a substantial number of first-time dislocations in lower-demand patients are managed without surgery. Rehabilitation focused on cuff and scapular mechanics is the main treatment, supported by activity modification and, where appropriate, a corticosteroid injection to make therapy tolerable.

Non-operative treatment is given a fair trial with a defined checkpoint rather than being extended indefinitely. If function is not improving by that point, the plan is revisited.

Fellowship training in shoulder surgery at Rush University Medical Center covers the full range of procedures, from arthroscopic rotator cuff repair and labral repair to stabilization for recurrent instability and anatomic or reverse shoulder replacement for arthritis and irreparable cuff disease.

The choice among these depends on the tissue quality, the pattern of injury, bone loss where instability is involved, and what the patient needs the shoulder to do. Arthroscopic approaches are used when they serve the patient; a larger procedure is recommended when it is the more durable answer rather than avoided for its own sake.

Shoulder recovery is slower than most patients expect, and setting that expectation up front is part of the plan. Rotator cuff repair generally involves a period of sling protection while the tendon heals, followed by staged motion and then strengthening; shoulder replacement usually allows earlier comfortable motion but still takes months to reach full strength.

Written protocols are shared with the patient and their therapist, and the plan is adjusted at follow-up based on how the shoulder is actually progressing.