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The rotator cuff is a group of muscles that originates on the shoulder blade (the scapula) and insert on the top of the arm bone (the humerus). To evaluate for a rotator cuff tear, a doctor will perform an examination after a history is taken.
If no tear is present, a procedure called a "subacromial decompression" or "acromioplasty" is performed to allow more room for the rotator cuff to move. Shoulder tendonitis (or tendinitis) is an inflammation injury to the tendons of your shoulder's rotator cuff.
The most common cause of shoulder tendonitis is repeated microtrauma to the rotator cuff tendons rather than a specific one-off trauma. Your physiotherapist or sports doctor will suspect shoulder tendonitis based on your symptom history and some clinical tests.
An ultrasound scan is the preferred method of investigating a shoulder tendonitis and associated injuries such as shoulder bursitis.
Shoulder tendonitis is a progressive disorder that often co-exists with shoulder bursitis or bicipital tendonitis and can deteriorate into calcific tendonitis or rotator cuff tears, which may require surgery, with neglect or poor treatment.
The good news is that most shoulder tendonitis is reversible and very successfully treated. Your shoulder physiotherapist is an expert in shoulder assessment and biomechanical correction. Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate shoulder tendonitis and prevent recurrence.
In the early phase you’ll most likely be unable to fully lift your arm or sleep comfortably. Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling.
To support and protect your tendon injury, you may need to be wear a sling or have your shoulder taped to provide pain relief.
Shoulder tendonitis may take several weeks to heal while we await Mother Nature to form and mature the new scar tissue, which takes at least six weeks. In most cases, you will also have developed short or long-term protective tightness of your joint capsule (usually posterior) and some compensatory muscles.
Signs that your have full soft tissue extensibility includes being able to move your shoulder through a full range of motion. Normal shoulder blade-shoulder movement - known as scapulohumeral rhythm - is required for a pain-free and powerful shoulder function. Your physiotherapist is an expert in the assessment and correction of your scapulohumeral rhythm. You may find it difficult to comprehend, but your neck and upper back (thoracic spine) are very important in the rehabilitation of shoulder pain and injury.
Your physiotherapist will assess your neck and thoracic spine and provide you with the necessary treatment as required.
Your rotator cuff also provides the subtle glides and slides of your shoulder’s ball joint on the glenoid socket to allow full shoulder movement.
It may seem odd that you don’t attempt to restore the strength of your rotator cuff until a later stage in the rehabilitation. Your physiotherapist will prescribe the most appropriate rotator cuff strengthening exercises for you.
Sports that involve overhead arm positions such as racquet sports, throwing, bowling or swimming have high incidences of shoulder tendonitis. Work-related injuries will often require a discussion between your doctor, rehabilitation counsellor or employer. For more specific advice about your shoulder tendonitis, please contact your PhysioWorks physiotherapist. A physical exam may need to be conducted by a physician to properly diagnose a shoulder bone spur. Shoulder pain associated with a bone spur originates from the inflammation the spur causes. A shoulder bone spur is a bony growth that forms on the edge of the bone within the shoulder joint.

The formation of a bone spur in the shoulder generally results from either the presence of osteoarthritis in the shoulder joint or persistent stress to the joint as associated with repetitive movements.
The existence of a bone spur is generally discovered during the administration of an X-ray or other imaging test. The shoulder pain associated with a bone spur does not originate from the spur itself, but the irritation and inflammation the spur causes. Those who experience swelling and pain in the shoulder should seek medical attention to determine if a shoulder bone spur is the cause of the discomfort.
A shoulder bone spur that is not causing discomfort or complications is generally not treated. There have been fossils unearthed from ancient creatures who appear to have suffered from osteophytes. Whether you call it a bone spur, osteophytes or in some cases, a parrot beak, some people describe it as just painful. Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up fully. It is technically possible to do an arthroscopic examination of almost every joint in the human body. Professor Kenji Takagi in Tokyo has traditionally been credited for performing the first arthroscopic examination of the knee joint of a patient in 1919.
While Bircher is often considered the inventor of arthroscopy of the knee,[4] the Japanese surgeon Masaki Watanabe, MD receives primary credit for using arthroscopy for interventional surgery.[5][6] Watanabe was inspired by the work and teaching of Dr Richard O'Connor.
The first operating arthroscope was jointly designed by these men, and they worked together to produce the first high-quality color intraarticular photography.[8] The field benefited significantly from technological advances, particularly advances in flexible fiber optics during the 1970s and 1980s. Knee arthroscopy has in many cases replaced the classic arthrotomy that was performed in the past. Arthroscopic surgeries of the knee are done for many reasons, but the usefulness of surgery for treating osteoarthritis is questionable. Hip arthroscopy was initially used for the diagnosis of unexplained hip pain, but is now widely used in the treatment of conditions both in and outside the hip joint itself.
Arthroscopy is commonly used for treatment of various diseases of the shoulder including subacromial impingement, acromioclavicular osteoarthritis, rotator cuff tears, frozen shoulder (adhesive capsulitis), chronic tendonitis and partial tears of the long biceps tendon, SLAP lesions and shoulder instability.
Arthroscopy of the wrist is used to investigate and treat symptoms of repetitive strain injury, fractures of the wrist and torn or damaged ligaments. Many invasive spine procedures involve the removal of bone, muscle, and ligaments to access and treat problematic areas. Arthroscopic (also endoscopic) spinal procedures allow a surgeon to access and treat a variety of spinal conditions with minimal damage to surrounding tissues. Arthroscopy — A surgical technique whereby a doctor inserts a tube like instrument into a joint to inspect, diagnose and repair tissues. Arthroscopic surgery uses small incisions and small tools, about the size of a pencil, to perform the procedure. This may be recommended if anti-inflammatory medicines, cortisone injections into the shoulder, and physical therapy fail to relieve the pain of bursitis. According to the Anesthesia Manual of Surgical Procedures, pain from Rotator Cuff surgery is rated at 6 out of 10 on a scale of 1 to 10, with 1 being no pain and 10 being the worst pain.
In some cases it may mean that you need to sleep relatively upright or with pillow support. If these spurs happen in areas that rub against nerves, like in the spine area, there could be problems.
The surgeon looks at a video screen which is connected to a camera that is inserted into the body, together with working instruments. Arthroscopic procedures can be performed either to evaluate or to treat many orthopedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage.
Instead, for knee arthroscopy for example, only two small incisions are made — one for the arthroscope and one for the surgical instruments to be used in the knee cavity. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage.

The joints that are most commonly examined and treated by arthroscopy are the knee, shoulder, elbow, wrist, ankle, foot, and hip.
Initially, he used an electric Jacobaeus thoracolaparoscope for his diagnostic procedures, which produced a dim view of the joint.
Today knee arthroscopy is commonly performed for treating meniscus injury, reconstruction of the anterior cruciate ligament and for cartilage microfracturing. A double-blind placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in 2002.[9] In this three-group study, 180 military veterans with osteoarthritis of the knee were randomly assigned to receive arthroscopic debridement with lavage, or arthroscopic lavage alone without debridement (a procedure only imitating the surgical debridement, where superficial incisions to the skin were made to give the appearance that the debridement procedure had been performed). The most common indication currently is for the treatment of femoroacetabular impingement (FAI) and its associated pathologies, however, this is by no means where it ends. In some cases, thoracic (mid-spine) conditions requires a surgeon to access the problem area through the rib cage, dramatically lengthening recovery time. Recovery times are greatly reduced due to the relatively small size of incision(s) required, and many patients are treated on an outpatient basis.[13] Recovery rates and times vary according to condition severity and the patient's overall health.
People typically complain of difficulty with overhead activities, like reaching for items off a high shelf, brushing the back of the hair, or fastening a bra. By stitching the rotator cuff back to the bone, the rotator cuff can heal in its proper location.
This reduces recovery time and may increase the rate of surgical success due to less trauma to the connective tissue. Recently it has been discovered that the Danish physician Severin Nordentoft reported on arthroscopies of the knee joint as early as 1912 at the Proceedings of the 4lst Congress of the German Society of Surgeons at Berlin.[1] He baptized the procedure (in Latin) arthroscopia genu. Later, he developed a double-contrast approach to improve visibility.[3] Bircher gave up endoscopy in 1930, and his work was largely neglected for several decades. Arthroscopy can also be performed just for diagnosing and checking of the knee; however, the latter use has been mainly replaced by magnetic resonance imaging. For two years after the surgeries, patients reported their pain levels and were evaluated for joint motion.
It is important to wait until there is no swelling left around the knee before doing any serious exercise or extensive walking, because the knee will not be fully stable; extensive exercise may cause pain and in some cases cause the knee to swell more.
The MRI will show the muscles and tendons around the shoulder and allow the doctor to see the rotator cuff. The surgeon sees inside the shoulder with the arthroscope and its images are projected on a video screen. The stitches are held in the bone with metal anchors or plastic that are drilled into the bone.
If a rotator cuff tear is present and a repair is performed, a "subacromial decompression" is usually done along with the repair.
Activity restrictions will apply after surgery until appropriate rehabilitation goals have been achieved. In cases where there is no real reaction or complaint about the spur, there may be no need to treat it.
It is especially useful for professional athletes, who frequently injure knee joints and require fast healing time. Nordentoft used sterile saline or boric acid solution as his optic media and entered the joint by a portal on the outer border of the patella. Neither the patients nor the independent evaluators knew which patients had received which surgery (thus the "double blind" notation).
Bursitis is inflammation of a fluid filled sac (bursa) on top of the rotator cuff that serves to lubricate the movement of the shoulder. In cases where there needs to be some intervention there are a couple of ways to approach it.
However, it is not clear if these examinations were anatomic studies of deceased or of living patients.
Sometimes this fluid leaks into the surrounding soft tissue causing extravasation and edema.

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