When pain, weakness, or disability affects the shoulder, it can severely impact your day-to-day activity. At Orthopaedic Institute of Central Jersey, we understand you want an accurate diagnosis and an effective treatment plan that can help you return to your routine as quickly as possible. At our state-of-the-art practice, we have on-site access to some of the best technology available. Furthermore, our board certified orthopaedic surgeons offer the most advanced surgical and non-surgical techniques available for a comprehensive range of shoulder conditions. We want you to feel comfortable in our hands; we have the skill, training, and commitment to provide you with unparalleled care.
For more information about our diagnostics and treatment options, please follow the links below. You can also contact us today with any questions, and we can help you schedule a consultation.
Ultrasound is an imaging modality that allows physicians to evaluate muscles, tendons, and joints without radiation. It allows dynamic evaluation of the joint structures. It is also sometimes used to assist in guiding joint injections. Ultrasound is very useful in evaluating tendon injuries, muscle injuries or any fluid collection such as ganglion cysts or Baker cysts. It can be used to evaluate rotator cuff tears and is especially useful in patients who have had surgery with implants placed, as MRI is less useful due to scarring from surgery and effect of the implants on the quality of the MR image. Ultrasound can be incorporated into a routine visit and does not need to be scheduled ahead of time such as with an MRI or CAT scan. It is also useful in the claustrophobic patient who cannot tolerate MRI scans. For this reason, it is becoming more useful in establishing diagnosis earlier and more conveniently for many musculoskeletal conditions. The Orthopedic Institute does offer ultrasound assisted injections as well as diagnostic ultrasound for the treatment of appropriate muscle and tendon injuries and conditions.
Magnetic Resonance Imaging, or MRI, is used to evaluate multiple shoulder pathologies, including rotator cuff tears. It is usually well tolerated, and can be performed in an open setting at the Orthopaedic Institute. It provides your doctor with information on size and location of a tear, and can provide indications as to whether or not surgical repair is required or recommended. Another benefit of MRI is that your doctor can view other shoulder structures, including the labrum/biceps tendon, and any atrophy of the surrounding musculature. The procedure takes approximately 30 minutes.
Arthroscopy of the shoulder is useful as it allows both diagnostic and therapeutic intervention. Diagnostically, an arthroscopy allows your surgeon to evaluate the rotator cuff tendon in real time under direct visualization. This can help confirm, or rule out lesions that were noted on an imaging study such as an MRI. It allows us to evaluate the entire shoulder including the cartilage and labrum as well as the rotator cuff. It can be performed outpatient and is tolerated well by patients. Both debridement (removing the defective tissue) and repair can be performed at the time of arthroscopy. Additionally, other pathologies found at the time of surgery can be addressed at the same surgical setting.
Treatment of Rotator Cuff Disease
Oral medications are often the first line of treatment. Anti–inflammatory medications can be used to reduce inflammation in the bursal sac or the rotator cuff tendon lining. Often these are well tolerated and allow patients to continue with their normal activities of daily living while using them. Patients should discuss the risks and benefits of the medication with their doctor.
Injections in the rotator cuff bursa using steroid combined with a local anesthetic can be very helpful and reduce pain within 48 hours. Not only are they therapeutic, but often they are helpful diagnostically as they can help separate pain emanating from the rotator cuff from pain that is secondary to conditions separate from the shoulder, such as a pinched nerve in the neck. Often the anti–inflammatory injections are used to reduce pain in order to allow the physical therapy to proceed in a more comfortable manner.
Physical therapy is a mainstay of treatment of rotator cuff disease. Many studies point to altered mechanics at the shoulder, as a primary cause of pain. Often the muscles that stabilize the shoulder blade(scapula), as well as the rotator cuff, can become weak secondary to aging or to repetitive use, either occupational or sports related. Often, correcting the patient’s shoulder mechanics and providing an exercise program on a long term basis, can prevent recurrence of symptoms.