Shoulder Conditions

  • What it is. The rotator cuff is a group of four tendons that hold the ball of the shoulder in its socket and help you lift and rotate your arm. A tear can happen suddenly from a fall or lifting, or slowly from wear over time.

    Common symptoms. Pain on the outer shoulder, often worse at night or when lying on that side. Weakness or pain when lifting the arm overhead or reaching behind you.

    How it's diagnosed. A physical exam to test strength and motion, X-rays, and often an MRI or ultrasound for further evaluation/to see the size of the tear, typically ordered after a trial of conservative management (if symptoms do not improve).

    Treatment. Most partial tears and some small full tears improve with physical therapy, activity changes, anti-inflammatory medicine, and sometimes a steroid injection. Surgery is considered for larger or new/acute tears, tears in active patients, or when pain and weakness do not improve after a trial of conservative management. Most repairs are done arthroscopically (through small incisions with a camera).

  • What it is. Irritation of the rotator cuff tendons and the fluid-filled sac (bursa) above them. The tendons can get pinched under the bony top of the shoulder when you raise your arm.

    Common symptoms. Aching on the outer shoulder that can spread down the upper arm. Pain with overhead reaching, and trouble sleeping on that side.

    How it's diagnosed. A physical exam and X-rays. An MRI may be ordered for further evaluation of the soft tissue (ie. if a rotator cuff tear is suspected).

    Treatment. Most people get better without surgery: physical therapy to strengthen the shoulder, rest from aggravating activities, anti-inflammatory medicine, and sometimes a steroid injection. If symptoms persist after several months, arthroscopic surgery (subacromial decompression) can make more room for the tendons.

  • What it is. Wear of the smooth cartilage that covers the ball and socket of the shoulder, so bone rubs on bone. It can come from age, an old injury, or inflammatory conditions like rheumatoid arthritis.

    Common symptoms. Deep shoulder pain, stiffness, loss of motion, and grinding or clicking. Pain often makes sleep and daily tasks like reaching overhead or behind your back difficult.

    How it's diagnosed. A physical exam and X-rays. A CT scan is often used to plan surgery.

    Treatment. Early on: activity changes, physical therapy for motion and strength, anti-inflammatory medicine, and injections. When pain and stiffness limit your life despite these, shoulder replacement reliably relieves pain and improves function.

  • What it is. Arthritis that develops after a large, long-standing rotator cuff tear. Without the cuff holding it in place, the ball rides up and wears against the socket.

    Common symptoms. Pain, weakness, and difficulty raising the arm. Some people cannot lift their arm above shoulder height.

    How it's diagnosed. A physical exam and X-rays; a CT scan or MRI may be used to plan treatment.

    Treatment. Physical therapy, medication and injections can help some symptoms. When pain and weakness are significant, a reverse total shoulder replacement is designed for this problem. It lets the shoulder muscle (deltoid) lift the arm without a working rotator cuff.

  • What it is. The lining of the shoulder joint (the capsule) becomes inflamed, then thick and tight, so the shoulder stiffens. It is more common in people in their 40s–60s, in women, and in people with diabetes or thyroid conditions.

    Common symptoms. Pain followed by steadily worsening stiffness in all directions. It typically moves through phases: painful "freezing," stiff "frozen," and gradual "thawing."

    How it's diagnosed. A physical exam showing loss of motion in every direction, with X-rays to rule out arthritis.

    Treatment. Most people improve without surgery, though it can take many months. Treatment includes steroid injections, gentle stretching and physical therapy, and pain control. If the shoulder stays stiff despite this, an arthroscopic capsular release and manipulation can free up the tight lining.

  • What it is. The labrum is a rim of fibrocartilage that deepens the shoulder socket. A dislocation (the ball coming out of the socket) can tear the labrum, and the shoulder may then slip out again. Labral tears can also come from repetitive overhead sports.

    Common symptoms. The shoulder feeling loose or slipping out of the joint, pain, catching, clicking, or weakness. Repeat dislocations often happen with the arm raised and turned out (externally rotate).

    How it's diagnosed. A physical exam and X-rays. An MRI, sometimes with dye injected into the joint (MR arthrogram), shows the labrum. A CT scan checks for bone loss on the socket.

    Treatment. First-time dislocations in some patients are treated with a sling followed by physical therapy. Young, active patients and those with repeat dislocations have a high chance of it happening again; for them, surgery to repair the labrum is often recommended. If there is bone loss from the front of the socket (anterior glenoid), a Latarjet or bone block procedure may be needed.

  • What it is. Wear and tear of the small joint where the collarbone meets the top of the shoulder blade. It is common in weightlifters and people who do heavy labor.

    Common symptoms. Pain on the top of the shoulder, especially when reaching across your body, lifting overhead, or doing push-ups or bench press.

    How it's diagnosed. A physical exam (pain pressing on the joint or reaching across the body) and X-rays. An injection into the joint can confirm it is the source of pain.

    Treatment. Activity changes, anti-inflammatory medicine, physical therapy, and steroid injections. If pain persists, arthroscopic surgery removes a small piece of the end of the collarbone (distal clavicle excision) so the bones no longer rub.

  • What it is. An injury to the ligaments that hold the collarbone to the shoulder blade, usually from a fall directly onto the shoulder. Separations are graded by how far the collarbone is displaced.

    Common symptoms. Pain on top of the shoulder right after a fall, and sometimes a bump where the collarbone sits higher than normal.

    How it's diagnosed. A physical exam and X-rays, sometimes comparing both shoulders.

    Treatment. Most separations heal well with a sling for comfort, ice, and physical therapy, even if a bump remains. Surgery to reconstruct the ligaments is considered for severe separations or when pain and weakness persist.

  • What it is. The long head of the biceps tendon runs into the front of the shoulder. It can become irritated, partly torn, or rupture completely, often together with rotator cuff or labral problems.

    Common symptoms. Pain in the front of the shoulder that can travel down the arm. A full rupture may cause sudden pain, bruising, and a bulge in the upper arm ("Popeye" arm).

    How it's diagnosed. A physical exam, and an MRI or ultrasound to look at the tendon and other shoulder structures.

    Treatment. Rest, anti-inflammatory medicine, physical therapy, and sometimes an injection. If pain persists, a biceps tenodesis moves the tendon to a new attachment point so it no longer causes pain. A complete rupture at the shoulder usually causes little loss of strength and is often treated without surgery.

  • What it is. Calcium deposits form within a rotator cuff tendon. The cause isn't fully known. Deposits can cause sudden, severe pain when the body starts to reabsorb them.

    Common symptoms. Shoulder pain that may come on suddenly and be intense, with pain lifting the arm.

    How it's diagnosed. X-rays show the calcium deposit; ultrasound can also show it.

    Treatment. Most cases improve without surgery: anti-inflammatory medicine, physical therapy, steroid injections, or a procedure to break up the deposit with a needle under ultrasound. Arthroscopic surgery to remove the deposit is an option if pain continues.

  • What it is. Breaks of the top of the arm bone (proximal humerus) or the collarbone (clavicle), usually from a fall. Proximal humerus fractures are especially common in older adults with weaker bones.

    Common symptoms. Pain, swelling, bruising that may spread down the arm and chest, and difficulty moving the arm. A collarbone fracture may cause a visible bump.

    How it's diagnosed. X-rays; a CT scan helps plan treatment for more complex breaks.

    Treatment. Most of these fractures can be treated nonoperatively with a period of immobilization in a sling, followed by physical therapy. Surgery is recommended when the bones are badly out of place, shortened, or broken into several pieces. Options include plates and screws, or a shoulder replacement for some complex proximal humerus fractures in older patients.

Shoulder Procedures

  • What it does. The worn ball and socket are replaced with smooth implants: a metal ball on a stem in the arm bone, and a plastic socket. The shape matches your natural shoulder.

    Who it's for. People with painful shoulder arthritis whose rotator cuff is healthy, when nonsurgical treatment no longer helps.

    What to expect. The surgery is done through an incision on the front of the shoulder, with a nerve block for pain control. You go home with your arm in a sling.

    Recovery. Sling for 4 weeks. Outpatient physical therapy starts 10–14 days after surgery. No lifting with the arm while in the sling, then no more than 2–5 lb until 3 months. No driving while in the sling or taking narcotic pain medication. Return to sports and weight lifting is discussed at your 3-month visit; most patients work toward it with a therapist at 4–5 months. Most people have far less pain and better motion, with improvement continuing for up to a year.

  • What it does. The ball and socket are switched: a metal ball is attached to the socket side, and a plastic cup to the arm bone. This lets the large deltoid muscle lift the arm when the rotator cuff no longer works.

    Who it's for. People with rotator cuff tear arthropathy, large tears that can't be repaired, arthritis with a damaged cuff, some complex fractures, and some failed prior replacements.

    What to expect. Similar to anatomic replacement: an incision on the front of the shoulder, a nerve block, and a sling afterward.

    Recovery. Sling for 4 weeks, with outpatient therapy starting 10–14 days after surgery. Early on, avoid pushing up from a chair with the operated arm and reaching behind your back. No lifting while in the sling, then no more than 2–5 lb until 3 months. Return to sports and heavier activity is discussed at your 3-month visit. Most people gain major pain relief and the ability to lift the arm, with improvement continuing for up to a year.

  • What it does. Only the ball of the shoulder is replaced; your own socket is kept.

    Who it's for. Selected patients with arthritis limited to the ball, some fractures, or when the socket isn't suitable for an implant. Total shoulder replacement is more commonly recommended today.

    What to expect. The surgery, nerve block and sling are similar to a total shoulder replacement.

    Recovery. Generally follows the same plan as a total shoulder replacement: sling for 4 weeks, therapy starting 10–14 days after surgery, and limited lifting until 3 months.

  • What it does. A prior shoulder replacement is removed or changed, often to a reverse total shoulder replacement.

    Who it's for. People whose shoulder replacement has worn out, loosened, become unstable, become infected, or whose rotator cuff has failed after an anatomic replacement.

    What to expect. Revision surgery is more complex than a first replacement. Planning usually includes a CT scan and sometimes blood tests or a joint fluid test to check for infection. Occasionally it is done in two stages.

    Recovery. Usually similar to a first replacement, but sometimes slower, with a longer time in the sling. Dr. Park will tailor your plan to what was found at surgery.

  • What it does. The torn tendon is reattached to the bone using small anchors and stitches, through several small incisions with a camera.

    Who it's for. People with a full-thickness tear causing pain and weakness, especially new tears and active patients, or tears that haven't improved with physical therapy.

    What to expect. Outpatient surgery, so you go home the same day, with a nerve block for pain control and your arm in a sling.

    Recovery. The tendon needs time to heal to the bone, so recovery is gradual. Sling for 4–6 weeks. You start gentle home exercises 1–2 days after surgery; formal physical therapy usually starts after your 4-week visit. No lifting heavier than a cell phone while in the sling, then no more than 5 lb until 3 months. No anti-inflammatory medicine for the first 4 weeks, because it can slow tendon healing. Full recovery commonly takes 6 months to a year.

  • What it does. The torn labrum is reattached to the rim of the socket with small anchors and stitches, and the loose capsule is tightened. It is usually done arthroscopically.

    Who it's for. People whose shoulder has dislocated or keeps slipping out, especially young and active patients, and overhead athletes with painful labral tears.

    What to expect. Outpatient surgery with a nerve block, going home the same day in a sling.

    Recovery. A sling for about 4–6 weeks while the repair heals, then physical therapy to regain motion and strength. Return to contact and overhead sports usually takes about 4–6 months and depends on strength and sport-specific testing.

  • What it does. A small piece of bone is moved to the front of the socket and fixed with screws. This rebuilds the socket and adds stability. In a Latarjet, the bone comes from the shoulder blade (coracoid); other bone block procedures use bone from elsewhere.

    Who it's for. People with recurrent dislocations who have lost bone from the socket, contact athletes, and some people whose earlier stabilization surgery failed.

    What to expect. An open surgery through an incision on the front of the shoulder, with a nerve block and a sling afterward.

    Recovery. A sling for several weeks, then physical therapy. The bone block must heal before heavy use; return to contact sports usually takes about 4–6 months.

  • What it does. The painful long head of the biceps tendon is detached inside the shoulder and reattached lower on the arm bone. It can be done arthroscopically, or through a small incision near the armpit (subpectoral).

    Who it's for. People with biceps tendinitis, partial tears, or instability of the tendon that hasn't improved with nonsurgical care. It is often done along with other shoulder surgery.

    What to expect. Outpatient surgery with a nerve block and a sling for comfort and protection.

    Recovery. Avoid heavy lifting and forceful elbow bending or forearm twisting for about 6 weeks while the tendon heals. Physical therapy helps you regain motion and strength. If done with another procedure, you follow that procedure's recovery plan.

  • What it does. Through small incisions with a camera, inflamed tissue and bone spurs are removed to make more room for the rotator cuff (decompression). If the AC joint is arthritic, a small piece of the end of the collarbone is also removed (distal clavicle excision).

    Who it's for. People with impingement, bursitis, or AC joint arthritis whose pain continues despite therapy and injections.

    What to expect. Outpatient surgery with a nerve block. No repair is done, so the shoulder can be used right away.

    Recovery. Sling for comfort only; most people stop using it after 1–2 days. Physical therapy usually starts 3–14 days after surgery. There are no specific activity restrictions; let pain be your guide. Most people improve steadily over 2–3 months.

  • What it does. Through small incisions with a camera, the tight, thickened joint lining is released so the shoulder can move again. A gentle manipulation under anesthesia is often done at the same time.

    Who it's for. People with frozen shoulder whose stiffness hasn't improved after months of injections and therapy.

    What to expect. Outpatient surgery with a nerve block. Moving the shoulder early is the key to keeping the motion gained.

    Recovery. Sling for comfort only, if at all. Physical therapy starts within days of surgery (usually 3–14 days), and daily home stretching is essential. There are no specific activity restrictions; let pain be your guide.

  • What it does. Broken bones of the upper arm or collarbone are put back in position and held with plates, screws, or rods so they can heal properly.

    Who it's for. People with fractures that are badly out of place, shortened, or broken into several pieces.

    What to expect. Surgery through an incision over the fracture, with a nerve block, followed by a sling.

    Recovery. A sling for several weeks while the bone heals, with gentle motion and physical therapy started as the fracture allows. Bone healing usually takes about 6–12 weeks, and full recovery of strength takes longer.

Elbow Conditions

  • What it is. Overuse damage to the tendon that attaches the forearm muscles to the outside of the elbow. Despite the name, most people who get it don't play tennis. Repetitive gripping, lifting and computer work are common causes.

    Common symptoms. Pain on the outside of the elbow, worse with gripping, lifting with the palm down, shaking hands, or turning a doorknob. Grip may feel weak.

    How it's diagnosed. A physical exam. X-rays, MRI or ultrasound may be used if symptoms don't improve.

    Treatment. Most people get better without surgery, though it can take months: activity changes, a forearm strap or wrist brace, stretching and strengthening in physical therapy, and anti-inflammatory medicine. Injections are sometimes used. If pain continues after 6–12 months of treatment, surgery can remove the damaged tendon tissue and repair the tendon.

  • What it is. Overuse damage to the tendon on the inside of the elbow, where the muscles that bend the wrist and fingers attach. It is caused by repetitive gripping, throwing, or swinging.

    Common symptoms. Pain on the inside of the elbow, worse with gripping, lifting with the palm up, or wrist bending. Some people also have tingling in the ring and small fingers if the nearby ulnar nerve is irritated.

    How it's diagnosed. A physical exam, with imaging if needed.

    Treatment. Rest from aggravating activities, bracing, physical therapy, anti-inflammatory medicine, and sometimes injections. Surgery is rarely needed and is considered only when symptoms persist despite months of treatment.

  • What it is. A tear of the biceps tendon where it attaches near the elbow. It usually happens suddenly when lifting something heavy with the elbow bent, most often in middle-aged men.

    Common symptoms. A sudden pop at the front of the elbow, pain, bruising, and a bulge higher in the arm where the muscle has pulled up. Weakness turning the palm up (like using a screwdriver) and bending the elbow.

    How it's diagnosed. A physical exam; an MRI or ultrasound confirms whether the tear is complete.

    Treatment. For active people, surgical repair is usually recommended to restore strength. Repair is easiest and most successful within the first 2–3 weeks, so call promptly if you think you've had this injury. Some less active patients choose nonsurgical treatment and accept some loss of strength.

  • What it is. A tear of the triceps tendon at the back of the elbow, usually from a fall on an outstretched hand or forceful straightening against resistance. It can also occur in weightlifters.

    Common symptoms. Pain, swelling and bruising at the back of the elbow, and weakness or inability to straighten the elbow against gravity.

    How it's diagnosed. A physical exam, X-rays (sometimes showing a small flake of bone), and an MRI.

    Treatment. Partial tears may heal with a brace and therapy. Complete tears in active people are usually repaired surgically, ideally soon after the injury.

  • What it is. The ulnar collateral ligament (UCL) on the inside of the elbow stabilizes it during throwing. Repeated throwing stress can stretch or tear it. It is most common in baseball pitchers and other overhead athletes.

    Common symptoms. Pain on the inside of the elbow during throwing, loss of velocity or control, and sometimes a pop. Tingling in the ring and small fingers can occur.

    How it's diagnosed. A physical exam with stress testing of the ligament, and an MRI (sometimes with dye in the joint).

    Treatment. Partial tears are often treated with rest from throwing, physical therapy, and a gradual return-to-throwing program. Complete tears, or partial tears that don't heal in athletes who want to keep throwing, may need UCL repair or reconstruction.

  • What it is. Small fragments of bone or cartilage floating in the elbow joint. They can come from an injury, arthritis, bone spurs, or cartilage damage (such as osteochondritis dissecans in young athletes).

    Common symptoms. Catching, locking, clicking, pain, and sometimes loss of full motion.

    How it's diagnosed. X-rays, and often a CT scan or MRI to find fragments that X-rays miss.

    Treatment. If loose bodies cause locking or pain, arthroscopic surgery removes them through small incisions.

  • What it is. Pressure on or irritation of the ulnar nerve (the "funny bone" nerve) as it passes the inside of the elbow. It can be worsened by keeping the elbow bent for long periods, leaning on the elbow, or throwing.

    Common symptoms. Numbness and tingling in the ring and small fingers, often worse at night or with the elbow bent. Later, hand weakness or clumsiness.

    How it's diagnosed. A physical exam, and often a nerve test (EMG and nerve conduction study) to measure how well the nerve is working.

    Treatment. Mild cases improve by avoiding pressure on the elbow and keeping it straighter at night (sometimes with a padded splint). If symptoms persist or weakness develops, surgery can release or move the nerve to take pressure off it.

Elbow Procedures

  • What it does. The torn biceps tendon is reattached to the forearm bone near the elbow, usually through a small incision at the front of the elbow, using an implant that holds the tendon to the bone.

    Who it's for. Active people with a complete distal biceps tear who want to restore strength in turning the palm up and bending the elbow. Results are best when repaired within 2–3 weeks of injury.

    What to expect. Outpatient surgery with a nerve block; you go home in a splint or brace.

    Recovery. The splint or brace protects the repair for the first few weeks, followed by physical therapy to regain motion. Light daily use returns over the first 6 weeks, but heavy lifting waits until about 3 months. Most people regain near-normal strength by 4–6 months.

  • What it does. In a repair, the torn ligament is reattached to the bone and often reinforced with a strong suture tape. In a reconstruction, a new ligament is made from a tendon graft, often taken from the forearm or leg. In both, the ligament is anchored into small tunnels or anchors in the bone.

    Who it's for. Throwing athletes with a complete UCL tear, or a partial tear that hasn't healed with rest and therapy, who want to return to throwing.

    What to expect. Outpatient surgery through an incision on the inside of the elbow, followed by a brace.

    Recovery. A structured rehab program protects the ligament, then rebuilds motion, strength, and throwing mechanics. Throwing restarts with a gradual interval throwing program. Return to competition typically takes about 6–9 months after a repair and about 12 months or longer after a reconstruction.

  • What it does. The damaged tendon tissue on the outside of the elbow (the ECRB tendon) is removed, and the healthy tendon is repaired back to the bone.

    Who it's for. People with tennis elbow whose pain continues after 6–12 months of nonsurgical treatment.

    What to expect. Outpatient surgery through a small incision on the outside of the elbow. You go home in a splint.

    Recovery. The splint comes off at your 2-week visit and is replaced with a wrist splint for daily activities. Avoid lifting with the palm down and forceful gripping during the first 6 weeks while you work on regaining full motion. Strengthening begins around 7 weeks, and most people return to full activities about 12 weeks after surgery.

  • What it does. Through small incisions with a camera, the surgeon can remove loose bodies, bone spurs, or inflamed tissue, and release a stiff joint lining.

    Who it's for. People with loose bodies, locking, painful bone spurs, or stiffness that hasn't improved with other treatment.

    What to expect. Outpatient surgery with a soft dressing. Moving the elbow early is important.

    Recovery. Gentle motion begins within days, often with physical therapy. Most people return to daily activities within a few weeks and to sports or heavy use over about 6–12 weeks, depending on what was done.

  • What it does. The torn triceps tendon is reattached to the tip of the elbow (olecranon) with strong stitches and bone anchors or tunnels.

    Who it's for. Active people with a complete triceps tear, or a large partial tear causing weakness.

    What to expect. Surgery through an incision at the back of the elbow, followed by a splint or brace.

    Recovery. The repair is protected in a splint or brace for several weeks, with bending gradually increased. Strengthening starts around 3 months, and most people return to full activity by 4–6 months.

  • What it does. The tissue pressing on the ulnar nerve at the inside of the elbow is released. If the nerve slips out of place or remains under tension, it is moved to the front of the elbow (transposition).

    Who it's for. People with cubital tunnel syndrome whose numbness persists despite splinting and activity changes, or who have weakness or nerve test changes.

    What to expect. Outpatient surgery through an incision on the inside of the elbow, with a soft dressing or a short time in a splint.

    Recovery. Gentle elbow motion usually begins within days. Pain from surgery settles over a few weeks. Nerve recovery is slower: tingling often improves over weeks to months, and longstanding numbness or weakness may not fully recover.