Anatomy: The rotator cuff is a group of muscles and associated tendons that support and give mobility to the glenoid and the humerus. They are composed of the supraspinatous, infraspinatous, subscapularis, and the teres minor muscles.

Symptoms: These muscles are essential to normal shoulder function for daily activities and for sports performance. Inflammation and/ or degeneration of these tendons may cause pain at rest or with activity, especially with motion of the arm away from the trunk. Patients may note pain that originates in the shoulder with provocative motion that may radiate down the arm. Pain may be present at rest and also when sleeping. Degeneration of the rotator cuff could advance and could present in the form of a rotator cuff tear. Tears of the rotator cuff may present as a gradual or post-traumatitic onset of weakness.

Treatment: Tendonitis and/ or tears of these tendons and be treated with a number of non-invasive as well as invasive medical options. The mainstay of treatment is exercise and physical therapy. This rehabilitation regiment is augmented with oral and sometimes injectable anti-inflammatory medications. Surgical treatment consists of removing and bony spurs (osteophytes) on the acromion and debriding or repairing and tears down to is normal insertion sites on the humerus. The gold standard remains treatment with open surgical debridement and open rotator cuff repair. However, mini-open, modified mini-open, and arthroscopic rotator cuff repair are considered the future of shoulder surgery. These techniques in the right circumstances allow for fastest rehabilitation, less pain, and quicker return to normal function following surgery.

Anatomy: The shoulder joint is the body's most mobile joint, it consequently it has the propensity for dislocation. The shoulder joint is stabilized by rotator cuff muscles, hydrostatic pressure, and the capsule of the shoulder. Instability of the glenohumeral joint arises from injury to one of the aforementioned anatomic structures. This is known as traumatic instability. It can also arise from the dysfunction of the muscles around the shoulder and laxity of the soft tissues. Atramatic instability of shoulder is known as multidirectional instability.

Symptoms: Patients often complain of pain in the shoulder joint. They also complain of a sense of instability and unease when the shoulder is placed into certain provocative positions.

Treatment: The mainstay of treatment is physical therapy and exercise. In the case of refractory instability, operative intervention and reconstruction of the soft tissues for stabilization is performed. For traumatic anterior dislocation a combination labral reconstruction and tightening of the anterior capsule, traditionally called a bankhart repair, is performed. Multidirectional instability may be addressed with a procedure that tightens the anterior and inferior capsule is known as a capsular shift. Both these procedures have a high degree of success and maybe performed in a open fashion but also may be performed arthroscopically. Open for procedure for shoulder instability is the gold standard; however, arthroscopic reconstruction offers the patient faster initiation of rehabilitation and less post-operative pain.

Anatomy: Arthritis can develop in the glenohumeral joint, between the humerus and the glenoid. Acromial-clavicular arthritis develops between the clavicle and the acromion.

Symptoms: Pain with activities as well as with rest. Lack of a range of motion, grinding and tenderness to touch are some of the symptoms that patients state.

Treatment: Arthritis of the acromial-clavicular joint may be diagnosed and treated with an injection. Non-operative treatment of the AC joint involves medications and injections. Refractory cases may be treated with an open or arthroscopic distal clavicle excision. Arthritis of the glenohumeral joint may necessitate a total shoulder replacement if the muscles are intact.

Anatomy: Lateral Epicondylitis (Tennis Elbow): Degeneration and inflammation of the wrist extensor tendons is characterized by pain and tenderness at the lateral prominence of the elbow.

Anatomy: This condition is the similar to other arthritic conditions; however, lack of mobility is also a manifestation of elbow arthritis as well as pain. If lack of motion is the major complaint then x-rays and computer tomography can be used to determine the cause of diminished motion. Loose bodies in the elbow and bone spurs may cause lack of motion. In those cases the bone spurs and loose bodies can be removed and motion restored with the arthroscopic removal of the mechanical impediment.

In those cases when arthritis has worn the joint surface then the other option is elbow replacement surgery. Elbow replacement is a highly successful surgery in the proper patient population.