Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The treatment of rotator cuff disease depends on the severity of the
injury to the tendons of the rotator cuff and the underlying
condition of the patient.
Mild rotator cuff disease is treated with ice, rest, and antiinflammatory medications (such as ibuprofen and others). Generally,
a gradual exercise rehabilitation is instituted. Exercises are used
that are specifically designed for rotator-cuff strengthening.
Patients with persistent pain and motion limitation can often benefit
by a cortisone injection in the rotator cuff. Sometimes, repeat
injections are necessary.
More severe rotator cuff disease can require surgical repair.
Subacromial decompression is the removal of a small portion of the
bone (acromion) that overlies the rotator cuff. This removal can
relieve pressure on the rotator cuff in certain conditions and
promote healing and recovery. This procedure can be done by
arthroscopic or open surgical techniques. Both methods have been
reported to be equally successful.
The most severe rotator cuff disease, complete full-thickness rotator
cuff tears, usually requires surgical procedures for the best
results. These procedures, which can also be done by either
arthroscopy or open surgery, involve mending the torn rotator cuff
by suturing the tissues back together.
What is the outlook (prognosis) for rotator cuff disease?
Without
treatment, including exercise, the shoulder frequently permanently loses full
function from rotator cuff disease. Sometimes, scarring around the shoulder
(adhesive capsulitis) leads to a marked restriction of the range of shoulder
motion. This condition is referred to as a frozen shoulder.
Weeks of rehabilitation is the norm with significant rotator cuff
disease. Some patients never recover full function of the shoulder
joint.
Shoulder bursitis is inflammation of the shoulder bursa. Bursitis may be caused by injury, infection, or a rheumatic condition. Symptoms include pain, swelling, tenderness, and pain with movement of the shoulder joint. Treatment may involve ice compresses, rest, and antiinflammatory medications and depends on whether there is an infection.
A frozen shoulder (adhesive capsulitis) is when the shoulder joint experiences a significant loss in its range of motion due to inflammation, scarring, or injury. Treatment involves anti-inflammatory medication, cortisone injections, and physical therapy.
Post-polio syndrome (PPS) is a group of signs and symptoms that show up two to four decades after the initial polio infection. Symptoms of PPS include fatigue, pain, sleep disorders, muscle twitching, gastrointestinal problems, and weakness. Treatment focuses on slowing down to conserve energy and relieving symptoms with pain relievers.
Calcific bursitis is the calcification of the bursa caused by chronic inflammation of the bursa. Calcific bursitis most commonly occurs in the shoulder. Calcific bursitis treatment includes medication for inflammation, ice, immobilization, cortisone injections, and occasionally surgical removal of the inflamed bursa.
Hydroxyapatite crystal disease is the inflammation caused by hydroxyapatite crystals. These tiny crystals of hydroxyapatite deposit by mistake in or around joints and may cause inflammation of the joints and nearby tissues such as the tendons and ligaments (particularly causing rotator cuff problems in the shoulder). Treatment options include rest, cold application, medications to reduce inflammation, and cortisone-related medication injections.
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