SHOULDER

 

The shoulder is a “ball-and-socket” joint made up of the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle). This joint is the most flexible one in the body and allows for a full range of motion, but also makes the shoulder a common source of injury and instability.

We see a variety of shoulder problems.  Some of the more common conditions and treatments we offer are:

CONDITIONS

  • Broken Collarbone (Clavicle Fracture)
  • Frozen Shoulder (Adhesive Capsulitis)
  • Rotator Cuff Tear
  • Shoulder Instability
  • Labral Injury
  • Shoulder Dislocation
  • Shoulder Impingement

TREATMENTS

  • Acromioclavicular Joint Surgery
  • Arthroscopic Rotator Cuff Repair
  • Labral Repair
  • Bankart Repair
  • Shoulder Arthroscopy
  • SLAP Lesion Repair
  • Total Shoulder Replacement

While many of these conditions can be effectively managed through nonsurgical techniques, surgery is often needed to thoroughly correct the condition and allow patients to maintain an active and healthy life.

 

CAUSES OF SHOULDER PAIN

Shoulder pain is a common ailment of many people, although the incidence of pain tends to increase with age. This pain can be caused by a number of different shoulder conditions, and can be acute or chronic, and caused by injury or overuse. Damage or injury may occur within the muscles, ligaments, tendons and bones. Patients may experience stiffness, pain, loss of strength, limited range of motion and other debilitating symptoms.

Some of the most common shoulder conditions include:

  • Dislocation
  • Instability
  • Separation
  • Labral Tear
  • Rotator Cuff Tear
  • Bursitis
  • Arthritis

In order to determine the cause of your pain, your doctor will ask for details about your symptoms and medical history, and also perform a physical examination to evaluate the shoulder. An X-ray or CT scan may also be performed in order to examine the bones and soft tissues of the shoulder.

 

TREATMENT OPTIONS

 

The best treatment for shoulder pain depends on the location and cause of the pain. Your doctor will help decide which treatment is best for you after a thorough evaluation of your condition. Many shoulder conditions can be effectively treated through nonsurgical methods such as rest, applying ice or heat, stretching, physical therapy and anti-inflammatory medication.

Some patients with severe shoulder conditions may require surgery, but most of these procedures can be performed through arthroscopy. Surgery is often successful in repairing shoulder problems and restoring function and strength to the joint.

 

BROKEN COLLARBONE (CLAVICLE FRACTURE)

 

The clavicle, commonly known as the collarbone, is the bone of the shoulder joint that connects the arm to the rest of the body. Clavicle fractures most frequently occur as a result of trauma from a blow to the shoulder, fall or motor vehicle accident. They are most common in young children and older adults who are more susceptible to fractures.

Clavicle fractures cause the shoulder to slump downward and a bruise to appear over the fractured area. Some patients may hear a snapping sound when the fracture occurs. Pain is often experienced at the time of fracture and when the area is touched. Patients may also experience pain while trying to move the arm.

If you experience a collarbone fracture, you should seek immediate medical attention. Your doctor will take a brief medical history and examine your shoulder to determine whether or not a fracture has occurred. X-rays may be taken to determine the type and severity of the fracture.

Many fractured collarbones can be treated at home through conservative methods such as immobilization, aspirin, ibuprofen and a sling. Your doctor may instruct you to wear a sling at all times until pain subsides, which can take two to eight weeks depending on your age and the severity of your fracture. Patients whose bone has moved after the fracture may require surgery to repair the bone and allow it to heal properly.

 

FROZEN SHOULDER (ADHESIVE CAPSULITIS)

 

Frozen shoulder, also known as adhesive capsulitis, is a common condition that causes pain and stiffness in the shoulder as a result of a tightening or thickening of the capsule that protects the structures of the shoulder. Although the specific cause of this condition is not known, it most often occurs after recent immobilization of the joint or as a complication of diabetes. Frozen shoulder most often affects patients between the ages of 40 and 60.

Patients with frozen shoulder often experience pain, stiffness and limited range of motion that gradually worsens as the joint becomes more and more frozen. Eventually, the shoulder will shift into its thawing phase, during which pain and stiffness subside and range of motion is slowly restored.

Your doctor can diagnose frozen shoulder after a thorough evaluation of your condition, as well as an X-ray or MRI examination, which helps rule out other possible shoulder conditions.

Treatment for frozen shoulder usually focuses on managing pain and other symptoms as the condition progresses. This may include anti-inflammatory medications, corticosteroids and physical therapy. Minimally invasive surgical procedures, such as distension, arthroscopy and manipulation, may also be performed with a goal of stretching or releasing the contracted joint capsule.

 

ROTATOR CUFF TEAR

 

The rotator cuff is a group of tendons and muscles that support the shoulder joint and allow for complete movement while keeping the ball of the arm bone in the shoulder socket. These tendons and muscles may become torn or otherwise damaged from injury or overuse and can lead to pain, weakness and inflammation. Surgery is often needed to treat this serious condition.

Rotator cuff surgery may be performed arthroscopically or through an open procedure, depending on the type and severity of the condition. Both procedures are performed under general anesthesia and aim to reattach the tendon back to the arm, along with removing any loose fragments from the shoulder area.

 

SHOULDER INSTABILITY

 

The shoulder can often become dislocated or slip partially out of the joint, a condition known as subluxation. This often develops as a result of a traumatic injury that may stretch or tear ligaments in the shoulder, and may cause it to become unstable. Patients with an unstable shoulder often avoid participating in sports or other activities they would otherwise enjoy.

Shoulder stabilization can be performed through an arthroscopic procedure that may involve reattaching loose or torn ligaments to the joint with the use of special implants called suture anchors. These anchors are used to relocate and tighten injured structures, and then disintegrate over time. Depending on the individual patient’s joint stability, shoulder stabilization surgery can also repair tears of the biceps muscle tendon, a damaged rotator cuff, or tighten the shoulder capsule.

 

LABRAL INJURY

 

A labrum is a protective cuff of cartilage found in the shoulder that provides stability, cushioning and a full range of motion. A tear in the labrum, known as a labral tear, is caused by injury or overuse and can lead to pain and “catching” of the joint while moving. While many labral tears can be treated by managing pain symptoms and undergoing physical therapy, some cases require surgical treatment.

Labral repair aims to repair unstable shoulders with staples, anchors or sutures. It is usually performed using arthroscopy, which allows the surgeon to view the tear through a small camera and perform the procedure through tiny incisions. Larger tears may require an open procedure.

 

SHOULDER DISLOCATION

 

The shoulder is a “ball-and-socket” joint where the “ball” is the rounded top of the arm bone (humerus) and the “socket” is the cup (glenoid) of the shoulder blade. A layer of cartilage called the labrum cushions and deepens the socket. A dislocation occurs when the humerus pops out of its socket, either partially or completely. As the body’s most mobile joint, able to move in many directions, the shoulder is most vulnerable to dislocation.

Dislocation causes pain and unsteadiness in the shoulder. Other symptoms may include swelling, numbness, weakness and bruising. The majority of dislocations occur when the humerus slips forward, a condition called anterior instability. This may happen during a throwing motion. The humerus is also capable of dislocating backwards or downwards. In most cases, the dislocated shoulder can be manipulated back into place by a doctor in a process known as closed reduction.

Complications of shoulder dislocation or reduction can include a labrum or cartilage tear, a lesion on the glenoid bone after the humerus strikes it, tendon or ligament injuries, and blood vessel and nerve damage. Shoulders that have dislocated once are more likely to dislocate in the future, potentially resulting in chronic shoulder instability and weakness.

 

SHOULDER IMPINGEMENT

 

One of the most common causes of shoulder pain, impingement occurs when the front of the shoulder blade rubs against the rotator cuff as a person lifts his/her arm. The rotator cuff is a group of muscles and tendons that stabilizes the shoulder and permits lifting and rotating movements. If the rotator cuff weakens or is injured, the bone of the upper arm (humerus) can lift up, pinching the rotator cuff against the shoulder blade. The muscles can then swell further, creating a vicious cycle of pain and weakness that will not improve without intervention.

In addition to rotator cuff injuries such as tendonitis and tearing, impingement may be the result of bursitis, an inflammation of the cushioning sac between the rotator cuff and the shoulder blade.

Impingement worsens over time. At first, you may feel mild pain in the shoulder, which may radiate from the front of the shoulder to the side of the arm. The pain may worsen when you lift your arm, reach for something, or throw or serve a ball while playing a sport. There may be some swelling and tenderness at the front of the shoulder as well. As impingement progresses, pain and stiffness worsen until you may not be able to lift or lower your arm. Eventually, if left untreated, the condition may severely limit arm motion to the point that the shoulder becomes “frozen.”

People most at risk for developing impingement are athletes, especially those who swim or play baseball or tennis, and people whose occupations include repetitive lifting or overhead movements, such as painting and construction. Sometimes, impingement occurs after a minor injury, or even without a discernible cause.

 

ARTHROSCOPIC BANKART REPAIR

 

The socket of the shoulder, or glenoid, is covered with a layer of cartilage called the labrum that cushions and deepens the socket to help stabilize the joint. Traumatic injuries and repetitive overhead shoulder movements can tear the labrum, leading to pain, limited motion, instability and weakness in the joint.

Symptoms of a labral injury can include shoulder pain and a popping or clicking sensation when the shoulder is moved, as well as rotator cuff weakness. One of the most common labral injuries is a Bankart lesion, where the labrum pulls off the front of the socket. This happens most often when the shoulder dislocates. If a Bankart tear doesn’t heal properly, it can facilitate future dislocations, instability, weakness and pain.

Successful treatment of some Bankart lesions can at times be achieved through conservative methods such as rest, immobilization and physical therapy, particularly in older patients. However, many cases require surgery to reattach the torn labrum to the socket of the shoulder. This procedure is successful for most patients, allowing them to return to regular activities with little to no incidence of recurring dislocation.

Surgery to repair a Bankart lesion can often be performed through arthroscopy. Arthroscopy is a minimally-invasive technique that uses tiny incisions to insert a probe-like camera, allowing your surgeon to fully examine the area before performing corrections. The surgeon will then insert specialized instruments through the arthroscope to repair the damage to the shoulder at the exact location of the injury. These small incisions allow for more precise movement and reduce the risk of infection and other complications of surgery. Arthroscopy is especially effective in treating joint conditions such as when Bankart repair is necessary. This technique offers patients minimal pain and trauma, less scarring and less damage to surrounding tissue as well as a faster recovery and shorter length of rehabilitation than with traditional open surgery.

Patients under the age of 30 are more likely to sustain multiple shoulder dislocations after experiencing a Bankart lesion. In fact, more than 80 percent of patients under 30 experience a subsequent dislocation in the shoulder if surgery has not been performed. Correcting the lesion through surgical treatment will significantly reduce this occurrence and allow patients to take part in physical activities without the worries of dislocation.

After arthroscopic Bankart repair, patients will generally be required to keep their arm immobilized in a sling for approximately one month. In addition, you will need to undergo physical therapy for between one and four months to strengthen the muscle tissue and improve the range of motion in your shoulder. Most patients will be restricted from participation in contact sports for a six-month period after surgery to allow the shoulder to fully heal.

As with any surgical procedure, arthroscopic Bankart repair does pose a risk of complications, although it is uncommon. The risks include bleeding, infection, development of a blood clot, shoulder stiffness, failure of the repair to heal, shoulder weakness, failure to provide symptom relief and injury to a blood vessel or nerve. Your surgeon can discuss any potential risks with you prior to the surgery and answer any questions you may have.

 

ARTHROSCOPY

 

Arthroscopy is a minimally invasive procedure that can be used to treat many shoulder conditions by inserting a fiber-optic device and tiny surgical instruments into small incisions. Patients can benefit from less tissue damage, shorter recovery times and less scarring with arthroscopic techniques. This procedure can also be used for diagnostic purposes after a physical examination and other imaging procedures have been performed.

Also known as shoulder scope, arthroscopy can be used to treat rotator cuff tears, labral tears, impingement, biceps tendonitis and AC joint arthritis. The type of repair performed depends on each patient’s individual condition, but often involves removing inflamed tissue, reattaching torn tissue or replacing damaged cartilage. The incisions are closed with sutures and usually heal well.

 

SLAP LESION REPAIR

 

This arthroscopic procedure is performed to repair a tear of the biceps tendon at the point where it connects to the labrum, a ring of cartilage that surrounds the shoulder socket. A tear at this point is called a SLAP (Superior Labrum Anterior-Posterior) tear. SLAP repair is performed under general and regional anesthesia, and patients usually leave the hospital the same day.

 

TOTAL SHOULDER REPLACEMENT

 

Severe shoulder conditions with persistent symptoms that have not responded well to conservative treatments may benefit from shoulder replacement surgery. Shoulder replacement surgery replaces the damaged joint with an artificial one that allows patients to enjoy painless motion and resume their regular activities.

During the shoulder replacement procedure, the damaged bone and cartilage are replaced with a metal and plastic implant that helps relieve pain, stiffness and swelling, while improving range of motion and allowing patients to resume their regular activities.

 

To learn more about our Shoulder Procedures & Treatments, please contact us at (504) 349-6804 today to schedule an appointment.