Shoulder

Shoulder Conditions

Bankart Lesion

A Bankart lesion of the shoulder is a tear of the labrum that causes instability and recurrent dislocations of the shoulder joint. This type of injury often occurs when the shoulder pops out of joint, thereby tearing the labrum. This is quite common in younger patients.

Bursitis

The rotator cuff is a group of four muscles and their tendons that wrap around to form a "cuff" over the upper end of the arm at the shoulder. The rotator cuff helps guide the shoulder through many motions by allowing lift and rotation to the arm while stabilizing the ball of the shoulder within the socket. The space over the top of the rotator cuff is occupied by a bursa which is a fluid sac between the tendon and the acromion bone. Bursitis, a common condition, is inflammation of this fluid sac and occurs with repetitive overhead activity or overuse of the arm. The term impingement refers to pinching of the rotator cuff tendons and bursa against the acromion bone above it.

Labral Tear

Similar to the hip, the shoulder joint is a ball-and-socket joint. The ball of the upper arm bone is held in place within the socket of the shoulder blade. However, the shoulder socket itself is extremely shallow and unstable. The bones of the shoulder are not held in place adequately, thereby requiring extra support. To help compensate for this instability, the shoulder joint has a cuff of cartilage (labrum) that forms a cup for the end of the arm bone to move within. The labrum wraps around the shallow shoulder socket, thus making the socket deeper. In addition, the biceps muscle tendons of the upper arm attaches to the shoulder just above the labrum. This arrangement makes the shoulder much more stable and allows for a very wide range of movements.

A shoulder or arm injury may cause a labrum tear, but the labrum itself may simply become brittle with age and may fray and tear as part of the aging process.

Rotator Cuff Tear

The rotator cuff is a group of four muscles and their tendons that wrap around to form a "cuff" over the upper end of the arm at the shoulder. The rotator cuff helps guide the shoulder through many motions by allowing lift and rotation to the arm while stabilizing the ball of the shoulder within the socket. Tendonitis of the rotator cuff, a common condition, is inflammation of the tendons and bursa (bursitis) and occurs with repetitive overhead activity or overuse of the arm. Unfortunately, a rotator cuff tear is not an uncommon problem and is a frequent cause of disability and pain in the adult population. A rotator cuff tear occurs when there is a tear or injury to one of the rotator cuff tendons.

Shoulder Dislocation

A shoulder dislocation is an injury that occurs when the top of the arm bone (humerus) loses contact with the socket of the shoulder (scapula).

When a shoulder dislocation is diagnosed, the shoulder must be put back in place or “reduced.”

Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs when the tendons of the rotator cuff become compressed between the head of the humerus bone and a part of the shoulder blade. This syndrome can lead to a chronic inflammatory condition that may eventually develop into the weakening of the rotator cuff tendons. Ultimately, this situation could result in a torn rotator cuff.

Shoulder Separation

A shoulder separation occurs after a fall or a sharp blow to the top of the shoulder. This injury is usually sports related. Some separations happen in car accidents or falls. This is not the same as a shoulder dislocation, which occurs at the large joint where the arm attaches to the shoulder, although the two may appear to be the same.

The shoulder separation, or acromioclavicular (AC) dislocation, is an injury to the junction between the collarbone and the shoulder. It is usually a soft-tissue or ligament injury but may include a fracture (broken bone).

Sternoclavicular Joint Dislocation

The sternoclavicular (SC) joint is the pivot on which the shoulder girdle moves on the trunk. It is located at the junction of the collar bone and the breast bone. Dislocation of this joint most often results from a fall onto the shoulder.

The type of treatment your physician prescribes will depend entirely on the type of injury to your joint.

Anterior or forward dislocations are the most common and can sometimes occur with minimal trauma in patients with generalized looseness in their joints. Posterior dislocation of the sternoclavicular joint is less common than the anterior type but is potentially much more serious. Damage to important structures located behind the sternoclavicular joint (arteries, veins, nerves, esophagus, trachea) can cause difficulty breathing and swallowing, poor circulation to the arm and hand, and nerve damage.

Superior Labrum Anterior to Posterior (SLAP) Lesion Tear

The labrum is a fibrous bumper that helps to stabilize the shoulder joint. It provides an attachment site for a variety of other shoulder structures including the capsule, ligaments and biceps tendon. When the superior labrum is detached or torn at the site of the biceps tendon insertion, it is termed a superior labrum anterior to posterior tear (SLAP). A variety of injuries may cause damage to the superior part of the labrum where the biceps tendon inserts. The most common type of injuriesare repetitive over arm motion such as throwing a ball, falling on an outstretched arm or lifting a heavy object.

Overhead athletes or patients involved in repetitive overhead work can damage the superior labrum. This often generates a deep or posterior pain in the shoulder joint accompanied by a clicking, catching or popping sensation. There may be weakness with overhead activity. The throwing athlete often notices diminished velocity and control with throwing a ball. A thorough evaluation by your sports medicine physician is most appropriate to confirm this diagnosis. X-rays may be obtained in order to rule out any type of bony damage. An MRI may also be obtained in order to determine the degree of superior labral injury as well as the existence of any injury in the adjacent capsule, ligaments or biceps tendon.

When is it Time to Think About Surgery?About the SurgeryPreparing for SurgeryWhat to Expect After the SurgeryComplications and Risks of SurgeryRecovery PeriodReturning to WorkPost-Op ExercisesPrintable PDF

An MRI scan or ultrasound, along with a history and physical exam, are the most common ways used to evaluate the shoulder. Rotator cuff tears may cause pain and weakness in the affected shoulder. Most people say they are unable to sleep on the affected side due to the pain. In some cases, a rotator cuff may tear only partially. Partial tears may be painful but you can still move your arm normally. Certain types of partial rotator cuff tears may not require surgical repair and your physician may want to consider non-surgical options that may include: limiting activities, anti-inflammatory medications, physical therapy or an injection of a steroid medication into the shoulder joint.

In general, the larger the tear, the more weakness it causes. A complete tear generally makes it impossible to move the arm normally. It can be difficult to raise your arm away from your side by yourself. A complete rotator cuff tear will not heal and will require surgery if your goal is to return your shoulder to optimal function.

The surgery is done as an outpatient under general anesthesia and will take approximately 1 ½ hours. You may also receive a nerve block injection into your shoulder which will help with pain for several hours following the surgery. The surgeon will make approximately 3-5 small incisions (1/4 inch long) along the front, back and side of your shoulder. He will use these incisions to insert the arthroscope and several other tools. The arthroscope is a small camera device that allows the surgeon to look into the shoulder joint. He can insert tools to trim and remove the degenerative tissue and bone. The torn rotator cuff tendons are repaired by inserting suture anchors into the bone allowing for a strong attachment of the tendon to the bone. This will keep the tendon close to the bone allowing it to heal back to the bone.

You will awaken with a bulky dressing on your shoulder and a sling/pillow in place. Once you are awake, taking fluids, and are in stable condition, the IV will be removed and you will be discharged.

You should be examined by your family doctor to ensure that you are healthy enough for the planned surgery. You are encouraged to stop smoking before surgery to prevent lung complications or delayed healing. Pre-admission testing may be scheduled before your surgery which may include lab work, an EKG and a chest x-ray. Anti-inflammatory medications, aspirin and blood-thinning medications should be stopped one week before your surgery unless otherwise specified by your family doctor. These medications affect your blood clotting ability and could increase your risk for bleeding. Please bring the shoulder immobilizer with you the day of surgery.

The nerve block you may have received during surgery will generally eliminate pain for about 12 hours after surgery. The use of oral pain medications will be needed after the block has worn off. Expect significant pain for the first few days after surgery. The use of ice to your shoulder for the first week is very important. The bulky surgical dressing can be removed after 24-72 hours, depending on your physicians’ preference. You may then shower but do not submerge your shoulder in water. Remove your sling but keep your arm close to your side while showering. Do not apply lotion or antibiotic ointments to your incisions. You may keep your incisions open to the air if they are not draining, or apply clean dry band aids daily. You may be more comfortable resting or sleeping in a recliner type chair. You will have an appointment to see your surgeon in the office 2 weeks after surgery and any sutures will be removed. It is very important that you only remove your sling/pillow for showering and for passive exercises for the first 6 weeks.

Blood clots: Symptoms of a blood clot include pain, swelling or redness of your arm, calf or thigh. Call the office immediately if you develop any of these symptoms or go to the emergency room. If you develop sudden shortness of breath go the emergency room or call 911. The easiest way to help prevent blood clots is frequent walking following surgery.

Infection: Infection is rare but can occur following surgery. Symptoms include fever or chills, drainage, redness, a foul smell or increasing pain at the incision sites. Please contact our office if you experience any of these symptoms or have concerns. You are at a higher risk for infection if you have diabetes, rheumatoid arthritis, chronic liver or kidney disease, or if you are taking steroids.

Nerve damage: Damage to the nerves that surround the shoulder is rare but can occur. Notify your doctor if numbness and tingling around the shoulder is prolonged or worsens following surgery.

Anesthesia complications: Respiratory failure, shock, cardiac arrest and death are always possible during surgery. Patients with long-term kidney, heart, liver, or lung disease are at a higher risk. Nausea and vomiting from anesthesia are common. Coughing, deep breathing and drinking fluids will help to flush out anesthesia.

Bleeding: Trauma to the arteries and veins surrounding your shoulder is rare but may occur. Please contact our office if your surgical dressing becomes saturated with blood. It is common to have some bruising and discoloration around the shoulder and upper forearm.

It is important that your elbow stay close to your side when your sling is off for the first 6 weeks after surgery. Your surgeon will advise you when he wants you to begin formal physical therapy which could begin immediately following surgery or not until 6 weeks after surgery at your surgeon’s discretion. Rehabilitation after rotator cuff surgery can be a slow process. Getting the shoulder moving with simple passive exercises as soon as possible is important, however this must be balanced with the need to protect the healing tissues with the use of the sling/pillow. The first 12 weeks following surgery are focused on regaining motion in your shoulder with a progression in exercises/therapy. You will not begin any strengthening or resistance type exercises until 12 weeks following surgery.

Patients may return to work after they see their physician 2 weeks following surgery but will be restricted to only using their non-affected arm. Patients generally have work restrictions for 12 weeks following surgery. Patients with labor intensive jobs may have restrictions beyond 12 weeks. You will be restricted from driving for 6 weeks after surgery or until your physician has allowed you to discontinue wearing your sling.

Please perform the following exercises 6 times/day for 2 minutes each.

Stir the paint: Remove your sling and stand at a counter or table top. Bend forward and let your surgical arm dangle. Slowly move your arm in a circular motion as if you were stirring a can of paint. Repeat exercise going the opposite direction.

 

Handshake: Remove your sling and keep your elbow tucked in at your side. Move your surgical arm outward until you reach 90 degrees or a handshake position. Do not go over 90 degrees or move your elbow away from the side of your body.

Shoulder Specialists


Dr. Dirk A. Bakker
Dr. Dirk A. Bakker
Dr. Rick A. Baszler
Dr. Rick A. Baszler
Dr. Phillip J. Dabrowski
Dr. Phillip J. Dabrowski
Dr. Daniel J. Fett
Dr. Daniel J. Fett
Dr. Yousif I. Hamati
Dr. Yousif I. Hamati
Dr. Martin M. Pallante
Dr. Martin M. Pallante
Dr. Aaron D. Potts
Dr. Aaron D. Potts
Dr. Jeffrey D. Recknagel
Dr. Jeffrey D. Recknagel
Dr. James R. Ringler
Dr. James R. Ringler
Dr. Edward J. W. Shields
Dr. Edward J. W. Shields
APPOINTMENT