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 SurgeryComplications and Risks of SurgeryRecovery PeriodTreating and Preventing InfectionHome InstructionsPost-Op ExercisesPrintable PDF

You may need shoulder replacement surgery if you experience pain, loss of shoulder motion, and difficulty with daily activities of life. These symptoms may be related to arthritis (loss of cartilage) along with a torn or worn out rotator cuff tendon in your shoulder.

The reverse shoulder replacement uses a ball-and-socket joint where the ball is placed on the shoulder blade and the socket is placed on the top of the arm bone. This is reverse of our normal anatomy and is designed to make the deltoid muscle, the large shoulder muscle that caps the end of the shoulder, work better to make up for the deficiency of your worn out rotator cuff tendon.

This surgery involves the doctor making an incision approximately 4-6 inches long along the front of your shoulder. The surgery takes 1 ½- 2 hours long and is performed under a general anesthesia with a nerve block to reduce pain after surgery.

You should be examined by your family doctor to ensure 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 (lab work, EKG, chest x-ray) will be scheduled prior to your surgery. Medications such as anti-inflammatory medications, aspirin, and blood thinning medications should be stopped one week before surgery unless otherwise specified by your family doctor.

Most people are able to get out of bed with help the day of surgery. Hospital stay is usually 1-2 days. You may be discharged home with nursing services and a therapist to help with your home exercises.

Once home you are encouraged to be up and walking several times per day for short periods to restore your physical strength. You may be more comfortable resting or sleeping in a recliner type chair.

Home exercises are to be done 6 times per day to prevent shoulder stiffness. Formal physical therapy will begin when instructed by your surgeon usually 1-2 weeks after surgery.

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 to the emergency room or call 911.

Infection: Infection is rare but can occur following surgery. You are at higher risk of infection if you have diabetes, rheumatoid arthritis, chronic liver disease, or are taking steroids. Symptoms include: drainage, redness, fever, foul smell or increased pain of surgical site.

Blood loss: It is possible you may need a blood transfusion following surgery. Your doctor will evaluate you daily to determine this need.

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

Anesthesia complications: Risk of respiratory failure, shock, cardiac arrest, and death are always possible. Patients with long-term liver, kidney, heart or lung disease are at a higher risk. Nausea and vomiting from the anesthesia are common. Coughing and deep breathing as well as drinking fluids will help flush out the anesthesia gases.

Bone fracture: Although it is rare, a fracture could occur during surgery while fixating the implant.

Pneumonia: Lung congestion is possible following surgery when you are not as active. Coughing and deep breathing is encouraged to help you expand your lungs and clear any congestion.

Constipation: Bowel movements are slowed down with less activity and use of pain medications. Stool softeners will be encouraged after discharge to promote regular bowel movements and prevent constipation.

Dislocation of shoulder: Rarely happens but occurs when soft tissues around the shoulder joint are stretched too soon after surgery.

The average recovery period for shoulder replacement surgery is 4-6 months. Lower impact activities such as walking, biking and swimming are good forms of exercises after your recovery period.

Notify your family doctor if you develop any suspected infections so you can be placed on an antibiotic to prevent the spread of infection to your shoulder joint. Infections such as ear infections, ingrown toenails, bladder infections, sinus infections, and sore throats should be reported immediately. Make sure all of your doctors know you have had a joint replacement so you can be pre-medicated with an antibiotic before any dental work, bladder, bowel or vaginal surgeries or a colonoscopy.

Your sling must stay on at all times (even during sleep) and worn for 4-6 weeks following surgery. The chest strap wrapped around your body must stay on for the first 2 weeks. Ice to the surgery area (20 min on and 20 min off) will help decrease your pain and swelling.

72 hours following surgery you may remove dressing and shower but do not submerse your shoulder in water. You are allowed to remove your sling for showering only but keep your surgical arm at the side of your body during the shower. Soapy water may rinse over your surgical site but do not scrub this area. Pat dry the surgical site with a clean towel and leave the incision site open to the air. Do not apply any lotions, ointments, or Neosporin over the incision area.

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
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