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 PeriodHome InstructionsPost-Op ExercisesPrintable PDF

You may need shoulder arthroscopy surgery if you are experiencing shoulder pain, limited motion, instability, or stiffness. Surgery is usually recommended when you have failed nonsurgical treatments such as physical therapy, medications, or injections.

Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder arthroscopy is an option that may relieve painful symptoms that damage soft tissues surrounding the shoulder joint.

Shoulder arthroscopy surgery involves the doctor making a few small incisions around the shoulder, after using general anesthesia, to put you to sleep. Using an eye piece the doctor can see the inner tissues and surrounding bone of your shoulder on a television monitor. During surgery the doctor can inspect, diagnose, and repair problems in your shoulder.

This procedure will take approximately 1-1 ½ hours for the doctor to perform. You will wake up in the recovery room with a bulky shoulder dressing, an IV, and a shoulder sling in place. Once you are awake, taking fluids, and are in stable condition the IV will be removed and you will be able to go home.

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) may 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.

You will find comfort in relaxing in a recliner type chair to support your shoulder joint during rest or during sleeping hours. Getting up and walking is encouraged to speed your recovery.

You can expect pain and discomfort for at least a week after surgery. Apply ice to your shoulder and take pain medication as prescribed to help with your pain control. You may remove your shoulder dressing 48 hours after your surgery. Your sling may be discontinued at the discretion of your surgeon.

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. Symptoms include fever or chills, drainage, redness, a foul smell or increased pain at incision sites. You are at higher risk for infection if you have diabetes, rheumatoid arthritis, chronic liver or kidney disease, or are taking long term steroids.

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: Respiratory failure, shock, cardiac arrest, and death are always possible during surgery. Patients with long-term kidney, heart, or liver 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.

Bleeding inside the joint: Trauma to arteries or veins surrounding the shoulder is rare, but may occur. It is common for some bruising and discoloration to appear around the shoulder and down the arm following surgery. Bright bloody drainage from your incision sites is not common and the doctor should be notified.

 

The average recovery period for shoulder arthroscopy surgery is 2-4 weeks depending on the specific type of procedure performed. Most patients are back to work within a week if the job is sedentary and longer if the job is labor-intensive. Walking is encouraged to promote your strength during your recovery time.

Showering is permitted 48 hours after surgery. Soap and water may be applied to incision site area. Do not scrub or soak these incision sites or apply any lotions, ointments, or Neosporin. Pat dry incision sites following the shower and keep sites open to air.

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.

 

Wall walkers: Remove your sling and stand facing the wall. Take your surgical arm and use your fingertips to crawl up the wall as high as you can reach.

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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