Steroid injections for pain relief – how long do they last?

March 9, 2010 — admin

I had a steroid injection into my shoulder for a problem with bursitis. I got immediate relief that lasted about a week. Now my symptoms are starting to come back. How long do steroid injections usually work?

There aren’t too many studies just on the duration of pain relief with steroid injections into the joints. Results range from one week as in your case up to 13 weeks.

It’s clear that steroid injections work better than placebo injections with saline solution. And studies show that some steroids work better than others. Long-term pain relief may require a higher dose of the steroid.

In some cases steroid injections are used to control pain and reduce rehab time after arthroscopic surgery. In a patient with recurring bursitis there may be other factors such as posture and overuse to be addressed. The injection may help calm the joint enough to work on improving alignment and motion. Combining physical therapy with steroid injection may be one way to improve overall results.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Still have pain 3 weeks after shoulder surgery?

March 4, 2010 — admin

I had some shoulder surgery three weeks ago. I am doing my exercises faithfully, but there’s still quite a bit of pain. Is this normal?

Pain is a normal sign at certain points in the recovery process. This is most common during the early phase after an operation. Drugs to control pain and inflammation are used from one to three weeks after surgery.

At the same time, physical therapy to stretch and move the tissue is begun. The therapist will include exercises to retrain the muscles, restore normal posture, and begin motion. The program is progressed from three to six weeks postop.

Throughout this time, it’s best to complete the exercises without pain. Pain is a sign that something is wrong. Either the exercise is being done too soon or improperly. It’s better to do a little often than doing a lot occasionally.

Keep at it with the help of your therapist. Quality is more important than quantity. Good muscle control comes first before the ability to do many repetitions. Stop when the muscle gets tired. You’ll know you’ve reached this point when the muscle starts to shake or you can’t go through the same motion as during the first few repetitions.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Will laser heat treatment work for arthritis in the shoulder?

March 2, 2010 — admin

I heard there’s a new laser heat treatment for loose shoulders. Will this work for arthritis?

Using heat in the form of laser or radiofrequency has gained in popularity over the last 10 years. Uses for laser therapy in the shoulder are still limited. Research only supports its use for shoulder instability.

When the fibrous tissue surrounding a joint (the capsule) is torn or stretched, it’s causes joint laxity. This is another way to say “loose joint.” Joint laxity causes a joint to be unstable. In the case of the shoulder, this can lead to dislocation.

Currently, thermal devices are used to treat shoulder instability caused by damage to the capsule. Arthritis is a condition that primarily affects the bone and joint surfaces. Laser hasn’t been approved for use with arthritis at this time. More studies using laser are being done and may include arthritis in the future.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Blue hands are not just in Avatar!

February 25, 2010 — admin

Sometimes, I wake up in the middle of the night and my arm is cold and stiff. My hand is blue and it looks like I’ve lost the blood supply to my hand. What causes this?

The condition you’re describing is called positional cyanosis. Cyanosis means a bluish discoloration. It’s caused by a lack of oxygen to the tissues. This can occur if you sleep in one position too long or if you lay on the arm without moving for more than two hours.

Another possible cause of this problem is a condition called thoracic outlet syndrome (TOS). In the adult body, there’s a bundle of nerves and blood vessels that travel from the neck down the arm. These pass under the collarbone. If anything presses on the vessels, the blood supply can get cut off.

TOS can occur as a result of postural changes, bone spurs in the neck or shoulder, or problems with the muscles. A physical therapist can help you find the cause of the problem and solve it. If you don’t get relief from your symptoms in three months, see your doctor.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Elbows in or out for push-ups? It really does matter!

February 22, 2010 — admin

I have been doing push-ups as part of my regular exercise routine. Does it really matter whether my elbows are out or in?

Yes, actually it does make a difference as to which muscles are activated. In both positions, the chest muscles are the primary movers. However, with the elbows tucked into the sides, the triceps muscle behind the upper arm becomes more active. When the elbows are out, the deltoid muscle of the upper arm is more active.

You can actually test this for yourself by doing many repetitions of just one kind (elbows in versus elbows out). You’ll likely be sore within 24 to 48 hours. Repeat the exercise using the other method. Compare which muscles are more active by patterns of soreness.

Most people would prefer to avoid muscle soreness. There are ways to measure muscle activity. Studies of adults doing push ups against a force plate have measured muscle activity with this exercise. Besides the main muscle doing the action, other helper muscles are found this way.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Capsular pattern of frozen shoulder explained here

February 17, 2010 — admin

The doctor and physical therapist told me I have a frozen shoulder with a capsular pattern. I understand the frozen shoulder part but what does ‘capsular pattern’ mean?

The shoulder is a very complex joint with muscles, tendons, ligaments, bursae, and fibrous cartilage helping to hold it together and give it smooth motion. Four muscles and their tendons called the rotator cuff surround the shoulder joint like an envelope. These are covered by a fibrous connective tissue called the capsule.

The head of the humerus (upper arm bone) and the shoulder socket are enclosed by the capsule. Normally the capsule is large and loose. When injury or immobility damages the capsule a frozen shoulder can develop. This means the shoulder doesn’t move smoothly in the socket. It gets stuck or frozen in place. The medical term for this is adhesive capsulitis.

With a frozen shoulder a typical pattern of movement restriction starts. This is known as the capsular pattern of the shoulder. The greatest loss of motion is in outward or external rotation of the shoulder. Moving the arm away from the body is also limited. This is called shoulder abduction. In a severe capsular pattern inward or internal shoulder motion is also stuck.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Shoulder surgery for torn rotator cuff often uses anchors

February 9, 2010 — admin

My son is going to have a rotator cuff tear repaired surgically. The doctor described a special anchor suture that will be used to hold the tendon in place until it heals. What kind of problems can come from using these anchors?

Rotator cuff tears are often repaired using some kind of anchor or suturing system. The fixation devices are called suture anchors. They work like rivets to reattach the tendon to the bone. These anchors can be made of bone, metal, or plastic.

Problems differ depending on the type of anchor material used. For example, some anchors (like the bone buttons) require a hole predrilled before insertion. This extra step makes for a longer operation. Sometimes the surgeon has trouble making and then finding and using the hole.

Anchors made of bone are usually absorbed by the surrounding bone and don’t have to be removed. Plastic anchors may also “dissolve” or get absorbed by the bone. Some metal anchors are held in place by threads or barbs. These do not resorb and can cause problems if they move or come loose.

Other problems can include breakage of the anchors, anchor pullout, infection, or rerupture of the tendon. Infection and poor wound healing are problems in a small number of cases. Usually, these patients have diabetes or some other healthy issues or they are tobacco users.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Muscles can heal, but shoulder surgery may be necessary

February 4, 2010 — admin

I’m a construction worker. I tore my right biceps muscle lifting a heavy cement block. Can the muscle heal by itself?

Muscles in the arms and legs can heal after injury but it’s very slow. Recovery usually takes four to six weeks and may not be complete. You may have some loss of strength. Re-injury is common after these types of muscle strains.

Healing occurs in several steps or phases. First there’s bleeding at the site of injury. A bruise or bleeding into the muscle called a hematoma may occur. Some muscle cells will die, then inflammation occurs. Special cells called phagocytes clean up any damage or debris. Scar tissue forms to fill in the damaged area. Small blood vessels also form to supply the new tissue with blood.

The final result depends in large part on how severe the injury is. Good nutrition and rest are important to promote healing. The right amount and kind of movement can also help muscles heal at the right length-tension ratio needed for normal range of motion. In some cases, surgery is an option to reattach the tendon and muscle unit.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Different types of dislocated shoulder, different treatments

February 1, 2010 — admin

Three years ago I dislocated my left shoulder. They called it a Bankart lesion. Now I’ve dislocated the shoulder again with even more damage. This one’s called a Hill-Sachs lesion. How is that different from the first dislocation?

The shoulder joint is a ball-and-socket joint. The socket is fairly shallow. This puts the joint at risk for dislocation. To help deepen the socket, the shoulder joint has a rim of cartilage called a labrum. The labrum forms a cup for the end of the arm bone (humerus) to rest and move inside.

A Bankart lesion is an injury to the labrum caused by forward (anterior) shoulder dislocation. The force of the head of the humerus (upper arm bone) as it dislocates, tears the labrum and the ligaments attached to it. The shoulder joint is unstable when the labrum is torn. There isn’t anything to keep the head of the humerus from slipping forward out of the socket again. Surgery to repair the damage is usually needed.

A Hill-Sachs lesion is an injury that causes damage to the head of the humerus. It also occurs with shoulder dislocation. When the shoulder dislocates, the smooth surface of the humerus hits against the bony edge of the socket (called the glenoid). The collision causes a dent in the bone of the humerus. This is also called an impaction fracture.

The Hill-Sachs lesion can usually be seen on a normal shoulder x-ray. Surgery may not be needed. Treatment is designed to prevent further damage (and later arthritis) to the surface of the humerus.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Mastectomy could be cause of shoulder pain

January 28, 2010 — admin

I’m a 48-year old woman and I had a mastectomy for breast cancer three months ago. Now that I’m back to swimming, I notice I’m having trouble with my stroke. My husband says when I reach forward to stroke, the shoulder blade pops out noticeably. Could this be caused by the mastectomy?

You may be describing an injury to the long thoracic nerve that controls the serratus anterior (SA) muscle. When there is weakness in the SA the shoulder blade or scapula can’t rotate and slide like it should when the arm is lifted up. The result is called scapular winging.

Mastectomy is one possible cause for this problem. During the surgery for the mastectomy, the nerve can get stretched from the position of the arm. There are many other possible reasons such as a viral illness, working with the arms overhead, or lifting a heavy weight.

The best way to know for sure what’s going on is to have some testing done. Electromyography or EMG studies can find out for sure which muscles are involved. Nerve conduction velocity (NCV) tests can be done to see if the nerve is damaged. Talk to your doctor about these symptoms and see what he or she suggests.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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