Volleyball player surprised by shoulder dislocation

September 2nd — admin

I dislocated my shoulder playing a neighborhood pick up game of volleyball. I never knew it was coming. One minute I spiked the ball over the net and the next I was on the ground in pain. How is that possible?

Many shoulder dislocations occur at work or during recreational or sports activities. Most people give the same report the first time it happens. They didn’t have pain, popping, or any symptoms to suggest the shoulder wasn’t stable.

Once a shoulder has dislocated, it can happen again. Warning signs and symptoms of repeated dislocations called prodromal symptoms may not be present. Most of the symptoms of first or repeat shoulder dislocation such as pain, muscle spasm, and loss of motion occur after it’s already happened.

Some people can pop their own shoulder out of the socket. This is called voluntary dislocation. Patients are advised not to do this since the soft tissue around the shoulder can get stretched, putting the person at greater risk of chronic dislocation.

The more times a shoulder is dislocated, the greater chance there is for rotator cuff tears around the shoulder.

The specific dynamics of the first dislocation may not be fully understood. Repetitive motion is a likely factor. Was there a partial tear of the rotator cuff already present? Or do the rotator cuff tears seen with shoulder dislocations happen after the joint dislocates? Researchers are investigating these questions with the hope of preventing shoulder dislocation and the damage that can occur.

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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Options for hang glider who crashed, tearing rotator cuff

August 30th — admin

I’m a certified hang gliding instructor with 20 years of experience. Even so I hit an updraft and crashed, tearing three of the tendons in my shoulder. I’ve had two surgeries to try and repair this massive tear. They didn’t work. Are there any other options left to me?

Repair of massive tears of the rotator cuff can be problematic. In some cases they are considered irreparable. Studies have been done trying different surgical methods of treatment for this problem. So far there hasn’t been a single type of surgery that works best.

For the most part the best approach seems to be cleaning up the damaged tendons. This is called debridement. Then the bone across the top of the shoulder (acromion) is removed. This is called an acromioplasty. If just the underside of the acromion is shaved, it’s called a subacromial decompression.

When any part of the rotator cuff is torn and can’t be repaired, an imbalance occurs at the shoulder. That’s why the rest of the rotator cuff can get impinged. Reducing or removing the acromion leaves room for the remaining tendons of the rotator cuff to slide and glide without getting pinched.

Other surgeries used to reconstruct massive rotator cuff tears include tendon transfers, fusion, and tendon grafting. No one method seems to have better results than the others.

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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Rodeo rider may want shoulder replacement, not fusion

August 25th — admin

I’m a professional rodeo rider and had a bad calf roping accident. My right shoulder was dislocated severely and the muscles around the joint ruptured. After three surgeries already I’m going to have it fused. How do they do this operation? What can I expect during recovery?

Shoulder fusion is not used as commonly as it once was. Shoulder replacement has replaced fusion in many cases. If you haven’t already talked to your surgeon about a total shoulder replacement, you may want to ask about this as an option before shoulder fusion.

Shoulder fusion or arthrodesis is called a salvage procedure. The arm is saved from amputation but full shoulder motion isn’t preserved. You may not have enough motion to swing a rope over your head or enough strength to wrestle a calf to the ground.

The fusion is done using metal plates and screws. The reconstruction plate is actually one normally used in the hip or pelvic area. It goes up along the outside of the upper arm and over the top of the shoulder along the bony ridge of the shoulder blade. Screws help compress the bones together to fuse the area. Sometimes bone grafts are used to fill in any spaces left open.

Your arm will be immobilized for at least eight to 10 weeks. Some doctors use a special abduction pillow. Others put the arm in a full cast from wrist to shoulder. Once there is evidence of fusion on X-ray, rehab exercises can begin.

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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Dislocated collarbone does not always require surgery

August 20th — admin

My son is a freshman away from home at college. He fell from a ladder and dislocated his collarbone. He tells me he had a ‘closed reduction’ and he’s okay. What does this mean?

Reducing a dislocation of any joint means the joint is put back in place or ‘relocated.’ A closed reduction suggests the medical person who treated him was able to get it back in place without surgery.

Sometimes it’s just a matter of putting the patient in just the right position and the bone will slip back in place. For example, one way to relocate the collarbone (clavicle) to the sternum is to lie down on the back with the dislocated side on the edge of a table. A sandbag is put between the shoulders. The arm is brought out to the side and pulled out gently. The sound of a “pop” occurs when the clavicle goes back into place.

There are several other ways to relocate this joint. If that doesn’t work then surgery or open reduction may be needed. The clavicle is lifted up and put back in place. If it stays there without slipping down the incision is closed and the patient is immobilized in a special sling to hold it in place.

If the clavicle keeps slipping out of place then more extensive surgery may be needed. Your son should be advised not to do any lifting for the next six weeks until the joint is fully healed. Strenuous upper body exercises such as push-ups or pull-ups should also be avoided.

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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Rotator cuff problems diagnosed with “empty can test”

August 17th — admin

I took my son into the orthopedic surgeon for shoulder pain. I am reading the doctor’s report, which says there is a positive “empty can test”. What is this and what does it mean?

The empty can test refers to a position of the arm used to identify problems with the supraspinatus muscle. The supraspinatus is one of the four muscles/tendons that make up the shoulder rotator cuff.

The test was first described in the early 1980s by two very well-known orthopedic surgeons (Drs. Jobe and Moynes). The arm is raised out to the side with the elbow straight and the thumb pointing down towards the ground as if you were emptying out a can of soda pop.

The shoulder is fully rotated inward (internal rotation) during this test. Any weakness to resistance while in this position suggests a tear of the supraspinatus tendon.

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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Baseball pitching’s effect on shoulder

August 12th — admin

When I watch my son wind up and throw the ball when he’s pitching, I can’t help but wonder how that extreme motion is going to affect his shoulder joint years from now. Are there any studies to show what happens inside the joint?

There are some long-term effects of throwing in the shoulders of throwing athletes. The glenohumeral (shoulder) joint comes under high joint forces, speed, and stress during this activity.

Extreme positions of motion may actually alter the shape of the joint capsule and surrounding ligaments. Joint stability may even be compromised. Right now all we have are theories. Evidence to prove any of these changes occurs is lacking. Even the idea that the soft tissues “stretch out” after long-term throwing remains unproven.

In a recent study of elite baseball pitchers, physical therapists from the University of Florda offer some insight. They measured the joint motion and stiffness of 34 professional baseball pitchers. They found the same amount of motion on both sides (throwing versus nonthrowing shoulders). What they noticed was that the pitching arm had more external rotation. The nonthrowing arm had more internal rotation.

The front portion (anterior capsule) was stiff in both arms. This stiffness gave the joint greater stability. There was less risk of injury. The risk of arthritis in the adult years with overhead pitching in young children isn’t known yet. More long-term studies are needed.

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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Rotator cuff tear result of trauma, aging

August 9th — admin

I’ve just been diagnosed with a rotator cuff tear but I’m not an athlete and I can’t remember any injury or trauma. How is this possible?

There are actually two ways to tear the rotator cuff. Trauma is the most common in the young, athletic population. Aging is more common in the over 50 crowd. Aging comes with its own wear and tear process in the shoulder.

The rotator cuff is a group of four tendons surrounding the shoulder. Over time and with use, it’s possible to wear a hole in the rotator cuff. Many people aren’t even aware it’s happening. It a lot like wearing a hole in the seat of your pants.

Weakness and then pain start to get our attention. It’s not until the person has trouble reaching behind to unfasten a bra or put on a coat that the problem is recognized.

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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Simple movements can stress shoulder

August 4th — admin

I’m in a sling after shoulder surgery for the next six weeks. I’d really like to just try out my new arm. Is it such a bad thing to move it around?

We don’t really know how much force can be applied to normal tendons much less healing soft tissues. Animal and cadaver studies have given surgeons a general idea. The amount of acceptable force will increase over time as the tissues interface with the bone.

You’re best off to follow your surgeon’s advice carefully. The healing tissue is very weak and can’t hold together with stress or pull. Even the simplest of movements can put a greater load on the surgical site than it can handle.

Most surgeons give their patients specific guidelines to follow. There are some general guidelines for everyone having the surgery you had. There are some just for you based on your age, the condition of your soft tissues and bones, and the type of surgery done. Be sure and ask if you don’t know what are the limits in your case. You wouldn’t want to undo what the surgeon just spent hours (and your money) fixing.

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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What are the activity limits after rotator cuff surgery?

July 30th — admin

I’m in the early weeks of recovery from surgery for a rotator cuff tear. Just how much activity can the repair take? I’d like to know what are the limits.

Each surgical repair is different based on a few factors. First is the size of the tear and the method used to repair it. Second is the timing. You mentioned being in the early weeks of recovery. The amount of load the repair can handle increases as the tissue heals. In the first six weeks the load limits are much less than after six to eight weeks.

For example the load on the repair is much less with forward flexion of the arm compared to other shoulder movements. Passive motion (someone else moves the arm) versus active movement (you move the arm) has different load limits.

Your surgeon should have given you some idea of the limits both in terms of motion and lifting. Sometimes patients don’t realize the paperwork they take home with them has this information in it. Read everything given to you. Contact your surgeon directly if you don’t find what you are looking for.

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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No shoulder surgery needed for teenage football player

July 27th — admin

My 17-year old son separated his shoulder playing football. The doctors say ‘no surgery’ just rest and let it heal on its own. Could he get back to playing football sooner with an operation?

There are lots of problems with operations trying to repair the AC (acromioclavicular) joint. In fact more than 60 different ways to surgically repair the AC joint have been tried.

Wires and screws don’t seem to hold. They break or move causing problems. Sutures to hold the joint together don’t seem strong enough. Many times the joint starts to move apart again.

Surgery isn’t an option unless the person doesn’t recover with conservative care or the injury is so severe an operation is the only way to treat it.

If your son follows his doctor’s instructions he should heal in two to six weeks. Rehab should be completed before resuming football to prevent re-injury.

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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