My 80 year old mother and my 18 year old son suffered a hip dislocations. Why is my mother recovering faster?

December 23rd — admin

My 80-year-old mother and our 18-year-old son both suffered a hip dislocation on the same day. What do you think the chances are of that happening!? But my real question is — why is Mother recovering so much faster than our son? It seems like he has age on his side but he’s really poking along compared to Mom.

Most of us are familiar with older adults who fall and break a hip — or break a hip and fall. It’s an unfortunate event that adds insult to injury. But young adults are also at risk for hip dislocation from trauma. This time it’s more likely as a result of a high-speed car crash. The incidence of hip dislocations is on the rise, not just from motor vehicle accidents, but also from falls, sports injuries, and getting hit by a moving vehicle if you are a walker.It’s easy to fall into the trap of thinking that young people can heal easily and quickly and go their merry way. But, in fact, the risk of hip joint arthritis on that side goes way up after a traumatic hip dislocation at a young age. Even more so when there are other injuries along with the dislocation. Bone fractures, torn ligaments, and damaged joint cartilage are often present when the force of the injury is enough to dislocate the hip. Final results can depend on how quickly treatment (especially surgery) is provided. The accuracy of diagnosis is also important. If there is debris in the joint from bleeding or if there are bits of torn cartilage floating around inside the joint that go undetected, the patient’s results can be compromised.There are many other factors affecting the outcomes such as type of dislocation, presence of additional damage in and around the joint, need for more invasive surgery, and so on. And the wisdom of age has its advantages. Older adults may know better how to rest, apply common sense, and progress forward bit by bit. Younger adults may overdo, fail to follow their surgeon’s advice, and reinjure themselves during the prescribed period of rehabilitation.

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 a 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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When can patient play tennis again after arthoscopic shoulder surgery?

June 21st — admin

I’m going to have an arthroscopic surgical procedure for a problem with a chronic left shoulder dislocation. I’d like to get back on the tennis court in time for the adult summer league. What kind of rehab program should I expect?

Rehab programs after a shoulder stabilization procedure may be the same whether it was an open versus closed procedure. Sometimes this depends on the surgeon’s preferences. Type of sutures used, amount of damage to the soft tissues, and condition of the joint capsule are only three of the important considerations.

Most often, the protocol used during the early phase of rehab is one that can be modified for each patient. Your therapist will advance you along as quickly as possible. The rehab protocol is really just a guideline.

Most likely you will be put in a shoulder immobilizer (sling) in the operating room. This is worn for two to four weeks. Exercises are started at two weeks. Passive and active-assisted partial range of motion is allowed. Full, active range of motion is permitted at six weeks.

The therapist will progress you to and through a series of strengthening exercises. The speed at which you will be able to advance may depend on your level of pain, degree of stiffness, and strength. You will be able to start training for tennis participation between eight and 12 weeks. If there are no complications or problems, you may expect to return to your sport about four months after surgery.

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 a 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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Arthroscopic vs. incision approach for golfer’s shoulder, which is better?

June 16th — admin

I’m a semi-pro golfer with a bad shoulder from chronic dislocations. The surgeon has offered to do a stabilization procedure with either an open incision or arthroscopically. Is there much difference between these two operations?

Improvements in both surgical procedures has narrowed the gap of advantages of one over the other. The arthroscopic approach uses two or three puncture wounds to insert a long, thin scope into the joint. It has been suggested that this approach has a more pleasing appearance and shorter operative and recovery time.

The incision approach uses a fairly small open incision to access the joint. The main difference is that the subscapularis muscle is split during the open surgery. Some surgeons feel this puts the patient at a strength disadvantage.

To check out this theory, a team of surgeons and sport medicine staff from Canada put it to the test. They compared before and after muscle strength of the shoulder for an equal number of patients treated arthroscopically versus with an open incision.

They were surprised to find out that patients in both groups had significant strength deficits. External rotation was affected more than internal rotation for both groups. But there wasn’t a discernible difference between the two groups. The reason for these two findings remains unknown but a point of interest for future research.

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 a 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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College basketball player dislocated shoulder, is surgery necessary?

May 31st — admin

Our college-aged son dislocated his shoulder playing basketball. We are trying to figure out if he needs surgery or not. The staff at the local clinic say he can wear a sling for eight weeks and come out alright in the end. Is this sound advice?

Studies show that immobilizing the arm after a primary (first) shoulder dislocation doesn’t change what happens in the long-run. Even applying the sling several weeks after the dislocation first occurred doesn’t seem to change what will happen a year or even more than a year later.

Over half of all shoulder dislocations stabilize and recover well. In fact, according to a study over a period of 25 years, many patients with a shoulder dislocation couldn’t even remember which arm was dislocated.

Some experts have advised immediate surgery for anyone with a shoulder dislocation who is an athlete, especially throwing athletes. Results of the long-term study just mentioned did not agree with this counsel. According to their data, athletic activity was not linked with recurrent shoulder dislocation.

A trial period of immobilization followed by a rehab program is considered a good first step following shoulder dislocation. Even if surgery is eventually needed, the strengthening program will prepare the shoulder for a better result after surgical reconstruction takes place.

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 a 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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My 78-year old aunt dislocated her shoulder. Will putting off surgery make things worse?

February 28th — admin

My 78-year old aunt dislocated her shoulder last week. She’s wearing a sling and wondering how to decide if she should have surgery. How can we know what’s best for her? Is putting surgery off likely to make things worse in the end?

The need for immediate surgery after a first shoulder dislocation is not predictable. Many patients opt to wear a sling for a week or so. Then they start to gradually work on getting their motion and strength back. Sometimes people don’t even bother with the sling.

 Each patient must make his or her own decision about whether or not to have surgery. Is it their dominant arm? That’s important because in older adults, a shoulder dislocation can set them back in terms of function. Was the doctor able to put the shoulder back in place easily? If so, that would suggest minimal additional trauma to the soft tissues around the joint.

Was an X-ray, CT scan, or MRI done to show any damage done to the area? A torn rotator cuff or fractured bone might swing the decision more toward surgical intervention sooner than later.

A study to show the natural history of a first-time shoulder dislocation in people of all ages and occupations has been done. Natural history refers to what happens (final outcome) if the person is followed over a period of years. They reported that not all people needed surgery.

Those who had a rotator cuff repair did not dislocate again. Many patients who didn’t have surgery recovered fully. After five years, their shoulder was as stable as those who did have the repair operation.

The results of studies like these help us all realize that everyone is different. It’s not always possible to predict the best course of action. Sometimes, after looking everything over, it’s clear what to do. In other cases, doctors encourage their patients to take the conservative route. They advise patients to try rehab first, because they can always have the surgery later if that seems best.

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 a 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 is overtightened during operation to prevent dislocation

December 31st — admin

I had an operation on my shoulder to tighten it up and keep it from dislocating. Unfortunately, it worked too well. Now I can hardly move it at all. Will this gradually get better?

Over tightening the shoulder causing loss of motion and decreased function are reported with traditional open surgical treatment of shoulder instability. Long-term reports of such cases suggest over tightening with loss of motion can lead to arthritis.

It’s unlcear what the best treatment is for this complication. Conservative care with a physical therapist to increase range of motion may be helpful. A second surgery may be needed to avoid developing osteoarthritis (OA) from over compression of the joint. The surgeon can release some of the soft tissues around the front of the shoulder.

If painful OA does occur, then a shoulder replacement may be needed. A partial replacement called a hemiarthroplasty may be all that’s needed. Your surgeon will help you decide what’s the next best step. Your age, general health, and shoulder condition will all be considered in making the best treatment decision for you.

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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Can heat treatment cause loss of cartilage in shoulder?

December 23rd — admin

I had a chronically dislocating shoulder that never responded to nonsurgical treatment. Then I had radiofrequency heat to shrink the shoulder capsule. Now I’m losing the cartilage in the same joint. Could this be caused by the heat treatment?

The procedure you had with radiofrequency to heat and shrink the shoulder capsule is called thermal capsulorrhaphy. Although it has become a popular treatment option, long-term studies are lacking.

Case studies of individual problems have been reported silimar to yours. Loss of cartilage throughout the joint can occur. It’s thought that thermal energy is either more than expected or continues causing damage after it is stopped.

There’s some concern that the probes used to deliver the heat aren’t accurate. As a result, excessive heat is used causing cartilage cells to die. Other problems from this treatment have also been reported. Nerve damage and damage to the capsule can lead to recurrent shoulder instability.

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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Football player’s shoulder gives way – catch it before it dislocates

October 20th — admin

Our son is a high school football player. When he plays offensive lineman he complains afterwards of shoulder pain. He says when he uses his arms in the blocking position and comes up against another player, his left shoulder “gives way.” Is this something we should talk to the coach about?

It’s possible your son is having some shoulder instability. The head of the humerus, a round ball at the top of the upper arm bone may be moving backwards out of the joint. This is called subluxation if it’s not fully dislocating.

Repetitive loading in the blocking position can put the shoulder at risk for instability from dislocation. You should talk with the coach or trainer but the best thing may be to see an orthopedic surgeon. X-rays, scans, and special tests may be needed to accurately diagnose the problem.

A special rehab program designed for this problem should be tried before jumping into surgery. Most of the time there’s a muscle imbalance that can be overcome with the right kind of strength training. The joint itself may have to regain its full joint sense of position called proprioception. The physical therapist will also address this problem during rehab.

Early detection and intervention are the keys to getting back on the field and staying there without further injury. Don’t put this off when it may be a small problem and before surgery or other invasive treatment is 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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TV method for reducing dislocated shoulder often painful, ineffective

October 1st — admin

Our 14 year old son dislocated his right shoulder after falling off his mountain bike. He had to have anesthesia to put the joint back in place. Can’t they do this without surgery like you see on TV shows like ER or Scrubs?

Not all TV drama is real or accurate. Screen writers do try to research conditions, illnesses, and medical procedures and present them accurately.

In the case of shoulder dislocation, there are several ways to “reduce” or put the joint back in place. The most common method of shoulder reduction after dislocation is the traction counter-traction technique. The doctor pulls on the hand of the dislocated arm.

At the same time, pressure is applied into the armpit in the opposite direction. This method of shoulder reduction is often painful and doesn’t always work.

Using sedation such as general anesthesia relaxes the muscles around the joint. This allows the head of the humerus to slide over the rim of the socket and slip back into the joint.

What you saw on TV could have been the traction-counter traction method of reduction. Another way to do this is an old method called the Milch technique. The Milch method is a safe and easy way to reduce a dislocated shoulder joint. The patient’s arm is moved by the doctor or examiner into a position of 90 degrees of abduction and flexion as if to put the hand behind the head.

The head of the humerus slips back over the rim of the socket and fits back into the joint. No anesthesia and no surgery is required. Because it’s not a recent discovery and because it’s an old method, all doctors today may not know about the use of the Milch method to avoid surgery for shoulder dislocation.

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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Should teenage athlete have surgery or rehab for dislocated shoulder?

September 28th — admin

Our 16-year old daughter dislocated her shoulder playing soccer. We’ve been told she should have surgery by one surgeon and by another to try rehab first. What’s the current thinking on this?

Surgery to stabilize the shoulder after dislocation used to be saved for patients who had recurrent dislocations. It wasn’t routinely done after the first dislocation. Surgery has its complications and rehab worked for many people. This same guideline is still used by many surgeons. The change has come in patient selection.

Patients who are at high risk for another dislocation on the same side may be advised to have stabilization surgery after the first dislocation. Studies show that early repair makes a big difference in quality of life. This is especially true for younger patients (less than 30 years old).

Recurrence rates are as high as 75 percent in active individuals who try four weeks of immobilization followed by a rehab program. This compares to 11 percent in patients who are surgically repaired.

Recurrence rates have dropped and results have improved as surgical techniques have changed over the years. Now surgeons recognize the need to repair any damage to the soft tissues around the shoulder after dislocation.

For a young, active, athlete like your daughter the data suggests that early repair and rehab will put her back on the playing field sooner and with fewer problems compared to a wait-and-see rehab approach. You may want to get a third opinion to make sure there aren’t good reasons to choose one treatment approach over the other.

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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