Naples Orthopedic Surgeon - Dr. Robert J. Zehr » dislocated shoulder

Shoulder can dislocate even after surgery

admin — Tue, 20 Apr 2010 12:39:01 +0000

I have a chronic dislocating shoulder that needs fixing. The doctor told me there’s still a 25 percent chance the joint can dislocate again even after repair. Why is that?

Studies show that shoulder dislocation after repair occurs anywhere from 12 to 24 percent of the time. There are different reasons for this. Sometimes it depends on the type of surgery done to repair the problem.

For example, an open incision allows the surgeon to repair the tear in the cartilage and tighten up the joint capsule at the same time. Arthroscopic surgery may only include repair of the damaged soft tissue while leaving the capsular laxity alone.

Another factor in repeat dislocations after surgery is the patient. It’s important to follow the surgeon’s instructions. A shoulder sling may be needed for up to four weeks. Exercises must be done daily. Doing too much too soon is a common way to undo the benefits of the 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 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.

Different types of dislocated shoulder, different treatments

admin — Mon, 01 Feb 2010 21:20:53 +0000

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.

Mastectomy could be cause of shoulder pain

admin — Thu, 28 Jan 2010 21:55:01 +0000

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.

What is “shoulder instability”?

admin — Tue, 22 Dec 2009 03:25:24 +0000

What is “shoulder instability?”

Shoulder instability refers to a range of disorders. Instability can occur when soft tissues like ligaments, capsule, and tendons are damaged around the shoulder joint. The result may be a partial dislocation. This means the head of the humerus (upper arm bone) comes out of the socket but can go back in by itself. This is called a subluxation.

The other end of the spectrum occurs when the shoulder completely dislocates and must be put back in or reduced under anesthesia. Most shoulder instabilities are caused by trauma. If the damaged tissue doesn’t heal properly, the shoulder can dislocate many more times.

The treatment for chronic shoulder instability is usually surgery to repair the damage. This operation is done as an outpatient. The doctor puts a tiny lighted telescope and small instruments into the shoulder joint. Small anchors with suture attached are inserted right into the socket of the shoulder. The torn ligaments are reattached to the socket. Complete healing takes about four to six months.

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. For more information on this subject, visit www.zehrcenter.com.

Shrink wrapping may help dislocated shoulder

admin — Wed, 11 Nov 2009 13:43:03 +0000

One of my shoulders dislocates anytime I reach overhead and pull down with my arm. The doctor has suggested doing a shrink-wrap operation to tighten it up. How do they keep from melting the cartilage?

You may be talking about thermal shrinkage of capsular tissue that surrounds the shoulder joint. The capsule gets stretched out when the shoulder dislocates. More than one dislocation makes the problem worse.

Thermal shrinkage uses a heat source to raise the temperature of the tissue. In the process of heating and cooling down, the capsule tightens up. Research shows there’s an ideal temperature the tissue must reach during this procedure. Doctors are careful to keep within the “safe” range.

They also use a “striping” technique. The heat probe is passed up and down over the loose tissue. Some areas are left untreated between areas of shrinkage. The tissue is only heated up once. Studies show passing over the tissue more than once can cause injury to the capsule.

Doctors are also careful not to leave the probe in one spot too long. Some tissue can’t be treated with this method. Thin, torn, or poor quality tissue won’t hold up under the high heat. No one really knows yet how much tissue shrinkage gives the best result. More studies are underway.

Dislocated shoulder may require surgery

admin — Tue, 13 Oct 2009 10:33:36 +0000

I dislocated my shoulder. Should I have surgery?

Traditionally, doctors have treated dislocated shoulders with slings and physical rehabilitation. Unfortunately, this approach isn’t very effective in preventing repeat dislocations. This is especially true if you’re young. Studies show that athletes under age 25 re-injure their shoulders up to 94 percent of the time.

Surgery to stabilize the shoulder is a more aggressive approach. A new procedure uses an arthroscope– a camera-like device that lets doctors see inside the joint. With this instrument, doctors don’t have to make big incisions in the skin. This makes surgery less invasive. Doctors implant special tacks to hold the shoulder in place.

How effective is this procedure? It was recently tested on cadets at West Point. In this group of young, highly active patients, surgery resulted in stable shoulders 88 percent of the time. These patients had no complications from surgery. They were able to return to all their activities. Twelve percent of the patients had another injury within a year and a half of surgery. Still, this re-injury rate was felt to be small compared to that of patients who didn’t have surgery.

Talk to your doctor about your options for surgery, given your age and history.

Too busy for physical therapy? Rethink surgery!

admin — Tue, 22 Sep 2009 11:14:37 +0000

I recently dislocated my shoulder. I’ve heard about a new surgery available to fix it. Does that mean I won’t need to go through physical therapy? Frankly, I don’t have the time.

The surgery you are talking about is arthroscopy surgery, and it’s not all that new. However, it is being looked at more closely as an improvement over the traditional approach of simply placing the shoulder in a sling. Physical therapy is an integral part of the recovery process, regardless of the treatment approach. Since it’s your body, you need to have a say in how it is cared for. That said, many surgeons prefer not to operate if the plan for rehabilitation afterward can’t be agreed upon. Discuss your concerns with your surgeon.

Sling or Surgery? What's Best for Dislocated Shoulder?

admin — Wed, 19 Aug 2009 10:23:50 +0000

One of my rugby buddies is going to have surgery for a shoulder dislocation. My shoulder has dislocated three times since I first injured it last season. I haven’t had surgery and don’t even know if I was given the option. Should I have surgery?

In a recent study of people under 30 years old with a shoulder dislocation, arthroscopy surgery was compared to the more traditional approach of slinging the shoulder. Nearly everyone who chose surgery had an excellent return to strength and movement without having a future dislocation. Most of the sling-only patients had another dislocation within the year. Share your concerns with your orthopedist.

What exactly is a dislocated shoulder?

admin — Mon, 17 Aug 2009 12:59:26 +0000

What exactly is a dislocated shoulder?

A shoulder dislocation is a painful and disabling injury of the glenohumeral joint. Most dislocations are anterior (forward) but the shoulder can dislocate posteriorly (backwards). Inferior and posterolateral dislocations are possible but occur much less often. The specific type of dislocation is based on the position of the humeral head in relation to the glenoid (shoulder socket) at the time of the diagnosis. Reading this guide will help you understand what parts of the shoulder are involved, how the problem develops, how doctors diagnose the condition and what treatment options are available.

Loosening socket most common reason for failure of shoulder arthroplasty.

admin — Tue, 21 Jul 2009 14:10:55 +0000

What’s the most likely thing to go wrong with a total shoulder arthroplasty?

The most common reason total shoulder arthroplasties fail is loosening of the glenoid, or socket, component. Sometimes the new socket doesn’t line up right, or it may loosen, move, or even dislocate. Loosening occurs in about 10 percent of cases.