Ski jump results in torn cartilage plus frozen joint, how is this possible?

June 8th — admin

My 21-year-old son hurt his arm during a ski jump last winter. At first the surgeon thought he had a labral tear. But now his arm is frozen with no movement past 90 degrees. Does this makes sense? How can you have a torn cartilage and a frozen joint?

The labrum is a dense fibrocartilage ring that is firmly attached around the acetabulum (shoulder socket). It provides both depth and stability to the normally shallow acetabulum.

A labral tear can result in a painful and unstable shoulder. A stiff, painful (frozen) shoulder is not uncommon after shoulder trauma. This may be the body’s protective response. It is usually self-limiting. This means it will eventually get better on its own.

If conservative care does not take care of the problem, then surgery may be needed. The surgeon may just manipulate the shoulder. This is a careful moving of the shoulder through its full motion while the patient is anesthetized. If that doesn’t help, then incision and release of the anterior shoulder capsule may be 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 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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Pitching arm vulnerable to shoulder instability

May 18th — admin

I’ve been to three orthopedic surgeons now about a problem with my pitching arm. It hurts, clicks, and feels like it’s going to pop out of the socket. No one could figure it out. I finally had an arthroscopic exam that showed a posterior tear of the shoulder capsule. Why was this so hard to diagnose?

Posterior instability as a cause of shoulder pain and/or clicking is an uncommon, but not unheard of, condition. Anterior shoulder problems are much more common. In fact, many pitchers or throwing athletes suffer from an anterior instability. Posterior refers to the back of the shoulder. Anterior refers to the front of the shoulder.

In either case, repetitive microtrauma from the action of overhead throwing is the cause of the problem. During the follow-through phase of pitching, the shoulder is close to the body, flexed, and rotated inwardly. This repetitive motion may put stress along the back of the shoulder.

The shoulder capsule and labrum (rim of cartilage around the shoulder socket) can also get pinched causing pain. This is more likely to occur during the late cocking phase of throwing when the arm is drawn back and externally rotated.

The problem is made worse if the athlete has any natural laxity (looseness) or contracture (tightness) of the soft tissues in this area. Repeated stresses from throwing 100′s of pitches can lead to labral tears or a stretched capsule.

These types of injuries are not easy to diagnose. There can be different directions of instability at the same time causing confusion. Clinical signs and symptoms and results of testing aren’t always consistent for multidirectional injuries. Diagnosis is delayed when there is more than one lesion (and even a combination of problems).

The surgeon will have to sort out the site of damage and resulting structural and biomechanical problems. Even with history, physical exam, and imaging studies, arthroscopy may be the only way to make the final diagnosis.

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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Rehab sports-loving shoulder surgery patient like a soldier

November 15th — admin

I’d like to know what’s the fastest recovery time possible for shoulder surgery? I’m having a labral tear repaired and I want to get back to sports absolutely as fast as possible.

Your recovery time may depend on the type of surgery you are having. Labral tears of the shoulder can be repaired using an open versus an arthroscopic method. The final results are nearly the same, but studies show the arthroscopic group has fewer problems afterwards. There is also a shorter hospital stay and less blood lost with arthroscopic surgery.

If we use the military model, expected return to full athletic participation would be after four to six months. Since the goal of military medicine is to return the soldier to duty as soon as possible, it makes sense to use this model with young, athletes in equally good shape.

The rehab program after labral tears in the military is broken down into three main phases. Each stage lasts about four weeks (one month). During Stage 1, the patient is immobilized in a sling. Special shoulder and elbow exercises are allowed as taught by the physical therapist.

Stage 2 works to restore motion without damaging the repair. The therapist will teach you how to protect the surgical site while gaining shoulder motion. Stage 3 focuses on strengthening the muscles around the shoulder. The program progresses from there until the patient is ready for full, active duty. In your case, that would be a return to your preinjury levels of sports play.

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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The best candidate for hip rsurfacing

November 11th — admin

I am a 35-year old hospital nurse. Eighteen months ago, I tried to help a patient keep from falling. In the process, I tore the labrum (cartilage) in my hip. Even though I’m fairly young, the X-ray showed advanced arthritis on top of the injury. Would I be a good candidate for a hip resurfacing instead of a total joint replacement?

The best candidate for a hip resurfacing is a young, active patient who has moderate to early advanced arthritis. Patients who have had this operation range anywhere from 16 to 60 years old.

The advantage of the procedure is that it preserves much of the patient’s own hip. This makes it possible to have a total hip replacement later when the person is older. Older adults are less likely to outlive their implant.

Hip resurfacing may only affect the head of the femur or it may involve both the femoral head and the hip socket. The procedure is used because it removes as little bone from around the hip as possible.

The femoral component used during hip resurfacing is placed on the outside of the femoral head. The femoral shaft is never disturbed. This means that when a revision is needed, the femoral shaft can be used to hold the femoral component as if there has never been an artificial joint. The bone in this area has not been drilled, cut, shaved, or removed in any way.

Your surgeon will be able to advise you as to whether or not you may be a good candidate for this procedure. It is not advised for anyone with bone cysts or inflammatory arthritis. It is not for patients with severe arthritis or osteoporosis.

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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Surgery the only option for chronic hip pain?

December 14th — admin

My chronic hip pain has finally been diagnosed as a labral tear. The doctor thinks surgery is the only way to take care of this problem. Do I have any other options?

The labrum is a thin rim of fibrous cartilage around the hip socket. It helps hold the head of the femur in the shallow socket. It gives the hip stability. New studies suggest that labral tears can’t heal without surgery. There isn’t enough blood supply to the edge of the labrum.

Sometimes a piece of cartilage breaks off after the labrum is torn. This forms a loose body in the joint. Over time the loose body gets hard or calcifies. It can cause the hip to lock or catch during certain movements. The loose body can cause more damage to the joint so it must be removed at the same time the labral tear is repaired.

You mentioned “chronic” pain, which suggests you’ve had this problem for some time. The ongoing nature of your condition supports the idea that surgery is needed. If it was going to heal on its own, it would have happened by now.

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.

Posted in Hips. Tags: , . No Comments »
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